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Background: Increasing availability of highly effective cystic fibrosis (CF) transmembrane conductance regulator (CFTR) modulator therapy (HEMT) has improved the quality of life and long-term prognosis for many people with CF. Thus, more people with CF are considering parenthood. Almost all menwith CF (MwCF) are infertile because of congenital bilateral absence of the vas deferens (CBAVD). Based on CF animal models, CBAVD occurs early in gestation and is unlikely to be reversible using HEMT, but assisted reproductive techniques (ARTs) can enable MwCF to father children using the sperm in their testes. Animal reproductive models suggest no HEMT teratogenicity, and the amount of exposure of the fetus to HEMT via absorption of seminal fluid through the vaginal wall is predicted to be negligible, although to ensure no sperm exposure to HEMT, the life span of sperm would require MwCF to discontinue CFTR modulators for approximately 3 months before ART. Because abrupt discontinuation of CFTR modulators may result in health decline, MwCF and their providers must consider all potential risks. There are no published data in MwCF regarding use of HEMT during conception and partner pregnancy. Method(s): Beginning in August 2021, CF center staff in the United States, United Kingdom, and Australia completed a two-page anonymous questionnaire regarding MwCF who used CFTR modulators during ART (sperm retrieval and in vitro fertilization) or natural conception with subsequent partner pregnancy. Result(s): Providers have submitted 34 surveys for MwCF on CFTR modulators whose partner became pregnant after use of ART (n = 32) or natural conception (n = 2). The median age of the samplewas 32 (range 24- 43). Fifteen were homozygous for F508del, median percentage predicted forced expiratory volume in 1 second was 76% (range (22-111%), and median body mass index was 24 kg/m2 (range 18.5-32.1). Twenty-three were taking elexacaftor/tezacaftor/ivacaftor. The median time that MwCF were taking CFTR modulators before partner conception was 18 months (range 0-82). One newly diagnosed man initiated HEMT after sperm retrieval. Four MwCF stopped CFTR modulators before sperm retrieval, one of whom experienced pulmonary decline. None of the 19 MwCF whose condom use during pregnancy was known used condoms. Fetal complications in partners of MwCF included three first-trimester miscarriages, two* COVID, two breech presentation, two* vaginal bleeding, and one vasa previa. None of the complications were deemed definitively related to use of CFTR modulators. One MwCF experienced testicular infection after sperm retrieval#. Postpartum complications included three# infants with hypoxemia requiring neonatal intensive care unit stay, three maternal blood loss, one forceps delivery, and one caesarean section. No congenital anomalies were reported for any infant. (*/# overlap). Conclusion(s): Use of CFTR modulator therapy during partner conception and pregnancy in 34 MwCF has not resulted in higher-than-expected miscarriage rates or congenital anomalies. Providers should consider the risk to the health of MwCF combined with the lack of teratogenicity in animal reproductive models and limited safety data in the human fetus before discontinuing CFTR modulators before ART or natural partner conception. Survey collection is ongoing;results will be updated for presentationCopyright © 2022, European Cystic Fibrosis Society. All rights reserved
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The article presents an overview of the most significant publications on the topic of male infertility. The main selection criteria were the practical significance of the article, as well as the impact factor of the journal in which it was published, according to the SCImago Journal Rank (SJR). As a result, a list of 10 papers published in the first quarter (January - March) of 2022 was compiled. The review includes articles on the following issues: the role of coronavirus infection in male infertility, the effectiveness of aromatase inhibitors in infertile men, the effect of assisted reproductive technologies on the reproductive health of descendants, recurrent miscarriage, the effect of antibiotic therapy on the DNA fragmentation index, the role of antisperm antibodies in male infertility, the incidence of idiopathic male infertility, the Sixth Edition WHO guidelines for the ejaculate processing, as well as the relationship of depression with male infertility.Copyright © 2022 Izdatel'stvo Meditsina. All rights reserved.
