High estradiol levels in fresh embryo transfer cycles are not associated with detrimental impact on birth outcomes.

PURPOSE: There is an unclear relationship between estradiol levels and fresh embryo transfer (ET) outcomes. We determined the relationship between estradiol on the day of trigger, in fresh ET cycles without premature progesterone elevation, and good birth outcomes (GBO). METHODS: We identified autologous fresh ET cycles from 2015 to 2021 at multiple clinics in the USA. Patients with recurrent pregnancy loss, uterine factor, and elevated progesterone on the day of trigger (progesterone > 2 ng/mL or 3-day area under the curve > 4.5 ng/mL) were excluded. The primary outcome was GBO (singleton, term, live birth with appropriate weight). Log-binomial generalized estimating equations determined the likelihood of outcomes. RESULTS: Of 17,608 fresh ET cycles, 5025 (29%) yielded GBO. Cycles with estradiol ≥ 4000 pg/mL had a greater likelihood of GBO compared to cycles < 1000 pg/mL (aRR = 1.32, 95% CI 1.13-1.54). Pairwise comparisons of estradiol between < 1000 pg/mL versus 1000-1999 pg/mL and 1000-1999 pg/mL versus 2000-2999 pg/mL revealed a higher likelihood of GBO with higher estradiol (aRR 0.83, 95% CI 0.73-0.95; aRR 0.91, 95% CI 0.85-0.97, respectively). Comparisons amongst more elevated estradiol levels revealed that the likelihood of GBO remained similar between groups (2000-2999 pg/mL versus 3000-3999 pg/mL, aRR 1.04, 95% CI 0.97-1.11; 3000-3999 pg/mL versus ≥ 4000 pg/mL, aRR 0.96, 95% CI 0.9-1.04). CONCLUSION: In fresh ET cycles, higher estradiol levels were associated with an increased prevalence of GBO until estradiol 2000-2999 pg/mL, thereafter plateauing. In fresh ET candidates, elevated estradiol levels should not preclude eligibility though premature progesterone rise, and risk of ovarian hyperstimulation syndrome must still be considered.

Patient perspectives of telehealth for fertility care: a national survey.

PURPOSE: To evaluate patient satisfaction using telehealth for fertility care. METHODS: Cross-sectional survey using the validated telehealth usability questionnaire (TUQ) distributed nationally via fertility advocacy groups of fertility patients aged ≥ 18 years with self-reported use of telehealth for care. Patient satisfaction of telehealth for fertility care as determined by the TUQ questionnaire. The survey also included questions about telehealth related to usefulness, ease of use, effectiveness, reliability, and the option for patients to add open-ended comments related to their experiences using telehealth for fertility care. RESULTS: A total of 81 fertility patients completed the survey. Patients reported high rates of satisfaction (81.4%) with telehealth in areas of usefulness, ease of use, effectiveness, reliability, and satisfaction. However, many patients (60.5%) expressed a preference for in-person visits for their initial visit while the acceptability of telehealth increased for follow-up visits. Negative themes from respondent comments address that telehealth visits felt more impersonal and rushed. CONCLUSION: Fertility patients reported high satisfaction using telehealth for care. Patients still preferred in-person visits for initial consultations. For follow-up visits, most respondents favored telehealth or had no preference. Incorporation of telehealth in fertility practices should continue though it may be helpful for patients to be given options for visit types.

The ART of cryopreservation and its changing landscape.

The purpose of this review is to educate the reader on the role that cryopreservation has played and continues to play in the ever-evolving field of assisted reproductive technologies, specifically in clinical human fertility treatment. We discuss the science behind the cryopreservation methods and investigated some of the major considerations that any clinic or cryobank faces in terms of risks and liabilities, physical challenges that accompany the constantly growing collection of cryopreserved specimens, and what this means on the ethical and legal front. Finally, we take a glimpse in the future to explore what may be on the horizon for the preservation of gametes and reproductive tissues.

Use of Hormone Therapy in Women with Early Menopause and Premature Ovarian Insufficiency.

Women with early menopause or primary ovarian insufficiency (POI) experience a menopausal state a decade or more earlier than their peers. The health consequences for POI are vast and varied with detrimental effects seen on neurological, psychological, bone, and cardiovascular systems. The risk profile of POI patients requires special attention, as they differ from a typical menopausal population. This review will explore the health risks associated with POI and examine the various treatment options and also the risks associated with hormone therapy. Given the risks and benefits, POI patients should be strongly encouraged to start hormone therapy until the median age of menopause.