ABSTRACT
PURPOSE: In 2015, assisted reproductive technology (ART) accounted for 1.7% of all U.S. births, donor eggs accounted for over 17,000 started cycles in 2015, and donor sperm accounting for 6.2% of all cycles started in 2014. With increasing utilization of donor gametes as a method of assisting patients with infertility, the number of babies born each year utilizing gamete donation will also continue to increase. This study aimed to elucidate factors impacting decision to donate, amongst a representative national population. METHODS: A survey was distributed via the internet utilizing SurveyMonkey Enterprise with HIPAA compliance. Univariate regressions and frequencies were conducted between each demographic and personal characteristic and the willingness to donate. Log Binomial and linear regression was used categorical and continuous variables, and Risk ratios were calculated. RESULTS: In this large survey study, 64% of men and 50% of women reported they would be willing to donate gametes, with the majority desiring monetary compensation. Men with a high Consumer Financial Protection Bureau score were less likely to report that they would consider donating sperm compared to a medium high CFPB score. No other financial indicators were associated with considering donating sperm. There were no associations between CFPB score and egg donation outcomes. Black or African American women were less likely to consider donating their eggs compared to other groups, and more likely to desire > $5000 in compensation. CONCLUSIONS: In this large survey study, a small minority of participants reported they would be willing to donate to an unknown infertility patient for reproductive purposes. High and very high CFPB scores were associated with willingness to donate games, but not with desire for monetary compensation or amount.
ABSTRACT
BACKGROUND: More than 67% of all embryos transferred in the United States involve frozen-thawed embryos. Progesterone supplementation is necessary in medicated cycles to luteinize the endometrium and prepare it for implantation, but little data is available to show if this is beneficial in true natural cycles. We evaluated the use of luteal phase progesterone supplementation for cryopreserved/warmed blastocyst transfers in true natural cycles not using an ovulatory trigger. METHODS: Retrospective cohort study in a single academic medical center. We studied the use of luteal phase progesterone supplementation in patients undergoing true natural cycle cryopreserved blastocyst embryo transfers. Our primary outcome measure was ongoing pregnancy rate, with other pregnancy outcomes being evaluated (i.e. implantation rate, miscarriage rate, ectopic rate, and multifetal gestation). Categorical data were analyzed utilizing Fisher's exact test and all binary variables were analyzed using log-binomial regression to produce a risk ratio. RESULTS: Two hundred twenty-nine patients were included in the analysis with 149 receiving luteal phase progesterone supplementation and 80 receiving no luteal phase support. Patient demographic and cycle characteristics, and embryo quality were similar between the two groups. No difference was seen in ongoing pregnancy rate (49.0% vs. 47.5%, p = 0.8738), clinical pregnancy rate (50.3% vs. 47.5%, p = 0.7483), positive HCG rate (62.4% vs. 57.5%, p = 0.5965), miscarriage/abortion rate (5.4% vs. 2.5%, p = 0.2622), ectopic pregnancy rate (0% vs. 1.3%, p = 0.3493), or multifetal gestations (7.4% vs. 3.8%, p = 0.3166). CONCLUSION(S): The addition of luteal phase progesterone support in true natural cycle cryopreserved blastocyst embryo transfers did not improve pregnancy outcomes and therefore the routine use in practice cannot be recommended based on this study, but the utilization should not be discouraged without further studies. CAPSULE: Progesterone supplementation as luteal phase support in true natural cycle cryopreserved blastocyst transfers does not improve ongoing pregnancies.
ABSTRACT
BACKGROUND: Pregnant patients are at an increased risk for severe morbidity and mortality when compared to the general population. Imaging studies have become an integral part of the work-up for patients who present to the emergency department. However, lack of clear guideline has led to confusion regarding the appropriate indications and protocols for examining pregnant patients. OBJECTIVE: To investigate the comparative rates of imaging studies between pregnant and non-pregnant female patients who presented for emergent evaluation of chest pain and shortness of breath. STUDY DESIGN: All reproductive age females presenting to the emergency department at an academic teaching institution with a chief complaint of "chest pain" or "shortness of breath" from 2010 to 2015 were identifi ed. Cohorts were divided based on pregnancy status and chief complaint. Utilization rates of imaging studies were compared between cohorts. RESULTS: Over the study period 4,834 women were included. One hundred and seventy-four were pregnant. Pregnant patients with "chest pain" or "shortness of breath" were signifi cantly more likely to undergo a venous duplex, but less likely to undergo a chest X-ray as compared to non-pregnant patients. There was no difference in the rates of chest computed tomography (CT) imaging or magnetic resonance imaging (MRI) based on pregnancy status in our data set. CONCLUSION: Imaging studies are an integral adjunct for evaluation in patients reporting "chest pain" and "shortness of breath." Pregnancy places patients at an increased risk of severe sequelae requiring prompt diagnosis to prevent harm to the mother and fetus. American College of Obstetrics and Gynecology (ACOG) Committee Opinion 656 clearly states that, with few exceptions, radiography should not be withheld from pregnant patients. This study suggests that pregnant patients are signifi cantly less likely to undergo radiography, which could place them at increased risk for delayed diagnosis and treatment.