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Aplasia cutis congenita (ACC) is often sporadic, but familial cases have been reported. We report a case of a dichorionic diamniotic twin pregnancy in which both the male and female twins had matching areas of aplasia cutis on their scalps. An Irish couple sought fertility treatment using a donor egg and paternal sperm. Successful in vitro fertilization (IVF) and the transfer of two embryos resulted in a diamniotic dichorionic twin pregnancy. Two fetal poles were noted at the 12-week ultrasound (US) scans. The mother suffered from a minor urinary tract infection during the first trimester but had no other history of infection, including herpes simplex virus or COVID- 19. She was known to be varicella immune prior to pregnancy. The twins were born by elective caesarean section owing to breech presentation. Twin one was female and twin two was male. Both infants were born with scarring on the crown of their head, which was consistent with ACC. Cranial US showed no underlying bony abnormality. The rest of the cutaneous examination was normal and there were no other congenital anomalies. ACC is a rare, heterogeneous group of disorders characterized by the congenital absence of skin, which can be focal or widespread. It is thought to affect 1-3 per 10 000 live births. The exact cause of ACC is unclear. Various hypotheses have been suggested, including defective closure of the neural tube or embryonic fusion lines, intrauterine trauma, placental insufficiency, fetus papyraceus, amniotic membrane adhesions, intrauterine infections, teratogens and genetic mutations. The classification of ACC is based on the area affected, type of skin irregularity, associated congenital defects and mode of inheritance. Scalp ACC without multiple anomalies (category 1) is generally associated with an autosomal dominant or sporadic pattern of inheritance. These twins may have an autosomal dominant mutation that led to this phenotype. ACC can also be associated with fetus papyraceus or placental infarct. This is less likely in this case as only two embryos were transferred, and the pregnancy was dichorionic. Most cases of ACC associated with fetus papyraceus occur in monozygotic pregnancies. ACC lesions often heal spontaneously by re-epithelialization resulting in a hairless superficial scar. Twin one had a slightly smaller area affected by ACC and overlying eschar resolved several weeks after birth. Twin two has had no hair growth in the area. This case highlights the difficulties in ascertaining the aetiology of this rare condition in twin pregnancies.
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Background: The coronavirus disease 2019 (COVID-19) pandemic was a unique global challenge with a wide range of severity extending from an asymptomatic form to a serious intense respiratory syndrome. This study aimed to detect SARS-CoV-2 in the follicular and endocervical fluid of in vitro fertilization (IVF) candidate patients with a positive polymerase chain reaction (PCR) test for SARS-CoV-2. Method(s): All participants and their partners, who were a candidate to start assisted reproductive technology (ART) from April 2020 to October 2020, completed a triage questionnaire two weeks before starting the ART cycle. According to Avicenna center protocol, a diagnostic test for COVID-19 using real-time PCR of nasopharyngeal swabs was performed on all ART candidates, 48 hours before the day of the oocyte trigger. In the operating room, sterile swabs were used to provide cervicovaginal specimens to determine SARS-CoV-2 in cervicovaginal fluid. Moreover, the first aspirated follicular fluid was referred to the lab to assess the presence of SARS-CoV-2. Result(s): A positive PCR test for SARS-CoV-2 was verified in 32 participants. In this study, virus particles were not detected in the follicular and endocervical fluid of the women with positive PCR tests. Conclusion(s): We are still at the beginning of the road and need reliable data on the safety of ART at the time of the pandemic. The risk of infection during all processes of ART including oocyte retrieval needs attention. The fluid from mature follicles is a potential site to be infected and the human cumulus cells could not be a deterrent factor to the entrance of the virus in the oocyte. This process may lead to gametes infection. We did not detect virus RNA in the follicular and endocervical fluid of the patients with a positive PCR test. Although, more studies with a larger sample size are mandatory in this field.
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The proceedings contain 429 papers. The topics discussed include: a short peptide encoded by long non-coding RNA small nucleolar RNA host gene 6 promotes cell migration and epithelial-mesenchymal transition by activating transforming growth factor-beta/SMAD signaling pathway in human endometrial cells;a short peptide encoded by long non-coding rna small nucleolar rna host gene 6 promotes cell migration and epithelial-mesenchymal transition by activating transforming growth factor-beta/smad signaling pathway in human endometrial cells;compatible cut-off values for luteinizing hormone and the luteinizing hormone/follicle-stimulating hormone ratio in diagnostic criteria of the Japan society of obstetrics and gynecology for polycystic ovary syndrome;intracytoplasmic sperm injection cycle success in patients under 35 years old with diminished ovarian reserve plus severe male factor;assisted reproductive technology and neonatal intensive care unit: a retrospective observational study from a single center;the value of clinical symptoms, the neutrophil-to-lymphocyte ratio, and ultrasonographic features in predicting adnexal torsion: a case-control study;construction of a diagnostic classifier for cervical intraepithelial neoplasia and cervical cancer based on xgboost feature selection and random forest model;and impact of the COVID-19 pandemic on surgery for benign diseases in gynecology: a nationwide survey by the japan society of obstetrics and gynecology.
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The proceedings contain 158 papers. The topics discussed include: the success of various endometrioma treatments in infertility: a systematic review and meta-analysis;cell therapy accompanied by natural biomaterials, a novel therapeutic strategy for primary ovarian insufficiency treatment;ovarian hyperstimulation syndrome: a new look at an old problem;role of doppler ultrasonography and 3D ultrasound in female infertility;clinical outcome of artificial oocyte activation following intracytoplasmic sperm injection;the research priorities in infertility;how old is too old for infertility treatment?;the role of sexual dysfunction in men's health;recombinant follicle-stimulating hormone in treatment of sperm DNA fragmentation;the effect of zinc on tetrahydrocannabinol-induced Sertoli cells apoptosis;and detection of SARS-CoV-2 in follicular and endocervical fluid of in vitro fertilization candidates with positive polymerase chain reaction tests.
