American Society For Reproductive Medicine Research Articles

The evolving role of the Women's Health Specialist in cancer prevention and survivorship.

This review provides a framework for primary care physicians, internists, family doctors, NP's, PA's, and oncologists caring for women-henceforth referred to as Women's Health Specialists-to identify and screen patients who may be at high risk for inherited cancer syndromes; an intervention referred to as previvorship care. For women who undergo risk-reducing oophorectomy, survivorship care is critical to optimizing quality of life thereafter. In this paper, we review management of the unique survivorship needs and management options for women at risk for or with a cancer diagnosis, highlighting the importance of interdisciplinary care. To review the available previvorship and survivorship management strategies, a Pub Med search was performed using keywords "survivorship," "genetics," "cancer," "menopause," "hormone therapy," "screening" in addition to review of guidelines, position statements and expert, and committee opinions from the American College of OBGYN, the American Society of Clinical Oncology, The North American Menopause Society, the National Comprehensive Cancer Network , and the American Society for Reproductive Medicine. Women's Health Specialists are in a unique position to identify and screen women who may be at risk for inherited cancer syndromes as well as provide necessary survivorship management following transition from their oncologists' care.

Fertility Preservation: How to Preserve Ovarian Function in Children, Adolescents and Adults

Chemotherapy, pelvic radiotherapy and ovarian surgery have known gonadotoxic effects that can lead to endocrine dysfunction, cessation of ovarian endocrine activity and early depletion of the ovarian reserve, causing a risk for future fertility problems, even in children. Important determinants of this risk are the patient’s age and ovarian reserve, type of treatment and dose. When the risk of premature ovarian insufficiency is high, fertility preservation strategies must be offered to the patient. Furthermore, fertility preservation may sometimes be needed in conditions other than cancer, such as in non-malignant diseases or in patients seeking fertility preservation for personal reasons. Oocyte and/or embryo vitrification and ovarian tissue cryopreservation are the two methods currently endorsed by the American Society for Reproductive Medicine, yielding encouraging results in terms of pregnancy and live birth rates. The choice of one technique above the other depends mostly on the age and pubertal status of the patient, and personal and medical circumstances. This review focuses on the available fertility preservation techniques, their appropriateness according to patient age and their efficacy in terms of pregnancy and live birth rates.

ASRM müllerian anomalies classification 2021

There are many proposed classification systems for müllerian anomalies. The American Fertility Society (AFS) Classification from 1988 has been the most recognized and utilized. The advantages of this iconic classification include its simplicity, recognizability, and correlation with clinical pregnancy outcomes. However, the AFS classification has been criticized for its focus primarily on uterine anomalies, with exclusion of those of the vagina and cervix, its lack of clear diagnostic criteria, and its inability to classify complex aberrations. Despite this classification and others, the wide range of müllerian anomalies is still largely unknown and confusing to many providers. Consequently, müllerian anomalies may go undiagnosed for extended periods, receive inappropriate or inadequate surgical interventions, and result in persistent issues such as pain or loss of reproductive function. The American Society for Reproductive Medicine Task Force on Müllerian Anomalies Classification was formed and charged with designing a new classification. The Task Force set goals for a new classification and chose to base it on the iconic AFS classification from 1988 because of its simplicity and recognizability, while expanding and updating it to include all categories of anomalies. In addition, this was recognized as an opportunity to raise awareness of this area of medicine, educate providers and learners, and promote patient advocacy. Presented here is the new American Society for Reproductive Medicine Müllerian Anomalies Classification2021.

Hyaluronic Acid Gels Versus Estrogen Therapy as Treatments for Reducing Adhesions in Patients Undergoing Hysteroscopic Adhesiolysis

