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OBJECTIVE: Social media is a popular way to disseminate new information and opinions, perhaps furthered by the COVID-19 pandemic and quarantine. Our objective was to analyze information and sentiments posted regarding the COVID-19 vaccine (VAX) on fertility-related social media. MATERIALS AND METHODS: The search function of Instagram (IG) and Twitter (TW) was used to identify the first fifty accounts with the following terms: fertility doctor, fertility, OBGYN, infertility, TTC, and IVF. Accounts not in English, private, no posts in >1 year, or content unrelated to search terms were excluded. Accounts were evaluated for author type and categorized as physician (PH), individual (ID), or fertility center/fertility-related organization (FCO). Account demographics including number of followers and prior baseline post activity (number of likes/number of followers) were recorded. The VAX was approved on 12/11/2020 and posts dated 12/1/2020 - 2/28/2021 were reviewed. Posts mentioningthe VAX were analyzed for content: sentiment (positive, negative, or neutral), mention of research studies (RS), national guidelines (NG), personal experience (PE), side effects (SE), reproductive related (RR) content and post activity. Statistical analysis included Chi-Squared and Fisher's exact tests, with significance set to <0.05 (∗). RESULTS: 536 accounts were identified and 276 were included (133 IG and 143 TW). There were 104 PH accounts (45 IG, 59 TW), 91 ID accounts (62 IG, 29 TW), and 81 FCO accounts (26 IG, 55 TW). PH accounts were most associated with mention of COVID (83.7%∗) and VAX (68.3%∗), followed by FCO (37% COVID∗, 30.9% VAX∗), and ID (8.8% COVID∗, 6.6% VAX∗). PH was most associated with >1 VAX posts compared to FCO or ID (51.0% v 11.1% v 1.0%∗). Sentiments toward the VAX were largely positive for all groups (PH 90.3%, ID 71.4%, FCO 70%), or neutral (PH 9.7%, ID 28.6%, FCO 30%), with no negative posts identified. Trends in mentions and sentiments were similar on both IG and TW platforms. PH cited NG (24.6%∗) and RS (17.5%) more than ID and FCO, with most cited guidelines from ACOG, ASRM, and SMFM. ID posts were mostly PE (87.5%∗) and SE (57.1%∗). RR posts were most associated with FCO accounts (80%∗) which included pregnancy, infertility, and breastfeeding. Sub-group analysis of IG accounts showed an increase in activity on VAX posts compared to baseline by likes (PH 4.86% v 3.76%, ID 7.5% v 6.37%, FCO 2.49% v 0.52%) as well as comments (PH 0.35% v 0.28%, ID 0.90% v 0.69%, FCO 0.10% v 0.02%). CONCLUSIONS: Overall, the majority of posts expressed positive sentiments toward the VAX with no negative posts identified. PH were most likely to post about COVID-19, the VAX and guidelines. Few ID accounts posted but when present were about personal experiences or side effects and remained positive. IMPACT STATEMENT: There is an active conversation regarding COVID-19 and VAX information on social media, with the majority of posts expressing positive sentiment. Physicians play a large role in circulating information regarding the VAX on social media platforms, and can be influential in discussions of VAX guidelines and dispelling fertility myth.
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OBJECTIVE: The rise of the SARS-CoV-2 pandemic and temporary closures of fertility centers made the effect on POC cycles uncertain but garnered national attention1,2. We sought to assess the impact of the pandemic on POC cycles in a pandemic epicenter. MATERIALS AND METHODS: This is a retrospective cohort study of all POC cycles at an academic fertility center in New York City from 1/1/2019- 12/31/2020. Primary outcomes were number of POC patients (pts) and cycles. Secondary outcomes were pt relationship status, payment method, AMH, and cycle parameters;with subgroup analyses by age groups. We also examined the relationship between monthly number of POC cycles and national SaRS-CoV-2 cases. Statistical analyses included z-score analysis, Mann-Whitney, and Chi-squared, with p<0.05 significant. RESULTS: Despite a 5.5 week center closure in 2020, POC pts increased 14% and POC cycles increased 16% from 2019 to 2020 (Table), with a 32% increase seen between June-Dec, 2020 . There was a 28% increase in POC pts <37yo in 2020 (252 pts vs. 323 pts, p<0.04) and no change in pts >37yo in 2020 (p=0.9). Relationship status did not differ between years (16% partnered, 76% single, 8% unknown in 2019 vs. 16% partnered, 73% single, 11% unknown in 2020;p=0.6). Fewer patients in 2020 had insurance coverage (16% vs. 24%, p<0.001). AMH was higher in 2020 (2.3 vs. 2.1, p<0.03), but days of stimulation, oocytes retrieved, oocytes frozen, total gonadotropins, and maximum estradiol (E2) were not different (Table). While national SARS-CoV-2 cases peaked in April, July, and November 2020, monthly POC cycles at our center did not decrease with surges in SARS-CoV-2 after our center reopened in May (p=0.24). In 2020 there were 23 cycles cancelled, none due a positive SARS-CoV-2 test. CONCLUSIONS: POC volume increased at our center in 2020, especially in young patients, despite center closures and SARS-CoV-2 surges. IMPACT STATEMENT: More young people pursued POC despite the SARS-CoV-2 pandemic. Further research is needed to understand POC pt motivations and experiences during a pandemic. (Table Presented).