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Background: The coronavirus disease-2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is now spread all over the world. This study was designed to assess the possibility of SARS-CoV-2 presence in follicular fluid, which may have harmful effects on normal ovulation and fertility. Method(s): Five women who were candidates for Assisted Reproductive Technique (ART) and had a COVID-19 PCRpositive test on the day of oocyte retrieval participated in the study. SARS-CoV-2 tests were performed on the follicular fluid obtained from these women. Result(s): SARS-CoV-2 RNA was detected only in one follicular fluid sample, and other follicular fluid samples were negative. Conclusion(s): Because the COVID-19 effect on human reproduction is unknown, exact precautions should be taken during this pandemic, especially for women applying for ART.
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Background: It is well knowledge that various viral illnesses may interfere with a man's ability to father children. Through the angiotensin-converting enzyme-2 receptor, which is highly concentrated in testicular tissue, the corona virus illness known as COVID-19 may cause harm to several organs. On the other hand, there is a paucity of data about the transmission of severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) in sperm, as well as the virus's influence on spermatogenesis and the capacity for fertility. We intended to look into whether or not COVID-19 guys' sperm contained SARS-CoV-2 as well as examine how COVID-19 affected the overall quality of the sperm and the degree to which it's DNA was fragmented. Material(s) and Method(s): The survey was conducted between May 2022 to October 2022, with the participation of 40 male COVID-19 patients who were between the ages of 19 and 45 and enrolled at the RSDKS, Government Medical College, Ambikapur, Chhattisgarh. We tested each sample of sperm with a real-time reverse transcriptase and found no abnormalities. At the time of the initial sample, which took place during COVID-19, a comprehensive examination of the sperm was carried out. This analysis included the calculation of the sperm DNA Fragmentation Index. After 74 days had passed since the first sample, we were able to get the second specimen and carried out the aforementioned tests once again. Result(s): All of the sperm samples that were examined using real-time reverse transcription-polymerase chain reaction (RT-PCR) came back negative for SARS-CoV-2. These samples were taken during the first and second sampling. The initial sample had considerably lower levels of fructose, semen volume, vitality, total motility, sperm concentration, total sperm count, percentage of normal morphology, and cytoplasmic droplet percentage than the subsequent samples. On the other hand, the agglutination of the semen, the percentage of head defects, the DNA Fragmentation Index, the liquefaction time, the viscosity of the semen, and the number of leukocytes all rose. At the second sample, these results were inverted, but not to the level that would be considered optimal. These results all had a p-value less than 0.05, meaning they were statistically significant. As a result, COVID-19 has a detrimental impact on the characteristics of the sperm, including the sperm DNA fragmentation index. Conclusion(s): The quality of the semen remained low up until the second time it was sampled, despite the fact that we were unable to discover SARS-CoV-2 in the sample. It is recommended that assisted reproductive technology (ART) clinics and sperm banking facilities evaluate the quality of the sperm produced by males infected with COVID-19 and exclude men who have a history of being infected with SARS-CoV-2 until the men's sperm quality recovers to normal. Copyright © 2023 Ubiquity Press. All rights reserved.