<h3>Study Objective</h3> The purpose of this paper is to analyze studies on medication therapy (preoperative and postoperative estrogen) versus physical barrier application (hyaluronic acid-based gels) in reducing adhesions in patients undergoing hysteroscopic adhesiolysis. We discuss the success of these treatment methods in the context of their safety profiles and reduction of complications such as infertility. <h3>Design</h3> Articles from 2010 to 2020 that provided data specific to hysteroscopic adhesiolysis were compiled through a PubMed search with Boolean logic. <h3>Setting</h3> Dosing of estrogen therapy varied. The American Society for Reproductive Medicine's classification system for intrauterine adhesions (based on extent of involvement in the uterine cavity, menstrual pattern, and type of adhesion) were utilized by the majority of studies. <h3>Patients or Participants</h3> 728 patients were treated with hyaluronic acid gels and 475 patients with estrogen therapy. <h3>Interventions</h3> IUA recurrence rate and severity ratings, menstrual patterns, pregnancy rates, and adverse events from all studies were evaluated alongside aggregate findings with meta-analysis. <h3>Measurements and Main Results</h3> Returning to normal menstrual pattern was more commonly reported with estrogen therapy than with hyaluronic acid gel usage. No major adverse effects were reported for either treatment. Adhesion severity displayed a positive correlation with reduction in adhesion recurrence in the group treated with hyaluronic acid gels and among 5 patients with Asherman's Syndrome who received estrogen therapy as part of their management of a false passage following hysteroscopic adhesiolysis. Neither treatment yielded a significant effect on pregnancy rate. <h3>Conclusion</h3> While both treatments display a positive safety profile, randomized controlled trials with hyaluronic acid gels suggested more favorable outcomes in menstrual pattern and adhesion recurrence. Further research should aim to document all three factors measured in our study. We emphasize the need for data on gravidity and parity as well as concrete dosage amounts of estrogen over numerical ranges for a nuanced investigation of how these new treatments affect post-surgery pregnancy.

International Committee for Monitoring Assisted Reproductive Technologies world report: assisted reproductive technology, 2014†.

International Committee for Monitoring Assisted Reproductive Technologies world report: assisted reproductive technology, 2014†.

The Impact of SARS-CoV-2 on Sperm Cryostorage, Theoretical or Real Risk?

Cryopreservation of human gametes and embryos as well as human reproductive tissues has been characterized as an essential process and aspect of assisted reproductive technology (ART). Notably, sperm cryopreservation is a fundamental aspect of cryopreservation in oncological patients or patients undergoing gonadotoxic treatment. Given that there is a risk of contamination or cross-contamination, either theoretical or real, during the procedures of cryopreservation and cryostorage, both the European Society for Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) have provided updated guidelines for preventing or reducing the contamination risk of sexually transmitted viruses. Given the ongoing and worldwide COVID-19 pandemic, there is considerable interest in what measures should be taken to mitigate SARS-CoV-2 contamination during cryopreservation and cryostorage of semen samples. The SARS-CoV-2 virus is the virus that causes COVID-19, and whose transmission and infection is mainly aerosol-mediated. Several ART professional societies, including ESHRE and ASRM have proposed measures to mitigate the spread of the SARS-CoV-2 virus. Whether the proposed safety directives are enough to mitigate the possible SARS-CoV-2-contamination of sperm samples during cryopreservation or whether the policies should be re-evaluated will be discussed in this review. Additionally, insights regarding the possible impact of COVID-19 vaccination on the safety of sperm cryopreservation will be discussed.

The influence of diet on polycystic ovary syndrome

Background: Polycystic ovary syndrome (PCOS) is a common endocrinopathy in women in reproductive age. It is estimated that it affects about 5-10% of women aged 18-44. This disease is associated with reproductive dysfunction and metabolic disorders. According to the American Society for Reproductive Medicine (ASRM) 2018 guidelines, the first line treatment for PCOS are lifestyle adjustments, including dietary control and exercise. Hence a lot of research on the diet that is most appropriate for this group of people. Material and methods: PubMed research base was searched using the following keywords: diet, pcos, policystic ovary syndrome in 2017-2021. Results: The diet of women with PCOS is poorly composed, and dietary errors may affect the metabolic disorders occurring in these patients. Women with PCOS tend to have insufficient intakes of vitamin D, fiber, and vitamin B9, as well as excessive sodium intake. Mediterranean, ketogenic, low-carbohydrate, low-glycemic, low-AGE and pod-based diets positively affect this disease in various ways. Conclusions: PCOS is a very diverse disease that affects a large number of women around the world. Changing your lifestyle, including diet and exercise, is the first line treatment. This is why creating the best diet for these patients is extremely important. Current discoveries are very promising and give hope to create a model of nutrition that will be the best for these women. Large, multicentre randomized trials are still needed to develop diets that are appropriate for different patients because the disease picture is heterogeneous.