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OBJECTIVE: COVID-19 has influenced family building, delayed fertility care, and affected people's decisions about where to live.We sought to understand differences in movement of cryopreserved reproductive tissue before and during the pandemic. MATERIALS AND METHODS: This was a retrospective cohort study of patients who transported tissue into or out of a single academic fertility center in New York City (NYC). Tissue transport was compared the year before (PRE, 4/1/2019-3/31/2020) and after (DUR, 4/1/2020-3/31/2021) the height of the COVID-19 pandemic in NYC, an epicenter. The primary outcome was the number of patients transporting tissue DUR compared to PRE. Secondary outcomes were the number of geographic changes, type of tissue, geographic origin/destination, and type of movement (in or out). Statistical analyses were performed using Kolmogorov-Smirnov, Wilcoxon Signed Rank Sum, Chi-Square, and Fisher's Exact tests with p<0.05 considered significant. RESULTS: A total of 367 tissue transports were included, with similar rates between cohorts (PRE 46.3% (170/367) vs DUR 53.7% (197/367), p=0.16). The median age at transport was the same (PRE 41 (range 29-54) vs DUR 41 (range 28-54) years, p=0.54). A similar amount of tissue was transported in (PRE 30.0% (51/170) vs DUR 35.0% (69/197)) and out (PRE 70.0% (119/170) vs DUR 65.0% (128/197), p=0.32). Patients were more likely to transport embryos pre-pandemic (37.6% (64/170) oocytes vs 61.8% (105/170) embryos, PRE) and oocytes during COVID-19 (51.8% (102/197) oocytes vs 44.2% (87/197) embryos, DUR) (p<0.01). A subgroup analysis excluding tissue moved for a gestational carrier or donor gametes found a similar number of transports were due to patient geographic relocation (PRE 50.0% (61/122) vs DUR 40.5% (60/148), p=0.12). Examination of geographic origin and destination of tissue PRE vs DUR produced no identifiable trends (p=0.38). Timing of tissue transport varied. The monthly transport rates were relatively even PRE (average 8% per month). However, during the pandemic, there were few transports in the beginning (April-May 2020, 0-1% per month) followed by a peak of transports in June-August 2020 (10-11% per month) and February-March 2021 (11-16% per month) (p<0.01). Transport activities were impacted by closure of clinics and courier service availability. CONCLUSIONS: The rate of cryopreserved tissue movement did not differ in the year before versus during the pandemic at our center, despite being in a COVID-19 epicenter, although transport activities were concentrated into fewer days. There was peak movement of tissue three months after the pandemic onset and roughly one year from the start of the pandemic. The type of tissue transported shifted to favor oocytes during the pandemic, warranting more investigation in how COVID-19 impacted family building activities. IMPACT STATEMENT: Despite the impact of COVID-19 on reproductive and place of living choices, the pandemic did not affect the amount of cryopreserved tissue that was relocated. However, insight into the increased movement of oocytes and potential impacts on warming outcomes or timelines is necessary.
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Objective: Previous work by our group (1) showed that the rate of chromosomal mosaicism decreases with maternal age. However, the types of chromosomes involved, as well as the types of chromosomal mosaicism in individual embryos, have not yet been examined. Our objective was to determine whether maternal age was associated with the rate of sex and autosomal chromosome mosaicism and the rates of various types of mosaicism. Design: Retrospective cohort study of all blastocysts that underwent trophectoderm biopsy for preimplantation genetic testing for aneuploidy (PGT-A) from 1/2015 to 12/2018 at our center. Materials and Methods: All patients with blastocysts that underwent trophectoderm biopsy for PGT-A via Next Generation Sequencing with ≥1 chromosome in the mosaic range (20-80%) were included. The primary outcomes were: 1) the rate of sex and autosomal chromosome mosaicism and 2) rates of segmental mosaicism, full chromosome mosaicism and complex (≥3 mosaic chromosomes) stratified by maternal age. Statistical analyses included Kruskal-Wallis (KW) and linear regression (LR) to control for paternal age, with p<0.05 considered significant. Results: 1,670 patients with 10,545 embryos biopsied overall and 3,611 embryos with ≥1 mosaic chromosome met inclusion criteria. The number of embryos biopsied decreased with maternal age (p<0.01) as expected. 3,366 (93.2%) embryos had only autosomal chromosome mosaics, which was independent of maternal age (p=0.05). Alternatively, the percent of embryos with ≥1 sex chromosome mosaic (6.8% n=245) was significantly associated with maternal age without clear trend by age group (p<0.01). Table 1 shows PGT-A results by type of mosaicism stratified by maternal age. Segmental mosaicism peaked at maternal age 35-37, while complex mosaicism increased with maternal age. Full chromosome mosaicism was similar across age groups. Conclusions: Among our embryo cohort, rates of segmental mosaicism varied and complex mosaicism increased with maternal age. These results remained significant when controlling for paternal age. The rate of sex chromosome mosaicism was associated with maternal age but may not be sufficiently powered given the low number of chromosomes. Our results provide further data for counseling patients about mosaic embryo results. [Formula presented] References: 1. An Analysis Of The Effect Of Maternal And Paternal Age On Chromosomal Mosaicism, Pacific Coast Reproductive Society Annual Conference – Cancelled by COVID-19
ABSTRACT
Objective: The diagnosis and management of CE is debated1-4. Since many patients undergoing assisted reproductive technology (ART) are only tested after treatment failure, definitive management remains imprecise. The objectives of this study were to 1) determine the prevalence of CE in infertility patients and 2) the impact of CE on euploid embryo implantation. Design: Prospective, blinded, non-selection study of patients undergoing IVF/PGT-A. Materials and Methods: All IVF/PGT-A patients cycling between 6/2019 - 3/2020 were eligible. Exclusion criteria were: 1) age 42+, 2) embryo banking/not planning ET, 3) planning untested/fresh/mosaic ET. Consented subjects underwent a standardized endometrial biopsy (EMB) at retrieval. EMB results by a single laboratory were blinded until after single euploid ET resulted in 1) +heartbeat, 2) confirmed SAB or 3) negative hCG. Primary outcome was 1) presence/absence of CE, defined as 1+ plasma cell by CD138/section and 2) ongoing pregnancy rate. Secondary outcomes included number of plasma cells/section and stratified pregnancy outcomes. Power analysis for a prevalence of 20%5 with a 95% confidence = 246 subjects. Statistical analyses included Student’s t-test, Fischer’s Exact, logistic regression with p<0.05 considered significant. Results: 104 subjects consented and underwent EMB. Seven withdrew after EMB with 97 eligible for FET. In all biopsied patients, the mean age was 36.1±3.2 years (range 28-41), 66.4% identified as Caucasian, and the most frequent infertility diagnosis was primary/unexplained infertility (42.3%). On 3/17/20, in compliance with ASRM’s COVID recommendations, all IVF/FET cycles and recruitment stopped, at which time 54/97 had undergone FET/unblinding. There were no differences in age (p=0.83), distribution of race/ethnicity (p=0.57) or infertility diagnoses (p=0.77) between transferred and untransferred patients. Due to COVID cycle stop, unblinded biopsies were reviewed for result only (not unblinded), showing 25/104 biopsies (24.0%) positive for CE with plasma cells ranging 1-34. Demographics of transferred patients showed 46 (85.2%) had a programmed ET, 50 (92.6%) with a grade 3-5Bb or higher, and a median time to ET of 56 days. Overall, 39 (72.2%) had an ongoing pregnancy. 20.4% (11/54) had CE with plasma cells ranging 1-14. Subjects with CE had an ongoing pregnancy rate of 63.6% (7/11) that was not significantly different than 74.4% (32/43) in those subjects that were CE negative (p=0.48). Logistic regression showed no difference in ongoing pregnancy when stratified by cycle type, time to ET, lining thickness, embryo day or grade, and plasma cell count. To date, the SAB rate after implantation was similar (2/7 CE positive vs. 1/32 in CE negative, p=0.07). Notably, plasma cell count had an AOR 0.822 (0.668-1.01) and the only 2 SABs seen in patients with CE had plasma cell counts >10. Conclusions: We found a baseline prevalence of roughly 24.0% in ART patients that, to date, did not affect the ongoing pregnancy rate. Further analysis with a larger cohort to examine 1) the SAB rate, 2) alternative definitions of CE, and 3) the impact of COVID are necessary. References: 1. Cicinelli, E., Matteo, M., Tinelli, R., Lepara, A., Alfonso, R., Indraccolo, U., Marrocchella, S., Greco, P. & Resta, L. (2015). Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy. Human Reproduction. 30(2): 323-330. 2. Liu Y, Chen X, Huang J, Wang C, Yu M, Laird S, Li T. Comparison of the prevalence of chronic endometrisias determined by means of different diagnostic methods in women with and without reproductive failure. Fertility and Sterility. 2018;109(5): 832-8329. 3. Bouet P, El Hachem H, Monceau E, Gariepy G, Kadoch I, Sylvestre C. Chronic endometritis in recurrent pregnancy loss and recurrent implantation failure: prevalence and role of hysteroscopy and immunohistochemistry in diagnosis. Fertility and Sterility. 2016;105(1): 106-110. 4. Vitagliano A, Saccardi C, Noventa M, Di Spiezo Sardo A, S ccone G, Ciccinelli E, Pizzi S, Andrisani A, Litta PS. Effects of chronic endometritis therapy on in vitro fertilization outcome in women with repeated implantation failure: a systematic review and meta-analysis. Fertility and Sterility. 2018;110(1): 103-112e1. 5. Masbou AK, Keefe DL, Fino ME, Hodes-Wertz B, Blakemore JK, Grifo JA. Why do euploid embryos fail to implant? The role of CD138 and chronic endometritis. Current Opinion in Gynecology and Obstetrics. 2019;2(1): 372-378.Â