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Study question: Do the Merck family of fertility pen injectors (follitropinalfa, follitropin-alfa/lutropin-alfa, choriogonadotropin-alfa) meet the International Organization for Standardization (ISO 11608-1:2000/2012/ 2014) product-validation requirements? Summary answer: Each presentation of the family of fertility pen injectors performed as per the state-of-the-art product-validation specifications for dose accuracy in ISO 11608-1:2000/2012/2014 under atmospheric conditions. What is known already: Pen injectors for medically assisted reproduction must comply with ISO 11608-1:2000/2012/2014, which specifies essential performance requirements, including dose accuracy, and represent a benchmark for product reliability. Product-validation studies of the follitropin-alfa pen injector showed that three presentations (300 IU, 450 IU, and 900 IU) reliably dispensed accurate doses under a range of conditions, but no information was available for the follitropin-alfa/lutropin-alfa and choriogonadotropinalfa pen injectors. This study was done to confirm that the incremental dose/ clicks system was accurate for equivalence of volume (dose) delivered at standard atmospheric conditions for the complete Merck family of fertility pen injectors (follitropin-alfa, follitropin-alfa/lutropin-alfa, choriogonadotropin-alfa). Study design, size, duration: Laboratory-based dose accuracy measurement testing was carried out under standard atmospheric conditions, as specified in ISO 11608-1:2000/2012/2014, between 2015 and 2020. Participants/materials, setting, methods: Set doses (Vset) for three dose dial settings (minimum dose [Vmin], midpoint dose [Vmid] and maximum dose [Vmax] [follitropin-alfa, choriogonadotropin-alfa, and follitropinalfa/ lutropin-alfa]) or a single Vset (choriogonadotropin-alfa) were assessed, as appropriate. The last dose administered by the multi-dose device and cartridge and total extractable dose were assessed on the 900 IU and 300 IU follitropin- alfa and the 900 IU/450IU and 300/150 IU follitropin-alfa/lutropinalfa- pen presentations. Sixty measurements per assessment were made for each Vset. Main results and the role of chance: Measurements were performed at two manufacturing sites. Dose accuracy tests for Vmin, Vmid and Vmax (dose dial settings of 12.5 IU, 87.5 IU and 150 IU, respectively, for the 150 IU pen [n=2,226 (one site)];dose dial settings of 12.5 IU, 162.5 IU and 300 IU, respectively, for the 300 IU pen [n=742 per site];and dose dial settings of 12.5 IU, 237.5 IU and 450 IU, respectively, for the 450 IU [n=180 per site] and 900 IU pens [n=410 per site]) for the follitropin-alfa and the follitropinalfa/ lutropin-alfa pen injectors were within the acceptable limits defined in ISO 11608-1:2000/2012/2014. The results of further assessments of last dose and total extracted volume for each presentation of these devices were also within acceptable limits. Dose accuracy tests for the single use/single dose device classification (D1) of the choriogonadotropin-alfa pen injector (n=210 [one site]) showed that the Vset (6,500 IU) was within the acceptable limits according to ISO 11608-1:2000/2012/2014. Furthermore, dose accuracy tests for the single use/variable dose device classification (D2) of the choriogonadotropin-alfa pen injector (n=180 [one site]) showed that the Vmin (260 IU), Vmid (3,380 IU) and Vmax (6,500 IU) values were also the within acceptable limits. Limitations, reasons for caution: These assessments were carried out by laboratory scientists, who are not the intended users of the pen injectors, and were not delivered into human tissue;therefore, although these conditions meet the international standards, they do not reflect the real-world use of the pen injectors by patients. Wider implications of the findings: The Merck family of fertility pen injectors functions reliably and the incremental dose/clicks system dispenses accurate doses, providing users with confidence that they can accurately administer the prescribed dose and minimize drug wastage outside of a clinic environment, which is ore important than ever in light of the COVID pandemic.
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Introduction: Coronavirus disease 2019 (Covid-19) brought forth an unprecedented suspension of fertility treatment worldwide as a result of reallocation of hospital staffs and resources. We aim to establish patient's perspective on how Covid-19 pandemic had affected their fertility treatment and to ascertain their psychological status. Methods: This is a cross-sectional study performed in a single academic center in Malaysia between July to December 2021. Patient and partner with any causes of infertility and who are planned for fertility treatment were approached and asked to answer an anonymous electronic survey. Results: 165 patients were recruited to answer the survey. 66% of patients did not agree with the Ministry of Health Malaysia's recommendation to postpone fertility treatment. 97.6%, if given a choice, would want to continue with treatment. 75.8% of patients' main concern about delaying treatment would be advancing age and 11.5% cite concerns about reducing ovarian reserve if their treatment was disrupted. Patient's psychological status assessment showed findings of mild, moderate, severe and extremely severe level of psychological disorders in our patients. From multivariate logistic regression, mild level of stress was significant amongst 20-30 years old with p=0.000 (OR 1.3E
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Purpose or Objective The high burden of COVID-19 in hospitals puts increased pressure on oncological care worldwide, forces prioritization of healthcare resources and causes delays in cancer treatment pathways. Prior research underlined the importance of timely oncological care, as longer waiting times from diagnosis to treatment could result in poorer outcomes for some common malignancies. The aim of this study was to determine the impact of waiting time from diagnosis to treatment on overall survival in patients with cervical cancer treated with surgery or radiotherapy with curative intent. Materials and Methods Patients from a nationwide population-based cohort with newly diagnosed cervical cancer between 2010 and 2019 were studied. Patients who underwent surgery or radiotherapy with curative intent were selected. Waiting time was defined as the time interval between first pathologic confirmation of carcinoma and the day of first treatment. Waiting time was modeled as continuous (i.e. linear per week), dichotomized (i.e. ≤8 versus >8 weeks), and polynomial (i.e. restricted cubic splines). The association between waiting time and overall survival was examined using Cox proportional hazard analyses. Results Among 6,895 patients with newly diagnosed cervical cancer, 2,831 patients treated with primary surgery and 1,898 patients who received primary radiotherapy were included. Waiting time to surgery was 8.5 (±4.2) weeks on average and >8 weeks in 1,287 patients (45%). Waiting to radiotherapy was 7.7 (±2.9) weeks on average and >8 weeks in 681 patients (36%). In the surgery group, a longer waiting time was associated with younger age, fertility treatment, adenocarcinoma histology, poor differentiation grade, LVSI, higher T- and N-stage, and previous conization or portio amputation. Adjusted for confounders, waiting time to surgery was not significantly associated with overall survival (continuous HR 0.99 [95%CI: 0.95- 1.02], dichotomized HR 0.93 [0.69-1.26], polynomial HR in Figure 1). In the radiotherapy group, a longer waiting time was associated with higher BMI, higher number of co-morbidities, and lower T-stage. Chemotherapy was administered concurrently with radiotherapy in 1,276 patients (67.2%) and was not associated with a longer waiting time. Adjusted for confounders, a longer waiting time to radiotherapy was not significantly associated with poorer overall survival (continuous HR 0.97 [95%CI: 0.93-1.00], dichotomized HR 0.91 [0.76-1.09], polynomial HR in Figure 2). Conclusion This large population-based cohort study demonstrates that a longer waiting time from diagnosis to treatment (of up to 12 weeks) in patients with cervical cancer treated with curatively intended surgery or radiotherapy does not negatively impact overall survival. These results could help inform and reassure patients regarding their waiting time, for example when time is needed for fertility preservation.
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Background: A 33-year-old G0 presented at 8 weeks' gestation with sudden onset severe left sided pelvic pain. She had undergone three rounds of fertility treatment on a background polycystic ovarian syndrome. She was estimated to be 8 weeks gestation with an ultrasound confirmed intra-uterine-pregnancy (IUP). Our patient also returned a positive COVID result on arrival, but remained largely asymptomatic. Methods: Our patient reported 8/10 pain radiating from the left iliac fossa to the left lower back despite 25mg of Morphine. Examination revealed significant tenderness over the left lower abdomen with marked involuntary guarding. Ultrasound demonstrated viable IUP corresponding to 8 weeks 4 days, an enlarged left ovary measuring 330 ml containing large follicles with no flow detected in the ovarian parenchyma, in keeping with ovarian torsion. Given these findings and ongoing requirement for significant doses of opioid analgesics, a decision was made for Laparoscopic ovarian de-torsion +/-cyst decompression, having explained the risks posed to the IUP with possible disruption of the corpus luteum. Results: The left ovary had torted twice around its pedicle with a necrotic appearing fallopian tube and dusky appearing ovary. Laparoscopic de-torsion of the ovary and decompression of 3x ovarian cysts was performed without instrumentation of the gravid uterus. Conclusions: Consideration must be given to not only the clinical, but also the social and emotional factors at play when providing care in a clinical emergency with a good understanding of the risks posed to an IVF pregnancy and the challenges with providing timely care during the COVID-19 pandemic.
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OBJECTIVE: To determine the effect of COVID-19 exposure or diagnosis on fertility-related stress and early pregnancy outcomes We hypothesize that COVID-19 exposure or diagnosis would negatively impact fertility-related stress and subsequently fertility and early pregnancy outcomes. MATERIALS AND METHODS: In a single academic center, patients undergoing fertility treatments via IVF or FET between the ages of 18 to 45 were eligible to participate in this study. Patients were recruited at the beginning of their treatment cycle and completed the validated FertiQOL questionnaire as well as an online survey assessing COVID-19 exposure. Primary outcomes include pandemic-related stress levels such as grief, mood, anger, and pain. Cohorts studied included: non-COVID (no concern for COVID-19 infection, including no formal diagnosis or perceived illness) and COVID (perceived/symptomatic or confirmed diagnosis) patients. FertiQOL questionnaire results were analyzed between the two cohort groups. RESULTS: A total of 115 subjects were recruited. The non-COVID cohort consisted of 64 participants and the COVID cohort consisted of 51 participants. There was a significant decrease in satisfaction with the level of support from friends/family (p=0.04), in COVID patients compared to non- COVID patients. COVID patients were more likely for their infertility to negatively impact their mood (p= 0.0005). Though not statistically significant, COVID cohort patients trended towards poorer self-perceived health and decreased satisfaction with available fertility services. There were no significant differences in overall quality of life, anger, depression, pain, or perceived complications with use of medications and treatments. There was also not a significant difference in number of eggs retrieved, percent of mature eggs, or clinical/ongoing pregnancy rates. CONCLUSIONS: The COVID-19 pandemic has had a negative impact on infertility patient populations. Specifically, COVID patients with infertility experienced significantly decreased mood and less support from family and friends compared to non-COVID patients. While there is no difference in overall quality of life, or fertility and early pregnancy outcomes, understanding the nuances of patients' experiences in the pandemic will allow for more insight into the way in which care is provided. Additionally, COVID-19 diagnosis and exposure does not appear to affect fertility treatment or early pregnancy outcomes. Therefore patients may be counseled that previous COVID-19 infection or concerns regarding possible exposure do not affect their fertility and early pregnancy outcomes. IMPACT STATEMENT: This study shows the negative impact of perceived and confirmed COVID-19 exposure on stress levels related to infertility. These findings can guide how IVF patients are counseled and reassured during the pandemic.
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OBJECTIVE: In following national and state guidelines, most fertility practices in Connecticut closed for varying periods of time due to COVID-19. To patients, the reopening guidelines may have been seen as barriers to care such as delaying treatment, mandatory quarantine, and required COVID-19 testing. These changes in care were the motivating factors to uncover insight on patient perspectives towards guidelines, telehealth, and emotional obstacles during this time. The goal was to learn if Reproductive Medicine Associates (RMA) of CT, a private fertility practice in CT, met the needs of patients throughout COVID-19, such as effectively communicating information. We hypothesized that RMA of CT effectively conveyed relevant information and offered appropriate support to their patients in a satisfactory way during COVID-19. MATERIALS AND METHODS: An anonymous 33-question survey was created on SurveyMonkey. Demandforce was used to send surveys to 1,250 email addresses of patients who were active at RMA of CT from March 2020- October 2020. Chi square tests for statistical significance were used to evaluate the data. RESULTS: 369 respondents completed the survey. 56% of respondents were 35-44 and 88% chose female as their gender identity. 92% agreed or strongly agreed (A/SA) they felt safe from COVID-19 at RMA of CT. 56% of respondents A/SA felt more stressed about fertility treatment/testing during the pandemic than pre-pandemic. 90% A/SA that team members were helpful in handling patient frustrations related to COVID-19. 77% of respondents A/SA email was the most helpful form of communication to relay COVID-19 information. 73% of respondents stated they did not utilize support services from RMA of CT after changes were made due to COVID-19. 18% said they were unaware of these services. 90% of respondents A/SA telehealth met their needs. 95% A/SA that their physician was focused during these appointments. CONCLUSIONS: Evidence suggests that personalized emails were most effective in relaying time sensitive information. It was surprising that patients were unaware of support services offered, especially during an international crisis, as these services may have supported them in these times. It was encouraging that patients reported that RMA of CT team members were helpful, despite having to adjust to changes in protocols. Interestingly, only a little over half of patients reported feeling more stressed about fertility treatment/ testing during COVID-19 than pre-pandemic. Patients felt safe despite the generalized feeling of unsafety due to COVID-19. Patients reported that the shift to telehealth appointments was successful. This opens possibilities of continuing telehealth appointments to make care more accessible. IMPACT STATEMENT: During this complicated time, it was possible for a private fertility practice to adapt program protocols (such as successful telehealth appointments and effective communication dissemination) allowing patients to start or continue their family building, and for fertility team members to be sympathetic, accessible, and professional while following COVID-19 guidelines.
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OBJECTIVE: To assess rates of COVID-19 positivity in a fertility treatment population who continued to seek care throughout the pandemic. MATERIALS AND METHODS: A retrospective chart review of all patients actively pursuing fertility treatment and had a positive COVID-19 test between March 2020 and February 2021 at a University-affiliated IVF center was performed. Testing was performed on medication start date, and regularly throughout the treatment cycles, approximately once a week. Social distancing, mask use, and temperature and symptomatic screening was implemented early in the process. Rates of infection were calculated by dividing COVID-19 positive patients (whether symptomatic or asymptomatic) by total number of patients in care. This was then multiplied by 100,000, in order to compare our rates to the rate of cases in the state. Information on the general population's COVID-19 positivity rate was obtained from the State Department of Health. RESULTS: Rates of infection in our treatment population varied from 55 in August of 2020 to a high of 2333 per 100,000 in April of 2020. Rates of infection in the general population ranged from 167 per 100,000 to a high of 1367 in Nov of 2020. Our rates of infection did see a trend that was consistent with the curve of infections seen in the general population in the state (Table 1). CONCLUSIONS: Rates of infection were consistently at or below the state's rate per month for much of the 12-month period of study. The exceptions to this included April 2020, where we suspect that patients undergoing treatment were more likely than the general population to receive testing due to the center's testing policies compared to the lack of tests for the general population. Indeed, throughout the studied period, the patients receiving fertility treatment were much more likely than the general population to receive a test, as they were undergoing testing while asymptomatic. Additionally, the rate in February of 2021 was higher than that of the general population. IMPACT STATEMENT: The Covid-19 pandemic was unprecedented in the history of gynecologic endocrinology and infertility, and impacted the ability of patients to access fertility care worldwide. Our findings reveal that with proper mitigation techniques, infertility treatment can be safely delivered even in the face of a pandemic without radically increasing the risk of infection. (Table Presented).
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OBJECTIVE: The COVID-19 pandemic exacerbated existing and initiated new psychosocial, interpersonal, and environmental stressors. For menstruating people, these stressors may contribute to cycle irregularity and make family building an even more challenging journey. This study investigates the relationship between perceived stress and menstrual cycle and symptom changes during the COVID-19 pandemic. MATERIALS AND METHODS: A survey was administered to users of Ovia Health's Fertility mobile application in the United States from March 2020 to April 2021. Items captured changes in menstruation pattern and symptomology and included the Perceived Stress Scale 4-item version (PSS-4).1 A paired t-test was used to assess differences between groups. A p-value of < 0.05 was considered statistically significant. RESULTS: Out of a total of 12,302 respondents, 36% reported experiencing some menstrual cycle and/or symptom changes. Most commonly reported changes included cycle starting early or late (87%), stronger symptoms during menstruation (e.g. low back pain, cramping, discharge changes) (29%), and heavier bleeding during periods (27%). Respondents reporting menstrual cycle or symptom changes tended to score slightly higher on average on the PSS-4 compared to those who did not report any changes (8.5 v. 8.3, respectively, p < 0.05). PSS-4 scores in this sample were notably higher in all respondents, regardless of cycle/symptom irregularity, compared to pre-pandemic benchmarking in similar populations.2-3 CONCLUSIONS: These results demonstrate that this sample's reported stress levels during the pandemic were noticeably higher than pre-pandemic benchmarks, and that these stress levels may contribute to changes in reproductive physiological processes such as menstruation. These changes may be especially frustrating and impactful for individuals trying to conceive and those struggling with infertility. IMPACT STATEMENT: Reproductive medicine specialists should be aware of the relationship between stress fostered by the COVID-19 pandemic and menstrual pattern disruption, especially for patients trying to conceive with irregular menstrual patterns or those struggling with infertility. Providers should work together with their patients to formulate strategies to mitigate the impact of stress on menstrual cycle changes in order to optimize conception and fertility treatment outcomes.
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OBJECTIVE: The strain on the healthcare system and attempts to limit virus transmission during the COVID-19 pandemic reduced patients' access to healthcare services, particularly those seeking specialized or elective health services such as infertility treatment. Mandatory fertility clinic closures prolonged conception efforts and further complicated the already arduous family building journey. This study investigates the incidence of assisted reproductive technology (ART) delay or abandonment during the COVID-19 pandemic and assesses whether these rates varied by U.S. geographic region. MATERIALS AND METHODS: A survey was administered to users of Ovia Health's Fertility mobile application in the United States from March 2020 to April 2021. A Chi-squared test was performed to assess differences in ART delay or cancellation and geographical region. A p-value of < 0.05 was considered statistically significant. RESULTS: A total of 20,047 respondents qualified for inclusion in this analysis. Of the 16,527 respondents currently or formerly trying to conceive within the last six months, 16% reported utilizing intrauterine insemination (IUI), in vitro fertilization (IVF), or another form of ART. Though the majority of treatments proceeded as planned, almost one in five (17%) were delayed or cancelled between March 2020 and April 2021. Main contributors to the decision to delay or cancel ART efforts were temporary fertility clinic closures (28%), concern about the impact of COVID-19 on pregnant people or fetuses (28%), attempting to avoid healthcare facilities (22%), lack of availability of support people during pregnancy and labor (17%), and concerns about finances or job security (16%). ART delay or cancellation did not differ by geographic region (p > 0.05). CONCLUSIONS: Our results demonstrate how the closure of fertility clinics during the COVID-19 pandemic and concern about COVID-19's detrimental impact during pregnancy pushed people seeking these services to delay indefinitely or altogether abandon their family building efforts. These trends were similar across the United States, regardless of geographical region. As ART treatments and care plans resume, reproductive medicine specialists should reinforce safety mitigation strategies to reduce the risk of COVID-19 transmission, foster COVID-19 vaccination discussions, and empower and restore patients' confidence with the latest COVID-19 research findings. IMPACT STATEMENT: Clinical service models resuming ART services should center around addressing patients' main concerns for delaying or abandoning ART efforts, especially focused on empowering patients whose family building journeys were interrupted by fertility center closures during the COVID-19 pandemic.
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OBJECTIVE: To assess if COVID-19 infection differentially impacts first trimester outcomes in patients seeking infertility care at one large fertility practice. MATERIALS AND METHODS: A retrospective chart review of all female patients actively pursuing fertility care in a single fertility center with positive COVID-19 test results from March 2020 to February of 2021 was performed. Positive COVID-19 test results included PCR tests performed in our clinic and symptomatic patients who informed us of their outside positive test results by phone during their treatment with our clinic. This was compared to a control group of all comers in our clinic in 2020. Information was gathered on infertility treatment type, and pregnancy outcomes. Chemical pregnancy rate (CPR) is documented as a positive pregnancy test and ongoing pregnancy was documented as a positive fetal heart beat between 7-8 weeks of gestation and discharge to routine OBGYN care. Fishers exact test was used to calculate p value, statistically significant associations were considered to exist when the p value ≤0.05. RESULTS: A total of 178 cases of COVID-19 were documented in patients between April 2020 and February 2021. After COVID-19 infection (Covid+) sixty-two pregnancies were documented, with sustained implantation in fifty-three (85%) patients. In the subgroup of Covid+ patients that underwent subsequent fertility treatment the CPR was 30.1% with IUI, and 70.1% with IVF and single frozen embryo transfer. This is in comparison to our control population CPR of 14.1 % with IUI (p=0.002) and 68% (p=0.78) with IVF with single embryo transfer (Table 1). Clinical pregnancy loss rate was recorded and shown in Table 1. CONCLUSIONS: In an infertile population, a recent history of COVID-19 diagnosis did not negatively impact pregnancy outcome as measured against a control population. One of the limitations of this study was the relatively small sample size, which may have conflated our data on COVID-19 patients who underwent IUI, whose higher rate of pregnancy is unlikely to be clinically significant. IMPACT STATEMENT: Patients who have had COVID-19 and then proceeded with infertility treatment were no more likely than our control population to have first trimester complications in one fertility clinic. The findings from this study should provide reassurance that attempts at pregnancy do not need to be delayed after recovery from a COVID-19 diagnosis.
ABSTRACT
OBJECTIVE: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected millions of people. With the development and administration of the SARS-CoV-2 vaccines, there is growing evidence to suggest that there has been reduced transmission of the virus. However, the novelty of the vaccine has raised many questions for infertility patients due to the lack of research. This study examines the perceived anxiety level of patients at a fertility clinic in Manhattan who are undergoing infertility treatments, such as Timed Intercourse (TIC), Intrauterine Insemination (IUI), and In-Vitro Fertilization (IVF). Understanding the mental state of patients with infertility problems during the COVID-19 pandemic is vital for fertility clinics in their future patient assessments. MATERIALS AND METHODS: Surveys were administered to approximately 100 patients at a fertility clinic in Manhattan during early April 2021 - a few months after the first Covid vaccine was administered in the USA. The questionnaire asked patients to specify their treatment plan (TIC, IUI, IVF, oocyte cryopreservation, or no infertility problem). The survey included a 20-item Spielberger State-Trait Anxiety Inventory (STAI) assessing their current state of anxiety. For the STAI score cutoff, <40 = not anxious;40+ = high anxiety. Continuous variables were measured as mean and standard deviation and compared with a two-sample t-test or ANOVA. Categorical variables were compared with a Fisher test. A p-value <0.05 was considered statistically significant. Statistics were done with R version 4.0.5. RESULTS: There is no statistical significance in which group was more likely to have received at least one dose of the COVID-19 vaccines. However, the ''undecided'' group had the lowest percentage of individuals receiving the vaccine. There is also no statistical significance in the anxiety levels of the different groups of patients. The group with the greatest percentage of anxiety according to the STAI score is the ''undecided'' group. Fear of the COVID-19 virus being greater than the fear of the COVID-19 vaccine is a commonality between all the groups. CONCLUSIONS: The survey found that the greatest cause of apprehension in patients was the virus's unknown effects on their physical health. Majority of the hesitancy in receiving the vaccine was due to the potential side effects posed by the injection on pregnant women and their fetus. Interestingly, patients not in treatment had a trend towards higher fear and anxiety compared to patients undergoing infertility treatment. When broken down even further, patients who are undecided in their treatment are more anxious about both the COVID-19 virus and the vaccine. This indicates that the patient's treatment plan influences their view of the pandemic. IMPACT STATEMENT: Women with infertility issues experience tremendous amount of emotional turmoil, which can further interfere with their fertility. Recognizing the root of this population's anxiety during the COVID-19 pandemic can assist reproductive endocrinologists in forming treatment plans that integrate management of patient's psychological wellbeing.