Racial disparities in telehealth use during the coronavirus disease 2019 pandemic.

OBJECTIVE: To investigate the impact of coronavirus disease 2019 on initial infertility consultations. DESIGN: Retrospective cohort. SETTING: Fertility practice in an academic medical center. PATIENTS: Patients presenting for initial infertility consultation between January 2019 and June 2021 were randomly selected for prepandemic (n = 500) and pandemic (n = 500) cohorts. EXPOSURE: Coronavirus disease 2019 pandemic. MAIN OUTCOME MEASURES: The primary outcome was a change in the proportion of African American patients using telehealth after pandemic onset compared with all other patients. Secondary outcomes included presentation to an appointment vs. no-show or cancellation. Exploratory outcomes included appointment length and in vitro fertilization initiation. RESULTS: The prepandemic cohort vs. the pandemic cohort had fewer patients with commercial insurance (64.4% vs. 72.80%) and more African American patients (33.0% vs. 27.0%), although the racial makeup did not differ significantly between the two cohorts. Rates of missed appointments did not differ between the cohorts, but the prepandemic cohort vs. the pandemic cohort was more likely to no-show (49.4% vs. 27.8%) and less likely to cancel (50.6% vs. 72.2%). African American patients, compared with all other patients, during the pandemic were less likely to use telehealth (57.0% vs. 66.8%). African American patients, compared with all other patients, were less likely to have commercial insurance (prepandemic: 41.2% vs. 75.8%; pandemic: 57.0% vs. 78.6%), present to their scheduled appointment (prepandemic: 52.7% vs. 73.7%; pandemic: 48.1% vs. 74.8%), and cancel vs. no-show (prepandemic: 30.8% vs. 68.2%, pandemic: 64.3% vs. 78.3%). On multivariable analysis, African American patients were less likely (odds ratio 0.37, 95% confidence interval 0.28-0.50) and telehealth users were more likely (odds ratio 1.54, 95% confidence interval 1.04-2.27) to present to their appointments vs. no-show or cancel when controlling for insurance type and timing relative to the onset of the pandemic. CONCLUSION: Telehealth implementation during the coronavirus disease 2019 pandemic decreased the overall no-show rate, but this shift did not apply to African American patients. This analysis highlights disparities in insurance coverage, telehealth utilization, and presentation for an initial consultation in the African American population during the pandemic.

Uterine Transplantation: Recipient Patient Populations.

Uterine transplantation is an emerging treatment for patients with uterine factor infertility (UFI). In order to determine patient candidacy for transplant, it is imperative to understand how to identify, counsel and treat uterine transplant recipients. In this article, we focus on patient populations with UFI, whether congenital or acquired, including Mayer-Rokitansky-Kuster-Hauser, complete androgen insensitivity syndrome, hysterectomy, and other causes of nonabsolute UFI. Complete preoperative screening of recipients should be required to assess the candidacy of each individual prior to undergoing this extensive treatment option.

TEAM(ing): together each achiev(ing) more!

Providing medical care at the highest levels across various reproductive endocrinology and infertility settings necessitates seamless partnership among multiple people with diverse skill sets. In this introductory article for this month's Views and Reviews, the concept of teaming is presented, including the key concepts of collaboration, assembling the right team members, establishing goals, inspiring and empowering others, and encouraging new approaches to optimize outcomes. Following this introduction, thought leaders from diverse reproductive endocrinology and infertility spaces, including clinical, ambulatory surgery, laboratory, and research settings, present their experiences using teaming models to adapt team members' thinking, elevate the quality of scientific productivity, and achieve excellence in both patient care and laboratory and clinical outcomes.