INDICATIONS FOR SURROGACY FROM THE PERSPECTIVE OF THE GESTATIONAL CARRIER

The American Society for Reproductive Medicine (ASRM) Ethics Committee has published guidelines about indications for gestational carrier (GC) use, but deviations from these recommendations arise in practice. This study examined how informed GCs were regarding their intended parents’ (IPs’) indications for surrogacy. Furthermore, as assessment of personal risk and benefit prior to informed consent is pivotal in healthcare decision-making, we assessed GCs’ willingness to carry for various indications included as well as omitted from current guidelines.

RECURRENCE, RE-OPERATION, AND PREGNANCY RATES AFTER SURGICALLY TREATED OVARIAN ENDOMETRIOMA IN A SINGLE INSTITUTION: LONG-TERM FOLLOW UP OF 756 WOMEN

The aims of this study were to evaluate the cumulative recurrence, re-operation, and pregnancy rates after surgically treated ovarian endometrioma in a single institution for more than a 5-year follow up period. This was a retrospective chart review of the patients with ovarian endometrioma who underwent surgery between January 2008 and March 2016. Study subjects included premenopausal women with at least 5-years of follow-up. Exclusion criteria were patients with stage I or II ovarian endometrioma by revised American Society for Reproductive Medicine (rASRM) classification, those who underwent hysterectomy or bilateral oophorectomy, and presence of residual ovarian lesions on the first postoperative ultrasonography at 3-6 months. Recurrent ovarian endometrioma was defined as a new cystic mass measuring 20 mm or more on the ultrasonography. A total of 756 patients were recruited. The mean age was 31.8±6.3 years (median 31 years, range, 16-54 years) and the mean follow-up duration was 90.4±23.3 months (median 85.5 months, range, 60-155 months). Recurrent ovarian endometrioma was detected in 27.9% (211 of 756 patients), and re-operation was performed in 8.3% (63 of 756 patients). Total 29.9% (63 of 211 patients) with recurrent endometrioma was treated with repeated surgery. Using the Kaplan-Meier method, the cumulative recurrence rate at 24, 36, 60, and 120 months after surgical treatment of ovarian endometrioma was calculated as 5.9%, 8.7%, 15.5% and 37.8%, respectively. The cumulative re-operation rate at 24, 36, 60, and 120 months was 0.3%, 1.1%, 3.1% and 15.6%, respectively. After multivariate analyses, age ≤ 31 years (hazard ratio [HR]=2.108; 95% confidence interval [CI]=1.522-2.921; p<0.001), no subsequent pregnancy (HR=1.851; 95% CI=1.309-2.617, p<0.001), postoperative hormonal treatment ≤15 months (HR=2.869; 95% CI=2.088-3.941); p<0.001) were significant risk factors for recurrent ovarian endometrioma. Among the study patients, 316 (41.7%) women desired future pregnancy, and 171 of 316 (54.1%) were able to conceive and had uncomplicated delivery. Eighteen (5.7%) women experienced spontaneous abortion or ectopic pregnancy, and 36 (11.4%) women were either pregnant at the time of data collection or lost to follow up after confirming intrauterine pregnancy. Among the 316 patients who desired pregnancy, 91 (28.8%) failed to conceive. Considering the fact that longer postoperative hormonal treatment is the sole modifiable factor for recurrent ovarian endometrioma, we recommend long-term hormonal treatment until subsequent pregnancy, especially in younger age group.

Correlation of calprotectin serum levels with degrees of endometriosis: A cross-sectional study.

BackgroundEndometriosis is closely associated with delayed diagnosis due to the lack of a definitive and sensitive noninvasive approach. The use of calprotectin in inflammatory process has been demonstrated in various inflammatory diseases. Calprotectin has a significant correlation with high-sensitivity C-reactive protein (hs-CRP) and could be used as an inflammatory marker. No study thus far has evaluated the correlation between calprotectin and endometriosis.ObjectiveTo determine the correlation of calprotectin with the degree of endometriosis in order to help clinicians in establishing better early detection and management. