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Jarshaw CL, Omoregie O, Peck JD, Pierce S, Jones EJ, Hosseinzadeh P, Craig LB. Vaccination during pregnancy by race/ethnicity: a focus on American Indians/Alaska Natives. AJOG Glob Rep 2024; 4:100318. [PMID: 38445103 PMCID: PMC10914583 DOI: 10.1016/j.xagr.2024.100318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Vaccination during pregnancy reduces the incidence of infections and their associated adverse outcomes in both mothers and infants. The American College of Obstetricians and Gynecologists has recommended influenza and Tdap vaccination during pregnancy since 2004 and 2013, respectively. Several studies have examined disparities in vaccination rates during pregnancy by race/ethnicity. However, none have included American Indians/Alaska Natives as a specific racial/ethnic group on a national level. Current literature suggests that American Indian/Alaska Native infants experience increased morbidity and mortality from both influenza and pertussis infections compared with most other groups in the United States. OBJECTIVE This study aimed to evaluate the uptake of influenza and Tdap vaccinations during pregnancy by race/ethnicity, with a specific focus on American Indian/Alaska Native people. STUDY DESIGN This cross-sectional study used data from the Pregnancy Risk Assessment Monitoring System. Comparisons of vaccine uptake across racial/ethnic groups (American Indian/Alaska Native, Asian, non-Hispanic Black, non-Hispanic White, Hispanic, and "None of the above") were evaluated using weighted logistic regression analyses to estimate prevalence odds ratios with 95% confidence intervals. Models were adjusted for maternal age, parity, maternal education, marital status, payment method at delivery, prenatal care in first trimester, maternal smoking status, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation, and receipt of influenza vaccine reported by a health care provider. RESULTS For both vaccines, Asian respondents had the highest uptake (influenza, 70.1%; Tdap, 68.2%), whereas Black respondents reported the lowest uptake (influenza, 44.4%; Tdap, 57.9%). For the influenza vaccine, American Indian/Alaska Native respondents demonstrated a higher uptake compared with White respondents, and the magnitude of difference increased markedly after adjusting for respondent characteristics (adjusted odds ratio, 1.74; 95% confidence interval, 1.58-1.90). In the unadjusted analyses, Black individuals reported influenza vaccination at approximately half the rate of their White counterparts during pregnancy. This effect was attenuated but remained lower after adjustment for respondent characteristics (adjusted odds ratio, 0.73; 95% confidence interval, 0.70-0.76). For the Tdap vaccine, American Indian/Alaska Native respondents reported lower uptake than White respondents; however, this difference disappeared when adjusted for respondent characteristics (adjusted odds ratio, 0.99; 95% confidence interval, 0.83-1.19). Asian and Hispanic respondents displayed a similar uptake compared with their White counterparts for both vaccines. CONCLUSION Our findings indicate that there are racial/ethnic disparities in influenza and Tdap vaccination rates among pregnant individuals in the United States. Demonstration of increased uptake among American Indian/Alaska Native people in the crude analysis may reflect the success of various public health interventions through Tribal and Indian Health Service hospitals. Nonetheless, vaccination status during pregnancy remains seriously below national guideline recommendations. Greater measures must be taken to support preventative care in marginalized populations, with particular emphasis on community-driven solutions rooted in justice.
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Affiliation(s)
- Christen L. Jarshaw
- Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, College of Medicine, University of Oklahoma Health Sciences Center (Dr Jarshaw), Oklahoma City, OK
- Department of Obstetrics and Gynecology, Mountain Area Health Education Center (Dr Jarshaw), Asheville, NC
| | - Osariemen Omoregie
- Hudson College of Public Health, University of Oklahoma Health Sciences Center (Ms. Omoregie and Dr Peck), Oklahoma City, OK
| | - Jennifer D. Peck
- Hudson College of Public Health, University of Oklahoma Health Sciences Center (Ms. Omoregie and Dr Peck), Oklahoma City, OK
| | - Stephanie Pierce
- Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of Oklahoma Health Sciences Center (Dr Pierce), Oklahoma City, OK
| | - Emily J. Jones
- Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences Center (Dr Jones), Oklahoma City, OK
| | - Pardis Hosseinzadeh
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, College of Medicine, University of Oklahoma Health Sciences Center (Drs Jarshaw, Hosseinzadeh and Craig), Oklahoma City, OK
- John's Hopkins Fertility Center, Department of Gynecology and Obstetrics (Dr Hosseinzadeh), Baltimore, MD
| | - LaTasha B. Craig
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, College of Medicine, University of Oklahoma Health Sciences Center (Drs Jarshaw, Hosseinzadeh and Craig), Oklahoma City, OK
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Feferkorn I, Santos-Ribeiro S, Ubaldi FM, Velasco JG, Ata B, Blockeel C, Conforti A, Esteves SC, Fatemi HM, Gianaroli L, Grynberg M, Humaidan P, Lainas GT, La Marca A, Craig LB, Lathi R, Norman RJ, Orvieto R, Paulson R, Pellicer A, Polyzos NP, Roque M, Sunkara SK, Tan SL, Urman B, Venetis C, Weissman A, Yarali H, Dahan MH. Correction to: The HERA (Hyper‑response Risk Assessment) Delphi consensus for the management of hyper‑responders in in vitro fertilization. J Assist Reprod Genet 2024; 41:519-520. [PMID: 38079078 PMCID: PMC10894774 DOI: 10.1007/s10815-023-03003-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Affiliation(s)
- I Feferkorn
- Sackler Faculty of Medicine, IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
| | | | - F M Ubaldi
- GeneraLife Centers for Reproductive Medicine, Rome, Italy
| | | | - B Ata
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey
- ART Fertility Clinics, Dubai, United Arab Emirates
| | - C Blockeel
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Belgium
| | - A Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - S C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Av. Dr. Heitor Penteado 1464, Campinas, SP, 13075‑460, Brazil
- Department of Surgery (Division of Urology), University of Campinas (UNICAMP), Campinas, SP, Brazil
- Faculty of Health, Aarhus University, 8000, Aarhus C, Denmark
| | - H M Fatemi
- ART Fertility Clinics, Abu Dhabi, United Arab Emirates
| | - L Gianaroli
- Società Italiana Studi di Medicina della RiproduzioneS.I.S.Me.R. Reproductive Medicine Institute, Emilia‑Romagna, Bologna, Italy
| | - M Grynberg
- Department of Reproductive Medicine, Hôpital Antoine‑Béclère, University Paris-Sud (Paris XI), Le Kremlin‑Bicêtre, Clamart, France
| | - P Humaidan
- The Fertility Clinic, Skive Regional Hospital, Faculty of Health, Aarhus University, Resenvej 25, 7800, Skive, Denmark
| | | | - A La Marca
- Obstetrics, Gynecology and Reproductive Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, via del Pozzo 71, 41124, Modena, Italy
| | - L B Craig
- Section of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - R Lathi
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
| | - R J Norman
- Robinson Research Institute, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- FertilitySA, Adelaide, South Australia, Australia
- Monash Centre for Health Research and Implementation MCHRI, Monash University, Melbourne, Australia
- NHMRC Centre of Research Excellence in Women's Health in Reproductive Life (CRE-WHiRL), Melbourne, Australia
| | - R Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Tarnesby‑Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - R Paulson
- University of Southern California, Los Angeles, CA, 90033, USA
| | - A Pellicer
- Department of Pediatrics, Obstetrics and Gynecology, School of Medicine, University of Valencia, Valencia, Spain
- IVI Roma Parioli, IVI-RMA Global, Rome, Italy
| | - N P Polyzos
- Department of Reproductive Medicine, Dexeus Mujer, Hospital Universitario Dexeus, Barcelona, Spain
| | - M Roque
- Department of Reproductive Medicine, ORIGEN-Center for Reproductive Medicine, Rio de Janeiro, RJ, Brazil
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - S K Sunkara
- Department of Women and Children's Health, King's College London, London, UK
| | - S L Tan
- OriginElle Fertility Clinic, 2110 Boul. Decarie, Montreal, QC, Canada
| | - B Urman
- Department of Obstetrics and Gynecology and Assisted Reproduction, American Hospital, Istanbul, Koc University School of Medicine, Istanbul, Turkey
| | - C Venetis
- Unit for Human Reproduction, 1st Dept of OB/Gyn, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Centre for Big Data Research in Health, Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
- Virtus Health, Sydney, Australia
| | - A Weissman
- In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Yarali
- Division of Reproductive Endocrinology and Infertility, Dept. of Obstetrics and Gynecology, Hacettepe University, School of Medicine, Anatolia IVF and Women's Health Center, Ankara, Turkey
| | - M H Dahan
- Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, 888 Boul. de Maisonneuve E #200, Montreal, QC, H2L 4S8, Canada
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Hosseinzadeh P, Peck JD, Burks HR, Souter I, Xing A, Craig LB, Diamond MP, Hansen KR. Follicular phase length is not related to live birth outcome in women with unexplained infertility undergoing ovarian stimulation with intrauterine insemination cycles in a multicenter trial. F S Rep 2023; 4:361-366. [PMID: 38204957 PMCID: PMC10774873 DOI: 10.1016/j.xfre.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 01/12/2024] Open
Abstract
Objective To evaluate the effect of follicular phase length (FPL) on pregnancy outcomes and endometrial thickness (ET) among women with unexplained infertility undergoing ovarian stimulation with intrauterine insemination (OS-IUI) with clomiphene citrate, letrozole, or gonadotropins. Design Cohort analysis of the Reproductive Medicine Network's Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation randomized controlled trial. Setting Multicenter randomized controlled trial. Patients A total of 869 couples with unexplained infertility who underwent OS-IUI treatment cycles as part of the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation study. Interventions FPL was evaluated as a categorical variable defined by quintiles (q1: ≤11 days, q2: 12 days, q3: 13 days, q4: 14-15 days, and q5: ≥16 days). Main outcome measures Clinical pregnancy, live birth rates, and ET. Results Decreasing FPL quintiles did not reduce clinical pregnancy or live birth rates in unadjusted or adjusted models with all treatment groups combined or when stratified by the ovarian stimulation medication. All FPL categories had significantly thinner ET compared with the 5th quintile (≥16 days) among women treated with clomiphene citrate or letrozole. Similar but diminished associations were observed among women who underwent ovarian stimulation with gonadotropins, but the observed differences were limited to those with FPL of 12 days or shorter when compared with FPL ≥16 days. Conclusions Although shorter FPL was associated with reduced ET, it was not associated with the outcomes of clinical pregnancy or live birth in women with unexplained infertility undergoing OS-IUI in all treatment groups combined. Similar patterns existed when analyses of clinical pregnancy and live birth rates were stratified by treatment. Clinical trial registration NCT01044862.
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Affiliation(s)
- Pardis Hosseinzadeh
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Jennifer D. Peck
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
- Department of Biostatistics and Epidemiology, University of Oklahoma College of Public Health, Oklahoma City, Oklahoma
| | - Heather R. Burks
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Irene Souter
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Harvard Medical School, Massachusetts General Hospital Fertility Center, Boston, Massachusetts
| | - Angela Xing
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - LaTasha B. Craig
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Michael P. Diamond
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
- Department of Obstetrics and Gynecology, Augusta University, Augusta, Georgia
| | - Karl R. Hansen
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
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Hariton E, Alvero R, Hill MJ, Mersereau JE, Perman S, Sable D, Wang F, Adamson GD, Coutifaris C, Craig LB, Hosseinzadeh P, Imudia AN, Johnstone EB, Lathi RB, Lin PC, Marsh EE, Munch M, Richard-Davis G, Roth LW, Schutt AK, Thornton K, Verrilli L, Weinerman RS, Young SL, Devine K. Meeting the demand for fertility services: the present and future of reproductive endocrinology and infertility in the United States. Fertil Steril 2023; 120:755-766. [PMID: 37665313 DOI: 10.1016/j.fertnstert.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023]
Abstract
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.
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Affiliation(s)
- Eduardo Hariton
- Reproductive Science Center of the San Franisco Bay Area, San Francisco, California
| | - Ruben Alvero
- Fertility and Reproductive Health, Lucille Packard Children's Hospital, Sunnyvale, California; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
| | - Micah J Hill
- National Institutes of Health, National Institute for Child Health and Human Development, Program in Reproductive and Adult Endocrinology, Bethesda, Maryland
| | | | - Shana Perman
- Shady Grove Fertility, Washington, District of Columbia; Shady Grove Fertility, Columbia, Maryland
| | - David Sable
- Special Situations Life Sciences Fund and Department of Biological Sciences, Columbia University, New York, New York
| | - Fiona Wang
- Lucile Packard Children's Hospital/Stanford Children's Health and Stanford Fertility and Reproductive Health, Sunnyvale, California
| | - Geoffrey David Adamson
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, ACF, Stanford University, Stanford, California
| | - Christos Coutifaris
- Division of Reproductive Endocrinology and Infertility, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - LaTasha B Craig
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Pardis Hosseinzadeh
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Johns Hopkins University, Baltimore, Maryland
| | - Anthony N Imudia
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Erica B Johnstone
- Division of Reproductive Endocrinology and Infertility, University of Utah, Salt Lake City, Utah
| | - Ruth B Lathi
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Paul C Lin
- Seattle Reproductive Medicine, Seattle, Washington; Seattle Reproductive Medicine, Bellevue, Washington
| | - Erica E Marsh
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Michele Munch
- Department of Obstetrics and Gynecology, Pennsylvania State University Health, York, Pennsylvania
| | - Gloria Richard-Davis
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and Infertility, University of Arkansas, Little Rock, Arkansas
| | | | - Amy K Schutt
- Texas Fertility Center, Austin, Texas; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Kim Thornton
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston; Boston IVF, Waltham, Massachusetts
| | - Lauren Verrilli
- Division of Reproductive Endocrinology and Infertility, University of Utah, Salt Lake City, Utah
| | - Rachel S Weinerman
- Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Steven L Young
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - Kate Devine
- National Institutes of Health, National Institute for Child Health and Human Development, Program in Reproductive and Adult Endocrinology, Bethesda, Maryland; Shady Grove Fertility, Washington, District of Columbia; Departments of Obstetrics and Gynecology, Georgetown University and George Washington University, Washington, DC
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Craig LB, Jarshaw CL, Hansen KR, Peck JD. Association between obesity and fecundity in patients undergoing intrauterine insemination. F S Rep 2023; 4:270-278. [PMID: 37719104 PMCID: PMC10504554 DOI: 10.1016/j.xfre.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/25/2023] [Accepted: 05/15/2023] [Indexed: 09/19/2023] Open
Abstract
Objective To determine if an association exists between body mass index (BMI) and fecundity after intrauterine insemination (IUI). Design Retrospective cohort study. Setting Academic-based fertility clinic. Patients Patients undergoing IUI July 2007 to May 2012. Interventions None. Main Outcome Measures Primary outcome: live-birth rate (LBR) per IUI cycle; secondary outcomes: positive pregnancy test and clinical pregnancy rates (CPRs). Results A total of 1959 cycles were performed on 661 women (mean age, 31.9 ± 4.9 years). When examined by obesity class, LBR and CPR were similar for women with class I, II, and III obesity when compared with women with normal BMI. However, class III obese women (adjusted risk ratio [aRR], 1.70; 95% confidence interval [CI], 1.12-2.59) had increased pregnancy rates compared with normal BMI, but no differences in pregnancy rates were observed for women with class I or II obesity. In addition, pregnancy rates (aRR, 1.50; 95% CI, 1.12-2.02) and CPR (aRR, 1.51; 95% CI, 1.07-2.14) were higher in overweight women relative to normal BMI. Notably, among patients with ovulatory dysfunction, CPRs after IUI were reduced by 43% in obese women (aRR, 0.57; 95% CI, 0.37-1.07), whereas women without ovulatory dysfunction were twice as likely to achieve a clinical pregnancy when they were obese (aRR, 1.96; 95% CI, 1.19-3.24). The CIs for the obesity risk ratios in each stratum of ovulatory function exhibited no overlap, suggesting evidence of potential effect modification by ovulatory function. Conclusions LBRs after IUI were similar across BMI subgroups. This is in contrast to research of in vitro fertilization treatments showing lower LBR with increasing BMI. However, obesity may adversely affect IUI CPR in those with ovulatory dysfunction in particular. The reason for this discrepancy is unclear and warrants further study.
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Affiliation(s)
- LaTasha B. Craig
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Christen L. Jarshaw
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Karl R. Hansen
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Jennifer D. Peck
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Ulker A, Evans MB, Craig LB. The impact of the Dobbs decision on in-vitro fertilization and fertility care. Curr Opin Obstet Gynecol 2023; 35:306-310. [PMID: 37266567 DOI: 10.1097/gco.0000000000000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE OF REVIEW The 2022 Supreme Court ruling in Dobbs vs Jackson marks a frightening new reality in America. Physicians and patients have been left confused and concerned regarding the broader implications of this ruling. Now that the constitutional right to an abortion has been overturned and the power has been relinquished to individual states, there is justifiable concern regarding the impact on in-vitro fertilization (IVF). This review explores the ways IVF and fertility care are at risk in the context of our new reality. RECENT FINDINGS The decision to overturn the right to an abortion without specifying a viability standard opens the door to interpretation of when 'life' begins. Laws that do not specifically exempt IVF, or that include language suggesting that 'life begins at fertilization' pose a real threat to IVF. The potential for personhood laws poses a threat to embryo freezing and disposition, preimplantation genetic testing and culpability among other concerns. SUMMARY Limitations to IVF may become an unintended consequence to the Dobbs decision, making IVF less efficient, more costly and unsafe, and inevitably limiting access to care. It is therefore crucial that public health legislation be rooted in science and not dictated by religion or politics. Physicians must act alongside legislators to protect reproductive freedom and access to care.
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Affiliation(s)
- Ashley Ulker
- Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Gavrizi SZ, Hosseinzadeh P, Brush RS, Tytanic M, Eckart E, Peck JD, Craig LB, Diamond MP, Agbaga MP, Hansen KR. Sperm very long-chain polyunsaturated fatty acids: relation to semen parameters and live birth outcome in a multicenter trial. Fertil Steril 2023; 119:753-760. [PMID: 36681262 PMCID: PMC10176595 DOI: 10.1016/j.fertnstert.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/23/2022] [Accepted: 01/11/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To determine whether the levels of sperm very long-chain polyunsaturated fatty acids (VLC-PUFAs) are correlated with sperm parameters and the outcome of live birth after conventional therapy for unexplained infertility. DESIGN Cohort analysis of the Reproductive Medicine Network's Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation randomized controlled trial. SETTING Multicenter randomized controlled trial. PATIENTS Male partners from 185 couples with unexplained infertility who provided baseline semen samples for analysis. INTERVENTION We determined the levels of VLC-PUFAs in total lipid isolated from sperm membranes using liquid chromatography-mass spectrometry/mass spectrometry analyses. MAIN OUTCOME MEASURES Sperm concentration, motility, morphology, total motile count (TMC), and live birth after standard treatment for unexplained infertility. RESULTS Total VLC-PUFA percentage was positively correlated with sperm concentration (Spearman's rank correlation (rs) 0.56, P<.0001), TMC (rs = 0.40, P<.0001), and morphology (rs = 0.26, P=.0005). After adjustment for male body mass index, age, and race, a one-standard-deviation increase in the percentage of total VLC-PUFA was associated with a 62% increase in the geometric mean (GM) of sperm concentration (GM Ratio: 1.62 [95% confidence intervals {CI}: 1.45, 1.82]) and a 43% increase in the geometric mean of TMC (GM Ratio: 1.43 [95% CI; 1.24, 1.63]). Although no evidence of association was observed for sperm motility, a positive relationship was also observed between the percentage of total VLC-PUFA and sperm morphology [adjusted incidence rate ratio (IRR) for one-standard-deviation increase in total VLC-PUFA: 1.18 (95% CI; 1.02, 1.36)]. After adjustment for female age and treatment group, the probability of a live birth outcome was 72% more likely among those in the third tertile of hydroxylated VLC-PUFA percentage than in the first tertile (RR 1.72 [95% CI; 1.01, 2.94]). CONCLUSIONS The positive correlation between sperm VLC-PUFAs percentage and sperm parameters, as well as the significant association between hydroxylated VLC-PUFA percentage and the outcome of live birth, strongly suggest that this class of fatty liquid chromatography-mass spectrometry/mass spectrometry acids is essential for normal sperm structure and function.
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Affiliation(s)
- Sarah Z Gavrizi
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Pardis Hosseinzadeh
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma.
| | - Richard Steven Brush
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Dean A. McGee Eye Institute, Oklahoma City, Oklahoma
| | - Madison Tytanic
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Dean A. McGee Eye Institute, Oklahoma City, Oklahoma
| | - Erin Eckart
- Department of Biostatistics and Epidemiology, University of Oklahoma College of Public Health, Oklahoma City, Oklahoma
| | - Jennifer D Peck
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma; Department of Biostatistics and Epidemiology, University of Oklahoma College of Public Health, Oklahoma City, Oklahoma
| | - LaTasha B Craig
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Michael P Diamond
- Department of Obstetrics and Gynaecology, Augusta University, Augusta, Georgia
| | - Martin-Paul Agbaga
- Department of Cell Biology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma; Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Dean A. McGee Eye Institute, Oklahoma City, Oklahoma
| | - Karl R Hansen
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
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Hosseinzadeh P, Omoregie O, Jarshaw C, Kim A, Craig LB, Peck JD. RACIAL AND ETHNIC DISPARITIES IN SELF-REPORTED POST-PARTUM DEPRESSION IN WOMEN UNDERGOING FERTILITY TREATMENT IN THE UNITED STATES: PREGNANCY RISK ASSESSMENT MONITORING SYSTEM (PRAMS), 2012-2019. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.09.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Jarshaw CL, Hosseinzadeh P, Craig LB, Peck JD. THE ASSOCIATIONS BETWEEN BODY MASS INDEX AND LIVE BIRTH OUTCOMES AMONG PATIENTS WITH AND WITHOUT OVULATORY DYSFUNCTION UNDERGOING INTRAUTERINE INSEMINATION CYCLES. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Morosky CM, Cox SM, Craig LB, Everett EN, Forstein DA, Graziano SC, Hampton BS, Hopkins L, Sims SM, Mckenzie ML, Royce C, Morgan HK. Integration of health systems science and women's healthcare. Am J Obstet Gynecol 2022; 227:236-243. [PMID: 35489442 DOI: 10.1016/j.ajog.2022.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/19/2022] [Accepted: 04/23/2022] [Indexed: 11/19/2022]
Abstract
Health systems science addresses the complex interactions in healthcare delivery. At its core, health systems science describes the intricate details required to provide high-quality care to individual patients by assisting them in navigating the multifaceted and often complicated US healthcare delivery system. With advances in technology, informatics, and communication, the modern physician is required to have a strong working knowledge of health systems science to provide effective, low-cost, high-quality care to patients. Medical educators are poised to introduce health systems science concepts alongside the basic science and clinical science courses already being taught in medical school. Because of the common overlap of women's healthcare subject matter with health systems science topics, such as interprofessional collaboration, ethics, advocacy, and quality improvement, women's health medical educators are at the forefront of incorporating health systems science into the current medical school educational model. Here, the authors have described the concept of health systems science and discussed both why and how it should be integrated into the undergraduate medical education curriculum. Medical educators must develop physicians of the future who can not only provide excellent patient care but also actively participate in the advancement and improvement of the healthcare delivery system.
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Affiliation(s)
- Christopher M Morosky
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT.
| | - Susan M Cox
- Department of Medical Education, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - LaTasha B Craig
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Elise N Everett
- Department of Obstetrics, Gynecology, and Reproductive Services, The Robert Larner, MD College of Medicine at The University of Vermont, Burlington, VT
| | | | - Scott C Graziano
- Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL
| | - Brittany S Hampton
- Divisions of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Alpert Medical School of Brown University/Women & Infants Hospital, Providence, RI
| | - Laura Hopkins
- Division of Oncology, Department of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Shireen Madani Sims
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL
| | - Margaret L Mckenzie
- Department of Obstetrics and Gynecology, Cleveland Clinic South Pointe Hospital, Cleveland, OH
| | - Celeste Royce
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA
| | - Helen Kang Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
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Li H, Guo Y, Deng J, Gali H, Weedin EA, Burks HR, Craig LB, Yu X. GnRH receptor-activating autoantibodies in polycystic ovary syndrome: identification of functional epitopes and development of epitope mimetic inhibitors. Endocrine 2022; 75:959-963. [PMID: 34807394 PMCID: PMC8891032 DOI: 10.1007/s12020-021-02944-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE We have recently demonstrated that gonadotrophin-releasing hormone receptor-activating autoantibodies (GnRHR-AAb) are associated with polycystic ovary syndrome (PCOS). The aim of this study was to map the antigenic epitopes of GnRHR-AAb from PCOS patients, and develop retro-inverso peptide inhibitors that specifically target GnRHR-AAb. METHODS Serum samples from ten GnRHR-AAb-positive PCOS patients and ten GnRHR-AAb-negative healthy controls were tested. Epitope mapping for GnRHR-AAb was performed using a set of 11 overlapping octapeptides spanning the second extracellular loop of GnRHR. Antibody-blocking effect of the designed retro-inverso peptide inhibitors was evaluated in a cell-based bioassay. RESULTS Two peptide sequences, FSQCVTHC and HCSFSQWW, were found to react with all PCOS sera, but not with control sera. Two retro-inverso peptides that mimic the identified epitopes, d-CHTVCQSF and d-WWQSFSCH, significantly inhibited PCOS serum IgG-induced GnRHR activation. One of these two peptide inhibitors, d-CHTVCQSF, largely suppressed autoantibody-induced GnRHR activation, suggesting that the epitope sequence FSQCVTHC may be a major functional target of GnRHR-AAb. CONCLUSION We have identified a dominant functional epitope for GnRHR-AAb associated with PCOS, and demonstrated effective blocking of GnRHR-AAb activity with epitope-mimicking retro-inverso peptide inhibitors. These proteolytically stable decoy peptides may have important therapeutic implications in subjects who harbor these autoantibodies.
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Affiliation(s)
- Hongliang Li
- Section of Endocrinology and Diabetes, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Yankai Guo
- Section of Endocrinology and Diabetes, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jielin Deng
- Section of Endocrinology and Diabetes, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Hariprasad Gali
- Department of Pharmaceutical Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Elizabeth A Weedin
- Section of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Heather R Burks
- Section of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - LaTasha B Craig
- Section of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Xichun Yu
- Section of Endocrinology and Diabetes, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Li H, Guo Y, Deng J, Fischer H, Weedin EA, Burks HR, Craig LB, Yu X. Increased testosterone and proinflammatory cytokines in patients with polycystic ovary syndrome correlate with elevated GnRH receptor autoantibody activity assessed by a fluorescence resonance energy transfer-based bioassay. Endocrine 2021; 74:163-171. [PMID: 34013495 PMCID: PMC8440388 DOI: 10.1007/s12020-021-02761-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/07/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE The recently identified agonistic autoantibodies (AAb) to the gonadotropin-releasing hormone receptor (GnRHR) are a novel investigative and therapeutic target for polycystic ovary syndrome (PCOS). In this study, we used a new cell-based fluorescence resonance energy transfer (FRET) bioassay to analyze serum GnRHR-AAb activity and examine its relationship with testosterone and proinflammatory cytokines in patients with PCOS. METHODS Serum samples from 33 PCOS patients, 39 non-PCOS ovulatory infertile controls and 30 normal controls were tested for GnRHR-AAb activity and proinflammatory cytokines in a FRET-based bioassay and multiplex bead-based immunoassay, respectively. Correlation was analyzed using the Spearman's correlation test. RESULTS Serum GnRHR-AAb activity was significantly higher in the PCOS patients than for the ovulatory infertile (p < 0.05) and normal (p < 0.01) controls. GnRHR-AAb were positive in 39% of PCOS patients, 10% of ovulatory infertile controls, and 0% of normal controls. PCOS IgG-induced GnRHR activation was specifically blocked by the GnRHR antagonist cetrorelix. Serum levels of proinflammatory cytokines interleukin-2, interleukin-6, interferon-γ, and tumor necrosis factor-α were significantly increased in PCOS patients compared with ovulatory infertile and normal controls (p < 0.01). Correlation analysis demonstrated positive correlations of GnRHR-AAb activity with testosterone and proinflammatory cytokine levels in the PCOS group. CONCLUSIONS Elevated GnRHR-AAb activity, as assessed by a new FRET assay, is associated with increased testosterone and proinflammatory cytokines in PCOS, suggesting autoimmune activation of GnRHR may contribute to the pathogenesis of this common disorder.
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Affiliation(s)
- Hongliang Li
- Section of Endocrinology and Diabetes, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Yankai Guo
- Section of Endocrinology and Diabetes, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jielin Deng
- Section of Endocrinology and Diabetes, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Hayley Fischer
- Section of Endocrinology and Diabetes, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Elizabeth A Weedin
- Section of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Heather R Burks
- Section of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - LaTasha B Craig
- Section of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Xichun Yu
- Section of Endocrinology and Diabetes, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Gavrizi SZ, Peck JD, Eckart E, Agbaga MP, Tytanic M, Craig LB, Diamond MP, Hansen KR. SPERM VERY LONG CHAIN POLYUNSATURATED FATTY ACID (VLC-PUFA) CONCENTRATION: RELATION TO SEMEN PARAMETERS AND LIVE-BIRTH OUTCOME IN A MULTICENTER TRIAL. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Craig LB, Arya S, Burks HR, Warta K, Jarshaw C, Hansen KR, Peck JD. Relationship between semen regurgitation and pregnancy rates with intrauterine insemination. Fertil Steril 2021; 116:1526-1531. [PMID: 34417056 DOI: 10.1016/j.fertnstert.2021.07.1183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the relationship between semen regurgitation and intrauterine insemination (IUI) outcomes. We hypothesized that clinical pregnancy rates and live birth rates would be reduced when regurgitation occurred. DESIGN Retrospective cohort study. SETTING A university-based reproductive endocrinology and infertility clinic. PATIENT(S) Retrospective review of 1,957 IUI cycles performed on 660 patients between July 2007 and May 2012. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The primary outcome was live birth. Secondary outcomes were positive serum pregnancy result and clinical pregnancy. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a cluster-weighted generalized estimating equations method to estimate modified Poisson regression models with robust standard errors to account for multiple IUI cycles in the same patient. RESULT(S) Live birth rates were similar in IUI cycles with and without regurgitation (6.3% vs. 6.8%, respectively, RR = 0.82, 95% CI [0.53-1.26]). Clinical pregnancy rates in the presence or absence of regurgitation were 10.5% vs. 10.0% (RR = 0.99, 95% CI [0.73-1.35]). Positive serum pregnancy tests after IUI did not differ by regurgitation status (15.0% vs. 15.4%, RR = 0.97, 95% CI [0.75-1.24]). Results were unchanged when adjusted for covariates (age, race and ethnicity, body mass index, duration of infertility, medication, infertility diagnosis, total motile count, and method of sperm preparation). CONCLUSION(S) The presence of regurgitation during the IUI procedure is not related to pregnancy outcome.
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Affiliation(s)
- LaTasha B Craig
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
| | - Sushila Arya
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Heather R Burks
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Kaitlin Warta
- Department of Obstetrics and Gynecology, New Hanover Regional Medical Center, Wilmington, North Carolina
| | - Christen Jarshaw
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Karl R Hansen
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Jennifer D Peck
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Li H, Guo Y, Zhang G, Deng J, Fischer H, Craig LB, Yu X, Kem DC. Gonadotrophin-releasing hormone receptor autoantibodies induce polycystic ovary syndrome-like features in a rat model. Exp Physiol 2021; 106:902-912. [PMID: 33576068 DOI: 10.1113/ep089109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/09/2021] [Indexed: 12/11/2022]
Abstract
NEW FINDINGS What is the central question of this study? Is there a causal relationship between gonadotrophin-releasing hormone (GnRH) receptor-activating autoantibodies and polycystic ovary syndrome (PCOS)? What is the main finding and its importance? Induction of GnRH receptor-activating autoantibodies in rats resulted in increased luteinizing hormone pulsatility and testosterone concentrations, disrupted oestrous cycles, increased atretic follicles, and activation of insulin signalling in the pituitary and ovary. These changes replicate those seen in humans with PCOS, suggesting that GnRH receptor-activating autoantibodies might be involved in the pathogenesis of PCOS. ABSTRACT Gonadotrophin-releasing hormone receptor-activating autoantibodies (GnRHR-AAb) are associated with polycystic ovary syndrome (PCOS). In the present study, we examined the impact of GnRHR-AAb on reproductive function in GnRHR-immunized female rats. All immunized rats produced high titres of GnRHR-AAb targeting a dominant epitope located in the central region of the second extracellular loop of the GnRHR. Increased pulsatile luteinizing hormone secretion and testosterone concentrations were found in immunized rats. These rats exhibited disrupted oestrous cycles, increased ovarian follicular atresia, and activation of insulin signalling in the pituitary and ovary, as indicated by increased mRNA expressions of insulin receptor substrate, phosphatidylinositol 3-kinase and glucose transporter 1. No significant changes in inflammatory cytokines were detected in the ovarian tissue. These features mimic those observed in humans with PCOS. Our findings support the concept that chronic stimulation of the GnRHR by GnRHR-AAb, with an associated increase in pituitary luteinizing hormone secretion and ovarian androgen overproduction, might represent a new aetiological mechanism for PCOS.
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Affiliation(s)
- Hongliang Li
- Department of Medicine, Endocrinology Section and the Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Yankai Guo
- Department of Medicine, Endocrinology Section and the Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Cardiac Pacing and Electrophysiology Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Gege Zhang
- Cardiac Pacing and Electrophysiology Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jielin Deng
- Department of Medicine, Endocrinology Section and the Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Hayley Fischer
- Department of Medicine, Endocrinology Section and the Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - LaTasha B Craig
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma, USA
| | - Xichun Yu
- Department of Medicine, Endocrinology Section and the Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - David C Kem
- Department of Medicine, Endocrinology Section and the Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Royce CS, Everett EN, Craig LB, Fleming A, Forstein DA, Graziano SC, Hampton BS, Hopkins L, McKenzie ML, Morgan HK, Sims SM, Morosky C. To the Point: advising students applying to Obstetrics and Gynecology residency in 2020 and beyond. Am J Obstet Gynecol 2021; 224:148-157. [PMID: 33038302 PMCID: PMC7539929 DOI: 10.1016/j.ajog.2020.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/16/2020] [Accepted: 10/05/2020] [Indexed: 01/07/2023]
Abstract
This article, from the "To the Point" series by the Undergraduate Medical Education Committee of the Association of Professors of Gynecology and Obstetrics, is a guide for advising medical students applying to Obstetrics and Gynecology residency programs. The residency application process is changing rapidly in response to an increasingly complex and competitive atmosphere, with a wider recognition of the stress, expense, and difficulty of matching into graduate training programs. The coronavirus disease 2019 pandemic and societal upheaval make this application cycle more challenging than ever before. Medical students need reliable, accurate, and honest advising from the faculty in their field of choice to apply successfully to residency. The authors outline a model for faculty career advisors, distinct from mentors or general academic advisors. The faculty career advisor has detailed knowledge about the field, an in-depth understanding of the application process, and what constitutes a strong application. The faculty career advisor provides accurate information regarding residency programs within the specialty, helping students to strategically apply to programs where the student is likely to match, decreasing anxiety, expense, and overapplication. Faculty career advisor teams advise students throughout the application process with periodic review of student portfolios and are available for support and advice throughout the process. The authors provide a guide for the faculty career advisor in Obstetrics and Gynecology, including faculty development and quality improvement.
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Affiliation(s)
- Celeste S. Royce
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, and Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA,Corresponding author: Celeste S. Royce, MD
| | - Elise N. Everett
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine, University of Vermont, Burlington, VT
| | - LaTasha B. Craig
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, OK
| | - Angela Fleming
- Department of Obstetrics and Gynecology, Michigan State University College of Osteopathic Medicine, East Lansing, MI
| | - David A. Forstein
- Department of Obstetrics and Gynecology, Touro College of Osteopathic Medicine, Harlem, New York, NY
| | - Scott C. Graziano
- Department of Obstetrics and Gynecology, Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | - B. Star Hampton
- Department of Obstetrics and Gynecology, Women & Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Laura Hopkins
- Division of Oncology, Department of Obstetrics and Gynecology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Margaret L. McKenzie
- Department of Obstetrics and Gynecology, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, and Cleveland Clinic South Pointe Hospital, Cleveland, OH
| | - Helen K. Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Shireen Madani Sims
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL
| | - Christopher Morosky
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT
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Li H, Zhang G, Guo Y, Deng J, Fischer H, Craig LB, Kem DC, Yu X. Autoimmune activation of the GnRH receptor induces insulin resistance independent of obesity in a female rat model. Physiol Rep 2021; 8:e14672. [PMID: 33356018 PMCID: PMC7757370 DOI: 10.14814/phy2.14672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/24/2022] Open
Abstract
Polycystic ovary syndrome (PCOS), a metabolic and reproductive disease, is frequently associated with type 2 diabetes. We have demonstrated activating autoantibodies (AAb) directed toward the second extracellular loop (ECL2) of the gonadotropin-releasing hormone receptor (GnRHR) are present in a significant subgroup of PCOS patients. It is unclear whether GnRHR-AAb can induce peripheral tissue insulin resistance (IR) in animal models. Sixteen rats were divided equally into a GnRHR ECL2 peptide-immunized group (IMM group) and a control group (CON group). Sera GnRHR-AAb titer, luteinizing hormone (LH), and testosterone (T) were higher in IMM rats compared with CON rats. No significant difference in fasting blood glucose was observed between the two groups. However, the plasma glucose level at other time points of the IMM group was higher than that of the CON group during an intraperitoneal glucose tolerance test (IPGTT) and an insulin tolerance test (ITT) (p < 0.01). These data support the likelihood of the GnRHR-AAb induction of glucose intolerance and IR. Compared with the CON group, the IMM group showed a significant increase in insulin-stimulated phosphorylation of IRS-1 (p-IRS-1 S636/639) and a decrease in insulin-stimulated phosphorylation of Akt (p-AKT S473). Expression of the glucose transport genes including GLUT-2 in liver and GLUT-4 in white adipose tissue and skeletal muscle was significantly decreased in IMM rats compared with the CON rats. Serum levels of proinflammatory cytokines (TNF-α, IL-1α, and IL-18) were increased, while anti-inflammatory cytokines (IL-4 and IL-10) were decreased in the IMM group. Taken together, elevated GnRHR-AAb enhanced LH, hyperandrogenism, and inflammation. These changes are likely related to the observed peripheral tissue IR through the downregulation of the insulin-stimulated IRS/PI3K/Akt/Glut signaling pathway.
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Affiliation(s)
- Hongliang Li
- Section of Endocrinology and DiabetesDepartment of MedicineUniversity of Oklahoma Health Sciences CenterOklahomaOKUSA
| | - Gege Zhang
- Section of Endocrinology and DiabetesDepartment of MedicineUniversity of Oklahoma Health Sciences CenterOklahomaOKUSA
- Cardiac Pacing and Electrophysiology DepartmentThe First Affiliated Hospital of Xinjiang Medical UniversityUrumqiChina
- Xinjiang Key Laboratory of Cardiac Electrophysiology and RemodelingThe First Affiliated Hospital of Xinjiang Medical UniversityUrumqiChina
| | - Yankai Guo
- Section of Endocrinology and DiabetesDepartment of MedicineUniversity of Oklahoma Health Sciences CenterOklahomaOKUSA
- Cardiac Pacing and Electrophysiology DepartmentThe First Affiliated Hospital of Xinjiang Medical UniversityUrumqiChina
- Xinjiang Key Laboratory of Cardiac Electrophysiology and RemodelingThe First Affiliated Hospital of Xinjiang Medical UniversityUrumqiChina
| | - Jielin Deng
- Section of Endocrinology and DiabetesDepartment of MedicineUniversity of Oklahoma Health Sciences CenterOklahomaOKUSA
- Department of CardiologyRenmin Hospital of Wuhan UniversityWuhanHubeiChina
| | - Hayley Fischer
- Section of Endocrinology and DiabetesDepartment of MedicineUniversity of Oklahoma Health Sciences CenterOklahomaOKUSA
| | - LaTasha B. Craig
- Section of Reproductive Endocrinology & InfertilityDepartment of Obstetrics & GynecologyUniversity of Oklahoma Health Sciences CenterOklahomaOKUSA
| | - David C. Kem
- Section of Endocrinology and DiabetesDepartment of MedicineUniversity of Oklahoma Health Sciences CenterOklahomaOKUSA
| | - Xichun Yu
- Section of Endocrinology and DiabetesDepartment of MedicineUniversity of Oklahoma Health Sciences CenterOklahomaOKUSA
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Weedin EA, Burks HR, Yu X, Li HL, Aston CE, Kem DC, Craig LB. Elevated activity levels of activating autoantibodies to the GnRH receptor in patients with polycystic ovary syndrome. F S Rep 2020; 1:299-304. [PMID: 34223260 PMCID: PMC8244267 DOI: 10.1016/j.xfre.2020.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/28/2020] [Accepted: 09/26/2020] [Indexed: 11/02/2022] Open
Abstract
Objectives 1) To confirm the correlation of GnRH receptor (GnRHR) activating autoantibody (AAb) activity with polycystic ovary syndrome (PCOS) diagnosis in large well defined cohorts; and 2) to evaluate suppression of AAb activity with GnRH antagonist medication in transfected GnRHR cells exposed to serum of PCOS patients. Design Cross-sectional matched case-control study. Setting University-based research facility. Patients Sera from 200 patients with PCOS from the Pregnancy in Polycystic Ovary Syndrome II (PPCOS II) trial and from 200 race, parity-, age-, and body mass index (BMI)-matched ovulatory unexplained infertile control patients from the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) trial were obtained and used for this study. Interventions GnRHR AAb activity was determined with the use of the GeneBlazer cell-based fluorescence resonance energy transfer assay with and without cetrorelix, a GnRH antagonist. Main Outcome Measures 1) GnRHR AAb activity in PCOS patients compared with control subjects; and 2) effectiveness of GnRH antagonist in suppressing GnRHR AAb activity. Results GnRHR AAb activity levels in the PCOS group were significantly higher than in the control group. With cetrorelix, GnRHR AAb activity was largely suppressed in the PCOS group but not in the control group. These differences remained significant after adjusting for within-pair differences in age, BMI, and antimüllerian hormone (AMH) levels. Conclusions We confirmed higher GnRHR AAb activity levels in the sera of a large cohort of PCOS patients compared with unexplained infertile control subjects. Addition of cetrorelix resulted in significant suppression of AAb activity levels in PCOS patients as a group whereas control subjects were unaffected. GnRHR AAb, along with patient age and AMH level, may provide a promising future diagnostic test for PCOS.
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Affiliation(s)
- Elizabeth A Weedin
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Oklahoma City, Oklahoma
| | - Heather R Burks
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Oklahoma City, Oklahoma
| | - Xichun Yu
- Section of Endocrinology, Department of Medicine, Oklahoma City, Oklahoma
| | - Hong Liang Li
- Section of Endocrinology, Department of Medicine, Oklahoma City, Oklahoma
| | - Christopher E Aston
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - David C Kem
- Section of Endocrinology, Department of Medicine, Oklahoma City, Oklahoma
| | - LaTasha B Craig
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Oklahoma City, Oklahoma
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Weedin EA, Burks HR, Yu X, Li HL, Aston CE, Kem DC, Craig LB. A NOVEL DIAGNOSTIC APPROACH FOR POLYCYSTIC OVARY SYNDROME DIAGNOSIS USING GONADOTROPIN RELEASING HORMONE RECEPTOR AUTOANTIBODY ACTIVITY AND ANTIMULLERIAN HORMONE. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kem DC, Li H, Yu X, Weedin E, Reynolds AC, Forsythe E, Beel M, Fischer H, Hines B, Guo Y, Deng J, Liles JT, Nuss Z, Elkosseifi M, Aston CE, Burks HR, Craig LB. The Role of GnRH Receptor Autoantibodies in Polycystic Ovary Syndrome. J Endocr Soc 2020; 4:bvaa078. [PMID: 32803090 PMCID: PMC7417878 DOI: 10.1210/jendso/bvaa078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/11/2020] [Indexed: 12/28/2022] Open
Abstract
Objective Is polycystic ovary syndrome (PCOS) associated with activating autoantibodies (AAb) to the second extracellular loop (ECL2) of gonadotropin-releasing hormone receptor (GnRHR)? Design and Methods We retrospectively screened sera from 40 patients with PCOS and 14 normal controls (NCs) with regular menses using enzyme-linked immunosorbent assay (ELISA) for the presence of GnRHR-ECL2-AAb. We obtained similar data from 40 non-PCOS ovulatory but infertile patients as a control group (OIC) of interest. We analyzed GnRHR-ECL2-AAb activity in purified immunoglobulin (Ig)G using a cell-based GnRHR bioassay. Results The mean ELISA value in the PCOS group was markedly higher than the NC (P = .000036) and the OIC (P = .0028) groups. IgG from a sample of 5 PCOS subjects, in contrast to a sample of 5 OIC subjects, demonstrated a dose-dependent increase in GnRHR-stimulating activity qualitatively similar to the acute action of the natural ligand GnRH and the synthetic agonist leuprolide. The GnRHR antagonist cetrorelix significantly suppressed (P < .01) the elevated GnRHR activity induced by IgG from 7 PCOS patients while the IgG activity level from 7 OIC subjects was unchanged. Five other OIC subjects had relatively high ELISA values at or above the 95% confidence limits. On further study, 3 had normal or low activity while 2 had elevated IgG-induced GnRHR activity. One suppressed with cetrorelix while the other did not. The copresence of PCOS IgG increased the responsiveness to GnRH and shifted the dosage response curve to the left (P < .01). Conclusions GnRHR-ECL2-AAb are significantly elevated in patients with PCOS compared with NCs. Their presence raises important etiological, diagnostic, and therapeutic implications.
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Affiliation(s)
- David C Kem
- Section of Endocrinology and Diabetes, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma city, Oklahoma.,VA Medical Center, Oklahoma City, Oklahoma
| | - Hongliang Li
- Section of Endocrinology and Diabetes, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma city, Oklahoma
| | - Xichun Yu
- Section of Endocrinology and Diabetes, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma city, Oklahoma
| | - Elizabeth Weedin
- Section of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Anna C Reynolds
- Section of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Elizabeth Forsythe
- Section of Endocrinology and Diabetes, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma city, Oklahoma
| | - Marci Beel
- Section of Endocrinology and Diabetes, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma city, Oklahoma
| | - Hayley Fischer
- Section of Endocrinology and Diabetes, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma city, Oklahoma
| | - Brendon Hines
- Section of Endocrinology and Diabetes, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma city, Oklahoma
| | - Yankai Guo
- Section of Endocrinology and Diabetes, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma city, Oklahoma
| | - Jielin Deng
- Section of Endocrinology and Diabetes, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma city, Oklahoma
| | - Jonathan T Liles
- Section of Endocrinology and Diabetes, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma city, Oklahoma
| | - Zachary Nuss
- Section of Endocrinology and Diabetes, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma city, Oklahoma
| | - Myriam Elkosseifi
- Section of Endocrinology and Diabetes, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma city, Oklahoma
| | - Christopher E Aston
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Heather R Burks
- Section of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - LaTasha B Craig
- Section of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Li H, Guo Y, Zhang G, Deng J, Fischer H, Craig LB, Yu X, Kem DC. MON-002 The Effect of GNRHR Autoantibody on Reproduction Function and Insulin Signaling Intermediates in a New Animal Model of Polycystic Ovary Syndrome. J Endocr Soc 2020. [PMCID: PMC7208854 DOI: 10.1210/jendso/bvaa046.1934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Polycystic ovary syndrome (PCOS), a metabolic and reproductive associated disease, defined as hyperandrogenism with reproductive dysfunction including menstrual disorder, anovulation, infertility, polycystic ovary and so on. We previously showed reported a high percentage of activating autoantibodies (AAb) directed toward the second extracellular loop (ECL2) of gonadotropin-releasing hormone receptor (GnRHR) in PCOS patients, and further demonstrated elevated GnRHR-autoantibody (GnRHR-AAb) could induced insulin resistance in energy storage and peripheral tissue in immunized animals. In the present study, we have now induced specific GnRHR-ECL2 AAb in rats and explored the underlying mechanisms of their resultant reproductive dysfunction. Methods: Sixteen SD rats were randomly divided into 2 groups: a GnRHR group (n=8) and a control group (n=8). Rats in the GnRHR group were immunized with GnRHR ECL2 peptide while the controls were not. Epitope mapping of GnRHR-ECL2-directed AAb was performed using octapeptide multipin solid-phase peptides. Rat estrus cycle was measured through pudendum appearance and vaginal smears. Ovarian and pituitary tissues were collected to observe ovarian morphological changes, to examine the expressions of proteins and genes of insulin signaling pathway by Quantitative real-time PCR respectively. The concentration of inflammatory cytokines in the ovary was detected by Bio-plex Pro™ magnetic bead-based assays on the Bio-plex®. Results: The GnRHR-AAb titers and activity in the GnRHR group were significantly higher than the control group, and the GnRHR-AAb from the immunized rats reacted predominantly with the peptide sequence FSQCVTHC of the GnRHR-ECL2. Numbers of LH pulses and concentration of testosterone in GnRHR group were significantly higher than control group. The GnRHR group exhibited lower frequency of in the appearance of proestrus and estrous phases while the control group represented had a higher frequency in the appearance of metestrus and diestrus stages on estrus cyclicity. The GnRHR-immunized group showed demonstrated increased atretic follicles, decreased corpora lutea, loosely packed granulosa cells, and thecal cell hyperplasia in ovarian tissue compared with controls group. There was GnRHR group represented increased expressions of IRS-1, PI3K and GLUT-1 in ovarian and pituitary tissues compared with control group. However, no obvious changes of inflammatory cytokines are observed in ovarian tissues between two groups. Conclusion: Chronic elevated GnRHR-AAb exerts induced reproductive dysfunction through increased ovarian LH secretion and androgen production, thus likely leading to compensatory hyperinsulinemia which ultimately enhanced insulin signaling in reproductive tissues to exert more and androgen production to, which may provide a novel etiological mechanism for PCOS.
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Affiliation(s)
- Hongliang Li
- Department of Medicine, University of Oklahoma Health Sciences Center, Harold Hamm Diabetes Center, and VA Medical Center, Oklahoma City, OK, USA
| | - Yankai Guo
- Cardiac Pacing and Electrophysiology Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Gege Zhang
- Cardiac Pacing and Electrophysiology Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jielin Deng
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hayley Fischer
- Department of Medicine, University of Oklahoma Health Sciences Center, Harold Hamm Diabetes Center, and VA Medical Center, Oklahoma City, OK, USA
| | - LaTasha B Craig
- Section of REI, Dept of Ob/Gyn, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Xichun Yu
- Department of Medicine, University of Oklahoma Health Sciences Center, Harold Hamm Diabetes Center, and VA Medical Center, Oklahoma City, OK, USA
| | - David C Kem
- Department of Medicine, University of Oklahoma Health Sciences Center, Harold Hamm Diabetes Center, and VA Medical Center, Oklahoma City, OK, USA
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Oluborode B, Burks H, Craig LB, Peck JD. Does the ultrasound appearance of the endometrium during treatment with assisted reproductive technologies influence pregnancy outcomes? HUM FERTIL 2020; 25:166-175. [PMID: 32345073 DOI: 10.1080/14647273.2020.1757766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We evaluated endometrial pattern, defined as the relative echogenicity of the endometrium on a longitudinal uterine ultrasonic section, as a surrogate for endometrial receptivity in an attempt to evaluate the association between endometrial pattern and pregnancy outcome in women who underwent ART treatment. The primary outcome was live birth and secondary outcomes were clinical intrauterine pregnancy and miscarriage. Potential associations were evaluated using cluster-weighted generalized estimating equations to account for within-couple correlation among repeated ART cycles while adjusting for potentially confounding variables. There were 1034 ART cycles with embryo transfer (778 fresh, 256 frozen) among 695 women (median age: 31.0 (6.0) years). The average number of embryos transferred per cycle was 2.1. The clinical intrauterine pregnancy rate per transfer was 56.0% for fresh and 54.3% for frozen cycles. The overall live birth rate per embryo transfer was 48.4%. Live birth rates were unchanged when the endometrium was semi-trilinear (RR:0.91 CI:0.74,1.12) or unilinear (RR:1.15 CI:0.89,1.49) in comparison to trilinear endometrium after controlling for potentially confounding variables. Results were similar when analysed separately for fresh and frozen cycles and when evaluating associations with clinical intrauterine pregnancy and miscarriage rates. It appears that endometrial pattern does not significantly affect live birth in ART and our data do not support cancelling an ART cycle if the endometrium is less than trilinear.
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Affiliation(s)
- Babawale Oluborode
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA
| | - Heather Burks
- Section of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA
| | - LaTasha B Craig
- Section of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA
| | - Jennifer D Peck
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA
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McKenzie ML, Forstein DA, Abbott JF, Buery-Joyner SD, Craig LB, Dalrymple JL, Graziano SC, Hampton BS, Page-Ramsey SM, Pradhan A, Wolf A, Hopkins L. Fostering Inclusive Approaches to Lesbian, Gay, Bisexual, and Transgender (LGBT) Healthcare on the Obstetrics and Gynecology Clerkship. Med Sci Educ 2020; 30:523-527. [PMID: 34457696 PMCID: PMC8368615 DOI: 10.1007/s40670-019-00886-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This article from the "To the Point" series prepared by the Association of Professors in Gynecology and Obstetrics (APGO) Undergraduate Medical Education Committee (UMEC) provides educators with strategies for inclusion of Lesbian, Gay, Bisexual, Transgender (LGBT)-related content into the medical school curriculum. With a focus on the Obstetrics and Gynecology (OB/GYN) clerkship, we also address ways to enhance visibility of these curricula within existing clinical and teaching experiences.
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Affiliation(s)
- Margaret L. McKenzie
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland Clinic South Pointe Hospital, Executive Office, 20000 Harvard Road, Warrensville Heights, OH 44122 USA
| | | | | | | | - LaTasha B. Craig
- University of Oklahoma, Health Sciences Center, Oklahoma City, USA
| | | | - Scott C. Graziano
- Loyola University Chicago, Stritch School of Medicine, Maywood, IL USA
| | - Brittany S. Hampton
- Division of Urogynecology, Women & Infants Hospital of Rhode Island, Providence, RI USA
| | | | - Archana Pradhan
- UMDNJ-Robert Wood Johnson-New Brunswick, New Brunswick, NJ USA
| | - Abigail Wolf
- Thomas Jefferson University, Philadelphia, PA USA
| | - Laura Hopkins
- University of Saskatchewan, College of Medicine, Division of Oncology, Room 4562, Saskatoon, Canada
- Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8 Canada
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Hopkins L, Morgan H, Buery-Joyner SD, Craig LB, Everett EN, Forstein DA, Graziano SC, Hampton BS, McKenzie ML, Page-Ramsey SM, Pradhan A, Bliss S. To the Point: a prescription for well-being in medical education. Am J Obstet Gynecol 2019; 221:542-548. [PMID: 31181180 DOI: 10.1016/j.ajog.2019.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/10/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
Abstract
This article is from the "To The Point" series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee. The purpose of this review was to provide an overview of the importance of well-being in medical education. A literature search was performed by a Reference Librarian who used Ovid/MEDLINE to identify scholarly articles published in English on learner well-being, using the search terms "burnout," "resilience," "wellness," and "physicians" between 1946 and January 11, 2019. The accreditation expectations and standards, available assessment tools for learner well-being, existing programs to teach well-being, and some key elements for curriculum development are presented. This is a resource for medical educators, learners, and practicing clinicians from any field of medicine.
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Pradhan A, Buery-Joyner SD, Page-Ramsey S, Bliss S, Craig LB, Everett E, Forstein DA, Graziano S, Hopkins L, McKenzie M, Morgan H, Hampton BS. To the point: undergraduate medical education learner mistreatment issues on the learning environment in the United States. Am J Obstet Gynecol 2019; 221:377-382. [PMID: 31029660 DOI: 10.1016/j.ajog.2019.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/08/2019] [Accepted: 04/19/2019] [Indexed: 10/27/2022]
Abstract
This article, from the To the Point series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, is an overview of issues to consider regarding learner mistreatment and its effects on the undergraduate medical education learning environment in the United States. National data from the American Association of Medical Colleges Graduate Questionnaire and local data regarding learner mistreatment provide evidence that the learning environment at most medical schools needs to be improved. The American Association of Medical Colleges' definition of learner mistreatment focuses on active mistreatment, but data on passive mistreatment also contribute to a negative learning environment. The lack of tolerance for active mistreatment issues such as public humiliation and sexual and racial harassment need to be made transparent through institutional and departmental policies. Additionally, reporting mechanisms at both levels need to be created and acted upon. Passive mistreatment issues such as unclear expectations and neglect can also be addressed at institutional and departmental levels through training modules and appropriate communication loops to address these concerns. To fully confront and solve this challenging issue regarding learner mistreatment at the undergraduate medical education level, solutions to need to be implemented for faculty, residents, and students in the institutional, departmental, and clerkship settings.
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Craig LB, Brush RS, Sullivan MT, Zavy MT, Agbaga MP, Anderson RE. Decreased very long chain polyunsaturated fatty acids in sperm correlates with sperm quantity and quality. J Assist Reprod Genet 2019; 36:1379-1385. [PMID: 31073727 DOI: 10.1007/s10815-019-01464-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/26/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To determine if levels of very long chain polyunsaturated fatty acids (VLC-PUFA; ≥ 28 carbons;4-6 double bonds) in human sperm correlate with sperm quantity and quality as determined by a complete semen analysis. METHODS Ejaculates from 70 men underwent a complete semen analysis, which included volume, count, motility, progression, agglutination, viscosity, morphology, and pH. For lipid analysis, sperm were pelleted to remove the semen. Lipids were extracted from the cell pellet and methyl esters of total lipids analyzed by gas chromatography. The sphingolipids were enriched and sphingomyelin (SM) species measured using tandem mass spectrometry. Pair-wise Pearson correlation and linear regression analysis compared percent VLC-PUFA-SM and percent docosahexaenoic acid (DHA) to results from the semen analysis. RESULTS VLC-PUFA-SM species having 28-34 carbon fatty acids were detected in sperm samples, with 28 and 30 carbon VLC-PUFA as most the abundant. The sum of all VLC-PUFA-SM species comprised 0 to 6.1% of the overall SM pool (mean 2.1%). Pair-wise Pearson analyses showed that lower levels of VLC-PUFA-SM positively correlated with lower total motile count (0.68) and lower total count (0.67). Total VLC-PUFA-SM and mole % DHA (22:6n3) were not strongly correlated (- 0.24). Linear regression analysis confirmed these findings. CONCLUSION This study revealed a positive correlation between the levels of VLC-PUFA with sperm count and total motile count and suggests that both sperm quality and quantity may depend on the presence of VLC-PUFA. The lack of correlation between VLC-PUFA and DHA suggests that low VLC-PUFA levels do not result from inadequate PUFA precursors.
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Affiliation(s)
- LaTasha B Craig
- Section of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, College of Medicine, University of Oklahoma Health Sciences Center, PO Box 26901, AAT 2400, Oklahoma City, OK, 73126, USA.
| | - Richard S Brush
- Department of Ophthalmology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.,Dean A. McGee Eye Institute, Oklahoma City, OK, 73104, USA
| | - Michael T Sullivan
- Department of Ophthalmology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.,Dean A. McGee Eye Institute, Oklahoma City, OK, 73104, USA
| | - Michael T Zavy
- Section of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, College of Medicine, University of Oklahoma Health Sciences Center, PO Box 26901, AAT 2400, Oklahoma City, OK, 73126, USA
| | - Martin-Paul Agbaga
- Department of Ophthalmology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.,Dean A. McGee Eye Institute, Oklahoma City, OK, 73104, USA.,Department of Cell Biology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Robert E Anderson
- Department of Ophthalmology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.,Dean A. McGee Eye Institute, Oklahoma City, OK, 73104, USA.,Department of Cell Biology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
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Craig LB, Peck JD, Janitz AE. The prevalence of infertility in American Indian/Alaska Natives and other racial/ethnic groups: National Survey of Family Growth. Paediatr Perinat Epidemiol 2019; 33:119-125. [PMID: 30706501 PMCID: PMC6438739 DOI: 10.1111/ppe.12538] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/20/2018] [Accepted: 01/02/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The prevalence of infertility in American Indian/Alaska Native (AI/AN) populations is unknown. The objective of our study was to estimate the prevalence of infertility and impaired fecundity in the AI/AN population and other racial and ethnic groups. METHODS We analyzed female respondent data from the pooled National Survey of Family Growth (NSFG) cycles 2002, 2006-2010, and 2011-2013. We used modified Poisson regression with robust error variance accounting for survey weighting to estimate prevalence proportion ratios (PPR) and 95% confidence intervals (CI) for NSFG definitions of infertility and impaired fecundity by race and Hispanic ethnicity. RESULTS The prevalence of infertility and impaired fecundity in the pooled NSFG was 6.4% (95% CI 5.7, 7.0) and 11.0% (95% CI 11.0, 12.2), respectively. Compared to whites, blacks had a 1.45 times greater adjusted prevalence of infertility (95% CI 1.15, 1.83) and AI/ANs had a 1.37 times greater prevalence of infertility (95% CI 0.91, 2.06) compared to whites. We observed a 1.30 times greater prevalence of impaired fecundity among AI/AN (95% CI 1.04, 1.62) compared to whites. We observed no differences in impaired fecundity for black or Asian/Pacific Islander women compared to whites or for Hispanic compared to non-Hispanic women. CONCLUSIONS Inequalities in the burden of reproductive impairments among blacks and AI/AN women warrant further evaluation to identify opportunities for prevention and disparity reduction.
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Affiliation(s)
- LaTasha B Craig
- Section of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, College of Medicine, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Jennifer D Peck
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Amanda E Janitz
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
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Everett EN, Forstein DA, Bliss S, Buery-Joyner SD, Craig LB, Graziano SC, Hampton BS, Hopkins L, McKenzie ML, Morgan H, Pradhan A, Page-Ramsey SM. To the Point: The expanding role of simulation in obstetrics and gynecology medical student education. Am J Obstet Gynecol 2019; 220:129-141. [PMID: 30696555 DOI: 10.1016/j.ajog.2018.10.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/12/2018] [Accepted: 10/17/2018] [Indexed: 11/16/2022]
Abstract
This article, from the "To the Point" series prepared by the Association of Professors of Gynecology and Obstetrics (APGO) Undergraduate Medical Education Committee (UMEC), provides educators with an overview of the use of simulation in undergraduate medical education in the field of obstetrics and gynecology. Simulation plays an important role in the education of medical students. Students are increasingly serving as clinical observers and providing less direct patient care. Simulation can help standardize education and ensure quality and comparability across an enlarging educational environment. This article summarizes the expanding role of simulation in undergraduate medical education in obstetrics and gynecology and its effect on important learner outcomes such as confidence, knowledge, skills, workplace behaviors, and translation to patient care.
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Affiliation(s)
- Elise N Everett
- Department of Obstetrics and Gynecology, The Robert Larner, MD College of Medicine at the University of Vermont, Burlington, VT.
| | - David A Forstein
- Department of Obstetrics and Gynecology, Touro College of Osteopathic Medicine, Harlem, New York, NY
| | - Susan Bliss
- Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, NC
| | - Samantha D Buery-Joyner
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Inova Campus, Falls Church, VA
| | - LaTasha B Craig
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Scott C Graziano
- Department of Obstetrics and Gynecology, Loyola University Chicago, Department of Obstetrics and Gynecology, Stritch School of Medicine, Maywood, IL
| | - Brittany S Hampton
- Department of Obstetrics and Gynecology, Women & Infants Hospital of RI, Providence, RI
| | - Laura Hopkins
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
| | - Margaret L McKenzie
- Department of Obstetrics and Gynecology, Cleveland Clinic South Pointe Hospital, Cleveland, OH
| | - Helen Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Archana Pradhan
- Department of Obstetrics and Gynecology, Rutgers-Robert Wood Johnson Medical School-New Brunswick, New Brunswick, NJ
| | - Sarah M Page-Ramsey
- Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX
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Jacobs MH, Reuter LM, Baker VL, Craig LB, Sakkas D, Surrey E, Doody KJ, Jungheim ES, Bayrak AB, Hund M, Verhagen-Kamerbeek WDJ, Pardue D, Buck K, Timm B. A multicentre evaluation of the Elecsys ® anti-Müllerian hormone immunoassay for prediction of antral follicle count. Reprod Biomed Online 2019; 38:845-852. [PMID: 30930183 DOI: 10.1016/j.rbmo.2018.12.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
Abstract
RESEARCH QUESTION What concentration of anti-Müllerian hormone (AMH) corresponds to an antral follicle count (AFC) >15 for determination of ovarian reserve? DESIGN A prospective study conducted at 13 US fertility clinics in women aged 21-44 years who presented for AFC evaluation by transvaginal ultrasound. Serum samples were collected at the time of AFC evaluation (menstrual cycle day 2-4). AMH concentrations were measured by the Elecsys® AMH immunoassay; oestradiol and follicle-stimulating hormone (FSH) concentrations were also measured. The serum AMH cut-off able to detect AFC >15 with high sensitivity was determined (derivation cohort). Clinical performance of the AMH assay at the derived cut-off was evaluated (validation cohort). Receiver operating characteristic (ROC) analyses were also performed. RESULTS In the derivation cohort (n = 306), an optimal serum AMH cut-off value of 1.77 ng/ml was determined to correspond to AFC >15 with 89.63% sensitivity and 69.01% specificity, using the Elecsys AMH assay. In the validation cohort (n = 856), this 1.77 ng/ml cut-off could identify women with an AFC >15 with a sensitivity of 88.34% and a specificity of 68.29%; corresponding positive predictive and negative predictive values were 75.19% and 84.34%, respectively. ROC analyses demonstrated that AMH performed better than oestradiol or FSH in predicting AFC, with area under the curves of 85.7%, 57.1% and 69.7%, respectively, in the validation cohort. CONCLUSION The Elecsys AMH immunoassay provides a robust and fully automated method to measure serum AMH levels. Women with AMH values below the cut-off of 1.77 ng/ml are unlikely to have AFC >15.
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Affiliation(s)
- Michael H Jacobs
- Fertility and IVF Center of Miami, 8950 North Kendall Drive, Suite 103, Miami FL 33176, USA.
| | - Laura M Reuter
- Midwest Fertility Specialists, 12188-A North Meridian Street, Suite 250, Carmel IN 46032, USA
| | - Valerie L Baker
- Stanford Fertility Specialists, 1195 West Fremont Avenue, Sunnyvale CA 94087, USA
| | - LaTasha B Craig
- University of Oklahoma Health Sciences Center, 1100 North Lindsay Avenue, Oklahoma City OK 73104, USA
| | - Denny Sakkas
- Boston IVF, 130 Second Avenue, Waltham MA 02451, USA
| | - Eric Surrey
- Colorado Center for Reproductive Medicine, 10290 RidgeGate Circle, Lone Tree CO 80124, USA
| | - Kevin J Doody
- Center for Assisted Reproduction, 1701 Park PI Avenue, Bedford TX 76022, USA
| | - Emily S Jungheim
- Washington University Fertility and Reproductive Medicine Center, 4444 Forest Park Avenue No. 3100, St. Louis MO 63110, USA
| | | | - Martin Hund
- Roche Diagnostics International Ltd, Forrenstrasse 2, Rotkreuz 6343, Switzerland
| | | | - Deborah Pardue
- Roche Diagnostics Operations Inc., 9115 Hague Road, Indianapolis IN 46250-0457, USA
| | - Katharina Buck
- Roche Diagnostics GmbH, Nonnenwald 2, Penzberg 82377, Germany
| | - Barbara Timm
- Heartland Center for Reproductive Medicine, 7308 South 142nd Street, Omaha NE 68138, USA
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Abstract
Objectives Previous studies have identified racial/ethnic disparities in infertility care, but patterns among American Indian/Alaska Natives (AI/AN) have not been reported. Our objective was to evaluate infertility services use in the US by race/ethnicity using data from the National Survey of Family Growth (NSFG). Methods We analyzed female respondent data from the pooled NSFG cycles 2002, 2006-2010 and 2011-2013. Respondents reported use of infertility services and types of services. We calculated weighted crude and adjusted prevalence proportion ratios (PPR) and 95% confidence intervals (95% CI) using modified Poisson regression with robust error variances accounting for the complex survey design to compare infertility services use across race/ethnicities. Results Overall, 8.7% of women reported using medical services to get pregnant. The prevalence of using any medical service to help get pregnant was lower for American Indian/Alaska Native (AI/AN) (PPR: 0.60, 95% CI 0.43-0.83) and black (PPR: 0.53, 95% CI 0.44-0.63) compared to white women and in Hispanic compared to non-Hispanic women (PPR: 0.57, 95% CI 0.48-0.67). The prevalence of accessing treatment, testing, and advice also differed by race and ethnicity. Conclusions for Practice We observed disparities in accessing services to get pregnant among AI/AN and black women and reduced use of advice among Asian/Pacific Islanders compared to whites. We also observed reduced service utilization for Hispanic compared to non-Hispanic women. Differential utilization of specific services suggests barriers to infertility care may contribute to reproductive health disparities among underserved populations.
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Affiliation(s)
- Amanda E Janitz
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 309, Oklahoma City, OK, 73104, USA.
| | - Jennifer D Peck
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 309, Oklahoma City, OK, 73104, USA
| | - LaTasha B Craig
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, 840 Research Parkway, Suite 200, Oklahoma City, OK, 73104, USA
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Hullender Rubin LE, Anderson BJ, Craig LB. Acupuncture and in vitro fertilisation research: Current and future directions. Acupunct Med 2018; 36:117-122. [DOI: 10.1136/acupmed-2016-011352] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2017] [Indexed: 11/03/2022]
Abstract
Background Acupuncture is a common adjuvant treatment to support patients undergoing in vitro fertilisation (IVF). However, the impact of acupuncture and the different roles it can play in IVF remain unclear. Objective In this paper, we present an overview and critique of the current evidence on acupuncture's impact on IVF-related stress, describe harms, and propose future directions for investigation. Conclusion Two to three acupuncture sessions performed on or around the day of embryo transfer are insufficient interventions to improve IVF birth outcomes but provide significant IVF-related stress reduction. Research investigating acupuncture to support IVF is heterogeneous and confounded by the lack of an appropriate comparator. However, evidence suggests several acupuncture sessions improve endometrial thickness, reduce stress, and improve patient satisfaction. Observational studies suggest more sessions are associated with increases in clinical pregnancy and live birth rates. An optimised acupuncture intervention with a reasonable comparator is necessary for future studies, with evidence-based guidance on technique and number of sessions. Acupuncture should not be rejected as an adjuvant therapy for IVF, but more studies are needed to clarify acupuncture's role in supporting IVF cycles.
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Affiliation(s)
- Lee E Hullender Rubin
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
- Portland Acupuncture Studio, Portland, Oregon, USA
| | - Belinda J Anderson
- Academic Department, Pacific College of Oriental Medicine - New York Campus, New York, USA
| | - LaTasha B Craig
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Craig LB, Buery-Joyner SD, Bliss S, Everett EN, Forstein DA, Graziano SC, Hampton BS, McKenzie ML, Morgan H, Page-Ramsey SM, Pradhan A, Hopkins L. To the point: gender differences in the obstetrics and gynecology clerkship. Am J Obstet Gynecol 2018; 219:430-435. [PMID: 29852154 DOI: 10.1016/j.ajog.2018.05.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 11/30/2022]
Abstract
Gender differences in performance on the obstetrics and gynecology clerkship have been reported, with female students outperforming male students. Male students report that their gender negatively affects their experience during the clerkship. Additionally, there are fewer male students applying for obstetric/gynecology residency. This "To The Point" article by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee will describe the gender differences that have been found, examine factors that could be contributing to these issues, and propose measures to correct these disparities.
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Affiliation(s)
- LaTasha B Craig
- University of Oklahoma Health Sciences Center, Oklahoma City, OK.
| | | | | | - Elise N Everett
- The Robert Larner, MD, College of Medicine at the University of Vermont, Burlington, VT
| | | | - Scott C Graziano
- Loyola University Chicago, Stritch School of Medicine, Maywood, IL
| | - Brittany S Hampton
- Women & Infants Hospital of Rhode Island, Division of Urogynecology, Providence, RI
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Graziano SC, McKenzie ML, Abbott JF, Buery-Joyner SD, Craig LB, Dalrymple JL, Forstein DA, Hampton BS, Page-Ramsey SM, Pradhan A, Wolf A, Hopkins L. Barriers and Strategies to Engaging Our Community-Based Preceptors. Teach Learn Med 2018; 30:444-450. [PMID: 29578818 DOI: 10.1080/10401334.2018.1444994] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
ISSUE This article, from the "To the Point" series that is prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, is a review of commonly cited barriers to recruiting and retaining community-based preceptors in undergraduate medical education and potential strategies to overcome them. EVIDENCE Community-based preceptors have traditionally served as volunteer, nonsalaried faculty, with academic institutions relying on intrinsic teaching rewards to sustain this model. However, increasing numbers of learners, the burdens of incorporating the electronic medical record in practice, and increasing demands for clinical productivity are making recruitment and retention of community-based preceptors more challenging. IMPLICATIONS General challenges to engaging preceptors, as well as those unique to women's health, are discussed. Potential solutions are reviewed, including alternative recruitment strategies, faculty development to emphasize efficient teaching practices in the ambulatory setting, offers of online educational resources, and opportunities to incorporate students in value-added roles. Through examples cited in this review, clerkship directors and medical school administrators should have a solid foundation to actively engage their community-based preceptors.
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Affiliation(s)
- Scott C Graziano
- a Department of Obstetrics and Gynecology , Loyola University Stritch School of Medicine , Maywood , Illinois , USA
| | - Margaret L McKenzie
- b Department of Obstetrics and Gynecology , Cleveland Clinic Lerner College of Medicine , Cleveland , Ohio , USA
| | - Jodi F Abbott
- c Department of Obstetrics and Gynecology , Boston University School of Medicine , Boston , Massachusetts , USA
| | - Samantha D Buery-Joyner
- d Department of Obstetrics and Gynecology , Virginia Commonwealth University School of Medicine, Inova Campus , Church Falls , Virginia , USA
| | - LaTasha B Craig
- e Department of Obstetrics and Gynecology , University of Oklahoma Health Sciences Center , Oklahoma City , Oklahoma , USA
| | - John L Dalrymple
- f Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center , Harvard Medical School Boston , Massachusetts , USA
| | - David A Forstein
- g Touro College of Osteopathic Medicine, Harlem Campus , Touro College and University System , New York , New York , USA
| | - Brittany S Hampton
- h Obstetrics and Gynecology, Women and Infants' Hospital , Providence , Rhode Island , USA
| | - Sarah M Page-Ramsey
- i Obstetrics and Gynecology, University of Texas Health Sciences Center , San Antonio , Texas , USA
| | - Archana Pradhan
- j Department of Obstetrics , Gynecology, and Reproductive Sciences, Robert Wood Johnson Medical School , New Brunswick , New Jersey , USA
| | - Abigail Wolf
- k Obstetrics and Gynecology, Jefferson Medical College at Thomas Jefferson University , Philadelphia , Pennsylvania , USA
| | - Laura Hopkins
- l Department of Obstetrics , Gynecology, and Newborn Care, University of Ottawa , Ottawa , Ontario , Canada
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Abstract
BACKGROUND Studies comparing serum 25-hydroxyvitamin D concentrations in women with and without polycystic ovary syndrome (PCOS) have produced inconsistent results. Additionally, no previous studies have evaluated associations between vitamin D and specific PCOS phenotypes. METHODS This case-control study was conducted among women undergoing intrauterine insemination. Cases (N.=137) were diagnosed with PCOS and then further classified into 3 diagnostic phenotypes based on combinations of the Rotterdam criteria (ovulatory dysfunction+polycystic ovaries [N.=55]; ovulatory dysfunction +androgen excess [N.=15]; and ovulatory dysfunction, +polycystic ovaries, +androgen excess [N.=67]). Controls (N.=103) were ovulatory women without PCOS who were undergoing IUI. Serum total 25-hydroxyvitamin D concentrations were categorized as deficient (≤20 ng/mL), insufficient (21-29 ng/mL), and sufficient (≥30 ng/mL). Prevalence odds ratios (PORs) were calculated using logistic regression. RESULTS A higher proportion (59.9%) of PCOS cases lacked sufficient vitamin D levels compared to controls (47.6%; P value=0.06). The odds of vitamin D deficiency in all PCOS cases were twice that of controls (POR=2.03, 95% CI 0.97-4.26); however, the association was attenuated after adjusting for Body Mass Index (BMI) and race/ethnicity (adjPOR=1.43, 95% CI 0.62, 3.26). When examining PCOS phenotypes exhibiting androgen excess, crude associations were observed for deficient vitamin D levels (unadjPOR=2.93, 95% CI: 1.27, 6.77); however, the association decreased after adjustment for BMI and race/ethnicity (adjPOR=2.03, 95% CI: 0.79, 5.19). CONCLUSIONS Vitamin D deficiency occurred more frequently in PCOS cases with androgen excess, but associations were attenuated after adjusting for BMI and race/ethnicity. Combining etiologically distinct PCOS subgroups may obscure associations with lower vitamin D levels and other potential risk factors.
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Affiliation(s)
- Erin M Davis
- Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, KY, USA -
| | - Jennifer D Peck
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Karl R Hansen
- , Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Barbara R Neas
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - LaTasha B Craig
- , Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Arnold KC, Thai TC, Craig LB. Uterine Didelphys with Bilateral Cervical Agenesis in a 15-Year-Old Girl. J Pediatr Adolesc Gynecol 2018; 31:64-66. [PMID: 28807736 DOI: 10.1016/j.jpag.2017.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 07/31/2017] [Accepted: 08/07/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Isolated uterine didelphys requires no treatment in contrast to cervical agenesis, which requires a hysterectomy. Because of this, correct diagnosis of Müllerian anomalies is paramount for making recommendations for patient care. CASE A 15-year-old girl presented to clinic with pelvic pain and primary amenorrhea. Uterine didelphys with bilateral cervical agenesis was diagnosed using imaging. Hysterectomy was recommended and diagnosis was confirmed at surgery and according to anatomic pathology. SUMMARY AND CONCLUSION Our patient with uterine didelphys with bilateral cervical agenesis presented a diagnostic challenge, because, to our knowledge, it has never been reported before in the literature. Her pattern of anomalies had significant implications for future fertility. Radiology exam was vital to confirming this diagnosis in a young, virginal female patient.
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Affiliation(s)
- Kate C Arnold
- Department of Obstetrics and Gynecology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Theresa C Thai
- Department of Radiology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - LaTasha B Craig
- Department of Reproductive Endocrinology and Infertility, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma.
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Hopkins L, Hampton BS, Abbott JF, Buery-Joyner SD, Craig LB, Dalrymple JL, Forstein DA, Graziano SC, McKenzie ML, Pradham A, Wolf A, Page-Ramsey SM. To the point: medical education, technology, and the millennial learner. Am J Obstet Gynecol 2018; 218:188-192. [PMID: 28599897 DOI: 10.1016/j.ajog.2017.06.001] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/25/2017] [Accepted: 06/01/2017] [Indexed: 11/26/2022]
Abstract
This article, from the "To The Point" series that was prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, provides an overview of the characteristics of millennials and describes how medical educators can customize and reframe their curricula and teaching methods to maximize millennial learning. A literature search was performed to identify articles on generational learning. We summarize the importance of understanding the attitudes, ideas, and priorities of millennials to tailor educational methods to stimulate and enhance learning. Where relevant, a special focus on the obstetrics and gynecology curriculum is highlighted.
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Craig LB, Weedin EA, Walker WD, Janitz AE, Hansen KR, Peck JD. Racial and Ethnic Differences in Pregnancy Rates Following Intrauterine Insemination with a Focus on American Indians. J Racial Ethn Health Disparities 2018; 5:1077-1083. [PMID: 29318510 DOI: 10.1007/s40615-017-0456-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 12/17/2017] [Accepted: 12/26/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND No research exists on American Indian pregnancy rates following infertility treatment. Most racial/ethnic fertility research has focused on pregnancy following in vitro fertilization, with only rare studies looking at intrauterine insemination (IUI). The objective of our study was to compare fecundability following IUI by race/ethnicity, with a special focus on American Indians. METHODS This was a retrospective analysis of subjects undergoing IUI July 2007-May 2012 at a university-based infertility clinic. The primary outcome was positive pregnancy test, with a secondary outcome of ongoing pregnancy/delivery (OP/D). We calculated risk ratios (RR) and 95% confidence intervals (CI) using cluster-weighted generalized estimating equations method to estimate modified Poisson regression models with robust standard errors to account for multiple IUI cycles in the same patient. RESULTS A total of 663 females (median age 32) undergoing 2007 IUI cycles were included in the analysis. Pregnancy rates overall were 15% per IUI cycle. OP/D rates overall were 10% per IUI cycle. The American Indian patients had significantly lower pregnancy (RR 0.34, 95% CI 0.16-0.72) and OP/D rates (RR 0.33, 95% CI 0.12-0.87) compared to non-Hispanic whites when patient and cycle characteristics were controlled. Pregnancy and OP/D rates for blacks, Asians, and Hispanics did not differ from those of non-Hispanic whites. CONCLUSIONS Our finding of lower IUI treatment success among American Indian patients is novel, as no published studies of assisted reproductive technology or other fertility treatments have examined this subgroup separately. Further investigation of patient and clinical factors that may mediate racial/ethnic disparities in fertility treatment outcomes is warranted.
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Affiliation(s)
- LaTasha B Craig
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, PO Box 26901, COMB 2400, Oklahoma City, OK, 73126, USA.
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, PO Box 26901, AAT 2400, Oklahoma City, OK, 73126, USA.
| | - Elizabeth A Weedin
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, PO Box 26901, COMB 2400, Oklahoma City, OK, 73126, USA
| | - William D Walker
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, PO Box 26901, COMB 2400, Oklahoma City, OK, 73126, USA
| | - Amanda E Janitz
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St., Oklahoma City, OK, 73104, USA
| | - Karl R Hansen
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, PO Box 26901, COMB 2400, Oklahoma City, OK, 73126, USA
| | - Jennifer D Peck
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St., Oklahoma City, OK, 73104, USA
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Hampton BS, Pradhan A, Abbott J, Buery-Joyner SD, Craig LB, Forstein D, Hopkins L, Wolf A, Page-Ramsey SM. Journal Watch from ACE (Alliance for Clinical Education): Review of Medical Education Articles in Obstetrics and Gynecology, 2013-2015. Teach Learn Med 2017; 29:109-114. [PMID: 28051890 DOI: 10.1080/10401334.2016.1257430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Brittany Star Hampton
- a Department of Obstetrics and Gynecology , Warren Alpert Medical School of Brown University , Providence , Rhode Island , USA
| | - Archana Pradhan
- b Department of Obstetrics , Gynecology and Reproductive Sciences, Rutgers-Robert Wood Johnson Medical School , New Brunswick , New Jersey , USA
| | - Jodi Abbott
- c Department of Obstetrics and Gynecology , Boston University School of Medicine , Boston , Massachusetts , USA
| | - Samantha D Buery-Joyner
- d Virginia Commonwealth University School of Medicine Inova Campus , Falls Church , Virginia , USA
| | - LaTasha B Craig
- e Reproductive Medicine, University of Oklahoma College of Medicine , Oklahoma City , Oklahoma , USA
| | - David Forstein
- f Department of Obstetrics and Gynecology , University of South Carolina School of Medicine Greenville , South Carolina , USA
| | - Laura Hopkins
- g Department of Obstetrics and Gynecology , University of Ottawa , Ottawa , Ontario , Canada
| | - Abigail Wolf
- h Obstetrics and Gynecology, Thomas Jefferson University , Philadelphia , Pennsylvania , USA
| | - Sarah M Page-Ramsey
- i Department of Obstetrics and Gynecology , University of Texas Health Science Center San Antonio , San Antonio , Texas , USA
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Santoro N, Eisenberg E, Trussell JC, Craig LB, Gracia C, Huang H, Alvero R, Casson P, Christman G, Coutifaris C, Diamond M, Jin S, Legro RS, Robinson RD, Schlaff WD, Zhang H. Fertility-related quality of life from two RCT cohorts with infertility: unexplained infertility and polycystic ovary syndrome. Hum Reprod 2016; 31:2268-79. [PMID: 27402910 PMCID: PMC5027926 DOI: 10.1093/humrep/dew175] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 06/16/2016] [Indexed: 01/05/2023] Open
Abstract
STUDY QUESTION Does fertility-related quality of life (FertiQOL) differ by infertility diagnosis between women with polycystic ovary syndrome (PCOS) and their partners, compared with couples with unexplained infertility (UI)? SUMMARY ANSWER Women with PCOS report lower QOL than those with UI, whereas males with UI report lower QOL than males with PCOS partners. WHAT IS KNOWN ALREADY The fertility-specific QOL survey, FertiQOL, has been used to examine fertility-related QOL in a number of worldwide cohorts. Few data have addressed fertility-related QOL as a function of infertility diagnosis. Overall, men report better QOL than women with infertility, and there is variation in FertiQOL scores across different samples from different countries. STUDY DESIGN, SIZE, DURATION This was a prospective, cohort study derived from two concurrent, randomized clinical trials, and designed to examine QOL in infertile females with PCOS and UI at the time of enrollment compared with each other and their male partners; to compare concordance FertiQOL scores in this study across other worldwide cohorts; and to determine if baseline FertiQOL was associated with pregnancy outcome. PARTICIPANTS/MATERIALS, SETTING, METHODS Women with PCOS and their partners (n = 733 and n = 641, respectively), and couples with UI (n = 865 women and 849 men) completed a validated fertility-specific QOL survey (FertiQOL) at the time of the study screening visit. PCOS women were randomized to either clomiphene citrate or letrozole treatment; couples with UI were randomized to clomiphene citrate, letrozole or gonadotrophin plus IUI. FertiQOL results were compiled by diagnosis (PCOS or UI) and compared by diagnosis and sex using Wilcoxon Rank-Sum testing. Relationships between baseline FertiQOL and pregnancy outcomes were examined using logistic regression. Multivariable models were performed to assess the association between FertiQOL scores and key participant characteristics. MAIN RESULTS AND THE ROLE OF CHANCE Women with PCOS had lower total FertiQOL scores (72.3 ± 14.8) than those with UI (77.1 ± 12.8; P < 0.001); this was true for each domain (except Relational). These differences were largely explained by variation in BMI, hirsutism, household income and age. Women had lower overall FertiQOL scores than their male partners. Males with PCOS partners had higher scores than males with UI (84.9 ± 10.2 versus 83.3 ± 10.8; P = 0.003). Scores were not consistently associated with conception or pregnancy outcome. LIMITATIONS, REASONS FOR CAUTION The use of multiple tests of association may have resulted in spurious statistically significant findings. Inherent sociodemographic differences between women with PCOS and those with UI largely account for the lower QOL in women with PCOS. Our study was unable to assess if changes in QOL affected pregnancy outcome as FertiQOL data were collected prior to treatment. Finally, the participants for both studies represent their local communities, but are not a population-based sample and thus firm conclusions about how representative these couples are to the general population must be made with caution. WIDER IMPLICATIONS OF THE FINDINGS Women with PCOS with elevated BMI and hirsutism scores and with lower socioeconomic status may require more, targeted psychosocial support than those with other diagnoses. Possible attribution of infertility to the male partner appears to result in a lower QOL. There appears to be substantial national variation in FertiQOL scores, with US-based cohorts reporting overall higher QOL. STUDY FUNDING/COMPETING INTERESTS This work was supported by National Institutes of Health (NIH)/Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Grants U10 HD39005 (to M.D.), U10 HD38992 (to R.S.L.), (to C.C.), U10 HD38998 (to R.A.), U10 HD055942 (to R.D.R.), HD055944 (to P.C.), U10 HD055936 (to G.C.), U10HD055925 (to H.Z.); and U10 U54-HD29834 (to the University of Virginia Center for Research in Reproduction Ligand Assay and Analysis Core of the Specialized Cooperative Centers Program in Reproduction and Infertility Research). Most importantly, this research was made possible by the funding by American Recovery and Reinvestment Act. N.S., E.E., J.C.T., C.G., H.H., R.A., P.C., G.C., C.C., M.D., S.J., W.D.S. and H.Z. report no conflicts of interests/disclosures. L.B.C. reports research support from Ferring Pharmaceuticals and Roche Diagnostics; R.S.L. reports receipt of consulting fees from AstraZeneca, Euroscreen, Sprout Pharmaceuticals, Taken, Kindex, Clarus and Bayer, Inc., and research support from AstraZeneca and Ferring Pharmaceuticals. R.D.R. reports research support from AbbVie. TRIAL REGISTRATION NUMBER Pregnancy in Polycystic Ovary Syndrome II (PPCOS II), NCT00719186; Assessment of Multiple Intrauterine Gestations in Ovulation Stimulation (AMIGOS) NCT01044862, clinicaltrials.gov. TRIAL REGISTRATION DATE PPCOS II 17 July 2008; AMIGOS 7 January 2010. DATE OF FIRST PATIENT'S ENROLMENT PPCOS II 19 February 2009; AMIGOS 2 August 2010.
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Affiliation(s)
- Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, 12631 E 17th Avenue AO1 Room 4010, Aurora, CO 80045, USA
| | - Esther Eisenberg
- Fertility & Infertility Branch, NICHD, NIH, Bethesda, MD 20892, USA
| | - J C Trussell
- Department of Urology, State University of New York Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA
| | - LaTasha B Craig
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, PO Box 26901, WP 2410 Oklahoma City, OK 73126, USA
| | - Clarisa Gracia
- Department of Obstetrics and Gynecology, University of Pennsylvania Penn Fertility Center, 3701 Market Street, Philadelphia, PA 19104, USA
| | - Hao Huang
- Collaborative Center for Statistics in Science, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA
| | - Ruben Alvero
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, 12631 E 17th Avenue AO1 Room 4010, Aurora, CO 80045, USA Present address: Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA
| | - Peter Casson
- Present address: Northeastern Reproductive Medicine, 105 West View Rd. Suite 305, Colchester, VT 05446, USA
| | - Gregory Christman
- Present address: Department of Obstetrics and Gynecology, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32611-0294, USA
| | - Christos Coutifaris
- Department of Obstetrics and Gynecology, University of Pennsylvania Penn Fertility Center, 3701 Market Street, Philadelphia, PA 19104, USA
| | - Michael Diamond
- Present address: Georgia Regents University/Medical College of Georgia, 1120 15th Street, BA-7300, Augusta, GA 30912-3300, USA
| | - Susan Jin
- Collaborative Center for Statistics in Science, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA
| | - Richard S Legro
- Penn State College of Medicine, 500 University Drive, Hersey, PA 17033, USA
| | - Randal D Robinson
- University of Texas at San Antonio Health Sciences Center, 8300 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - William D Schlaff
- Present address: Department of Obstetrics and Gynecology, Thomas Jefferson University, 834 Chestnut Street, Suite 400, Philadelphia, PA 19107, USA
| | - Heping Zhang
- Collaborative Center for Statistics in Science, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA
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Pradhan A, Page-Ramsey S, Buery-Joyner SD, Craig LB, Dalrymple JL, Forstein DA, Graziano S, Hampton BS, Hopkins L, McKenzie M, Wolf A, Abbott JF. Undergraduate obstetrics and gynecology medical education: why are we underrated and underappreciated? Am J Obstet Gynecol 2016; 214:345-7. [PMID: 26522859 DOI: 10.1016/j.ajog.2015.10.915] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 10/21/2015] [Accepted: 10/23/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Archana Pradhan
- Undergraduate Medical Education Committee, Association of Professors of Gynecology and Obstetrics, Crofton, MD.
| | - Sarah Page-Ramsey
- Undergraduate Medical Education Committee, Association of Professors of Gynecology and Obstetrics, Crofton, MD
| | - Samantha D Buery-Joyner
- Undergraduate Medical Education Committee, Association of Professors of Gynecology and Obstetrics, Crofton, MD
| | - LaTasha B Craig
- Undergraduate Medical Education Committee, Association of Professors of Gynecology and Obstetrics, Crofton, MD
| | - John L Dalrymple
- Undergraduate Medical Education Committee, Association of Professors of Gynecology and Obstetrics, Crofton, MD
| | - David A Forstein
- Undergraduate Medical Education Committee, Association of Professors of Gynecology and Obstetrics, Crofton, MD
| | - Scott Graziano
- Undergraduate Medical Education Committee, Association of Professors of Gynecology and Obstetrics, Crofton, MD
| | - Brittany S Hampton
- Undergraduate Medical Education Committee, Association of Professors of Gynecology and Obstetrics, Crofton, MD
| | - Laura Hopkins
- Undergraduate Medical Education Committee, Association of Professors of Gynecology and Obstetrics, Crofton, MD
| | - Margaret McKenzie
- Undergraduate Medical Education Committee, Association of Professors of Gynecology and Obstetrics, Crofton, MD
| | - Abigail Wolf
- Undergraduate Medical Education Committee, Association of Professors of Gynecology and Obstetrics, Crofton, MD
| | - Jodi F Abbott
- Undergraduate Medical Education Committee, Association of Professors of Gynecology and Obstetrics, Crofton, MD
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Burks H, Peck J, Hansen KR, Quaas A, Craig LB. Clomiphene citrate stair-step protocol does not increase overall side effects compared to the traditional protocol. Fertil Steril 2016. [DOI: 10.1016/j.fertnstert.2015.12.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Peck JD, Quaas AM, Craig LB, Soules MR, Klein NA, Hansen KR. Lifestyle factors associated with histologically derived human ovarian non-growing follicle count in reproductive age women. Hum Reprod 2015; 31:150-7. [PMID: 26497957 DOI: 10.1093/humrep/dev271] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/02/2015] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Are lifestyle factors (smoking, BMI, alcohol use and oral contraceptive pill use) associated with the human ovarian reserve as determined by the total ovarian non-growing follicle number? SUMMARY ANSWER Light to moderate alcohol use was significantly associated with greater ovarian non-growing follicle (NGF) count, whereas other lifestyle factors were not significantly related. WHAT IS KNOWN ALREADY A single previous investigation has suggested that smoking and alcohol use are associated with lower ovarian follicle density. However, this investigation utilized follicle density as the outcome of interest rather than the estimated total ovarian NGF count. STUDY DESIGN, SIZE, DURATION This cross-sectional investigation included a convenience sample of premenopausal women from two different academic sites, the University of Washington (n = 37, from 1999-2004) and the University of Oklahoma (n = 73, from 2004-2013), undergoing incidental oophorectomy at the time of hysterectomy (total n = 110, age range 21-52 years). PARTICIPANTS/MATERIALS, SETTING, METHODS Prior to undergoing oophorectomy, participants completed detailed questionnaires regarding lifestyle exposures. Following surgery, total ovarian NGF counts were determined with systematic random sampling rules and a validated fractionator/optical dissector technique. Associations between lifestyle factors and log-transformed ovarian follicle counts were determined using multivariable linear regression. MAIN RESULTS AND THE ROLE OF CHANCE After controlling for age, BMI, oral contraceptive pill (OCP) use, tobacco use and site of collection, cumulative alcohol use (measured in alcoholic drinks per day multiplied by years of drinking) was associated with ovarian NGF count. Women reporting light (>0 to <1 drink-years) and moderate (1-3 drink-years) alcohol use had greater NGF counts (β = 0.75, P = 0.04, and β = 1.00, P = 0.03; light and moderate use, respectively) as compared with non-users. Neither heavier alcohol use (>3 drink-years), BMI, OCP use, nor tobacco use were significantly associated with the ovarian NGF count. Similar patterns of association with moderate cumulative alcohol use were observed when evaluating associations with pre-antral follicles and total follicle counts. LIMITATIONS, REASONS FOR CAUTION All participants in this convenience sample had a benign indication for hysterectomy, and therefore may not be broadly representative of the population without such an indication. Additionally, lifestyle factors were self-reported, and the sample size of the present investigation limits our ability to detect associations of smaller magnitude. WIDER IMPLICATIONS OF THE FINDINGS While our findings are in disagreement with a single investigation that utilized human follicle density as the outcome of interest, they are consistent with many studies investigating the relationship between lifestyle factors and the age of spontaneous menopause. Furthermore, they suggest a mechanism that does not involve accelerated follicular atresia to explain the association between smoking and an earlier age of menopause. STUDY FUNDING/COMPETING INTERESTS This investigation was funded by NIA R29-HD37360-04 (N.A.K.) and OCAST HR04-115 (K.R.H.) and by the National Institute of General Medical Sciences, Grant 1 U54GM104938 (J.D.P.). There is no conflict of interest.
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Affiliation(s)
- Jennifer D Peck
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Alexander M Quaas
- Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - LaTasha B Craig
- Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | | | - Karl R Hansen
- Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Hampton BS, Craig LB, Abbott JF, Buery-Joyner SD, Dalrymple JL, Forstein DA, Hopkins L, McKenzie ML, Page-Ramsey SM, Pradhan A, Wolf A, Graziano SC. To the point: teaching the obstetrics and gynecology medical student in the operating room. Am J Obstet Gynecol 2015; 213:464-8. [PMID: 25857571 DOI: 10.1016/j.ajog.2015.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/27/2015] [Accepted: 04/03/2015] [Indexed: 10/23/2022]
Abstract
This article, from the "To the Point" series that is prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, is a review of considerations for teaching the medical student in the operating room during the obstetrics/gynecology clerkship. The importance of the medical student operating room experience and barriers to learning in the operating room are discussed. Specific considerations for the improvement of medical student learning and operating room experience, which include the development of operating room objectives and specific curricula, an increasing awareness regarding role modeling, and faculty development, are reviewed.
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Park AL, Craig LB, Hansen KR, Wild RA, Quaas AM. In Women Under 35 with Unexplained Infertility, IUI Cycle Outcomes Using 50 mg of Clomiphene Citrate are Similar to Those Using 100 mg. Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2014.12.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Zavy MT, Craig LB, Wild RA, Kahn SN, O’Leary D, Hansen KR. In high responding patients undergoing an initial IVF cycle, elevated estradiol on the day of hCG has no effect on live birth rate. Reprod Biol Endocrinol 2014; 12:119. [PMID: 25430541 PMCID: PMC4258294 DOI: 10.1186/1477-7827-12-119] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 11/20/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The impact of elevated estradiol on the day of human chorionic gonadotropin (hCG) administration on in vitro fertilization (IVF) outcomes has been debated for over 25 years. Some investigators have shown a positive effect, others a negative effect; while most have shown no effect. Few studies have expressed their findings based on live birth. This study examined the relationship between estradiol level and other IVF cycle response parameters in relation to pregnancy, with a focus on live births after controlling for embryo quality. METHODS We performed a retrospective cohort study on 489 patients <40 years old that underwent an initial IVF cycle. Estradiol concentration on the day of hCG was categorized as; low <2000 pg/ml), mid (2001-4000 pg/ml) and high (>4000 pg/ml) to determine how estradiol level on the day of hCG affected response variables during the IVF cycle. We performed a subgroup analysis restricted to patients with good/fair quality embryos transferred (n=428), to control for embryo quality and assessed pregnancy outcome. The association between estradiol and live birth (LB) was then evaluated after identifying and controlling for confounding factors. Multivariate analysis was used to identify significant main effects and interactions in the model. Estradiol levels were also compared in patients having a LB or not (NLB) in both populations. RESULTS We found that estradiol was significantly related to + hCG, clinical pregnancy rate, age, and most other IVF cycle response variables. After performing the subgroup analysis controlling for embryo quality, we found that LB rates were not different. Only the main effects of average embryo quality at transfer (AEQS), age and transferring two embryos influenced LB. Estradiol levels were also compared in patients having a LB or NLB in both populations and was found to be higher/not different in LB patients. LB rates and AEQS were also not different in a subgroup of patients having an elevated level of estradiol (>4200 pg/ml) on the day of hCG in patients having embryo transfer on day 3 or day 5. CONCLUSIONS After controlling for embryo quality, elevated estradiol on the day of hCG had no effect on LB.
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Affiliation(s)
- Michael T Zavy
- Section of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma USA
| | - LaTasha B Craig
- Section of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma USA
| | - Robert A Wild
- Section of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma USA
| | - Sana N Kahn
- Section of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma USA
| | - Dena O’Leary
- Section of Uro-gynecology, Department of Obstetrics and Gynecology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma USA
| | - Karl R Hansen
- Section of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma USA
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Craig LB, Rubin LEH, Peck JD, Anderson M, Marshall LA, Soules MR. Acupuncture performed before and after embryo transfer: a randomized controlled trial. J Reprod Med 2014; 59:313-320. [PMID: 24937975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To compare the clinical pregnancy rates in women who underwent fresh embryo transfer (ET) with and without one acupuncture session before and after the transfer using a modified Paulus protocol. STUDY DESIGN The prospective, physician-blinded study randomized 113 women to either no intervention (n = 56) or acupuncture performed off-site (n = 57). Secondary outcomes were positive pregnancy test and live birth rates. Intent-to-treat analysis and per protocol analysis were performed. RESULTS No difference in age and in vitro fertilization-embryo transfer (IVF-ET) parameters were detected. Compared to the control group, the treatment group had a lower pregnancy rate (43.6% vs. 64.8%, p = 0.045). More women in the control group had live births than did those in the acupuncture group (56.0% vs. 36.0%, respectively, p = 0.033). Generalized mixed models revealed that patients who received acupuncture had lower odds of clinical pregnancy than those who did not undergo acupuncture treatment (OR = 0.42, 95% CI 0.19-0.93). CONCLUSION Our study found that acupuncture performed off-site on the day of ET was detrimental to the success of the transfer. More research is needed with a greater number of subjects to elucidate the role of acupuncture before and after ET, ideal treatment frequency, and to further explore the role of individualized acupuncture treatment on IVF-ET pregnancy rates.
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Khan S, Mannel L, Koopman CL, Chimpiri R, Hansen KR, Craig LB. The use of MRI in the pre-surgical evaluation of patients with androgen insensitivity syndrome. J Pediatr Adolesc Gynecol 2014; 27:e17-20. [PMID: 24001432 DOI: 10.1016/j.jpag.2013.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 05/24/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients diagnosed with androgen insensitivity syndrome (AIS) need bilateral gonadectomy (orchiectomy) for malignancy risk reduction. Imaging of the gonads (testicles) prior to surgery is recommended. Ultrasonography has typically been used. However, magnetic resonance imaging (MRI) provides better localization of the gonads and pre-surgical planning. CASES In this case series, we describe how MRI was utilized in planning surgical gonadectomy in 3 patients with complete AIS and to review the literature regarding MRI and AIS. SUMMARY AND CONCLUSIONS MRI prior to surgery was helpful in localizing and planning for removal of the gonads while preventing injury to other structures. Surgical specialists with experience with inguinal dissection were appropriately consulted when an inguinal dissection was likely to be needed to complete the gonadectomy.
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Affiliation(s)
- Sana Khan
- Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Lisa Mannel
- Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Christian L Koopman
- Department of Radiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Rao Chimpiri
- Department of Radiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Karl R Hansen
- Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - LaTasha B Craig
- Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
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Weedin EA, Wilson A, Carter A, White D, Hansen KR, Craig LB. Initiating Infertility Treatment: Does It Improve or Worsen Anxiety and/or Depression? Fertil Steril 2014. [DOI: 10.1016/j.fertnstert.2013.11.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Knowlton NS, Craig LB, Zavy MT, Hansen KR. Validation of the power model of ovarian nongrowing follicle depletion associated with aging in women. Fertil Steril 2014; 101:851-6. [PMID: 24424370 DOI: 10.1016/j.fertnstert.2013.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 11/30/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To validate recently proposed models of ovarian nongrowing follicle (NGF) decay associated with aging within the context of an independent data set. DESIGN Prospective investigation. SETTING Academic medical center. PATIENT(S) Normal appearing ovaries collected from 52 women (age 28-51 years) undergoing oophorectomy for benign gynecologic indications. INTERVENTION(S) Determining ovarian NGF counts with systematic random sampling rules and a validated fractionator/optical disector technique. The goodness-of-fit of predicted NGF counts based on the power and double Gaussian models and those observed in the validation set was assessed with the calculation of the Akaike information criterion and R(2) values. MAIN OUTCOME MEASURE(S) The goodness-of-fit between observed and expected ovarian NGF counts. RESULT(S) The power model was an excellent fit to the observed data. The average difference between the observed and expected NGF count was 0.161 (95% CI, -0.058, 0.327). In the present study population, the power model was a superior fit to the observed data compared with the double Gaussian model. CONCLUSION(S) This prospective investigation with an independent set of ovarian NGF counts validates the power model as an excellent characterization of the ovarian NGF decline associated with aging.
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Affiliation(s)
- Nicholas S Knowlton
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - LaTasha B Craig
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Michael T Zavy
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Karl R Hansen
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
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Craig LB, Smith C, Crow SM, Driver W, Wallace M, Thompson BM. Obstetrics and gynecology clerkship for males and females: similar curriculum, different outcomes? Med Educ Online 2013; 18:21506. [PMID: 24300748 PMCID: PMC3849500 DOI: 10.3402/meo.v18i0.21506] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 08/26/2013] [Accepted: 10/09/2013] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To determine if performance differences exist between male and female students on a 6-week obstetrics and gynecology (Ob/Gyn) clerkship and to evaluate potential variables that might underlie any observed variations. STUDY DESIGN Final clerkship grades and component scores (clinical evaluations, objective structured clinical examination [OSCE], oral examination, and National Board of Medical Examiners [NBME] subject examination) from July 2007 to June 2010 were matched by student and analyzed by gender. Basic science grade point average (GPA) and initial United States Medical Licensing Exam (USMLE) Step 1 scores were used to establish students' baseline medical knowledge. On a post-clerkship questionnaire, a subset of students reported the numbers of procedures they performed during the clerkship; students also completed online pre- and post-clerkship questionnaires reflecting their self-assessed confidence in women's health clinical skills. RESULTS Scores were analyzed for 136 women and 220 men. Final clerkship grades were significantly higher for females than for males (89.05 vs. 87.34, p=0.0004, η(2)=0.08). Specifically, females outscored males on the OSCE, oral, and NBME subject examination portions of the clerkship but not clinical evaluations. Males reported completing fewer breast examinations (p=0.001, η(2)=0.14). Pre-clerkship, males were significantly less confident than females in women's health clinical skills (p<0.01) but reached similar levels upon completion of the clerkship. No gender differences were detected for basic science GPA and USMLE Step 1 scores. CONCLUSION Student gender is associated with final grades on an Ob/Gyn clerkship. Further research regarding these differences should be explored.
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Affiliation(s)
- LaTasha B Craig
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA;
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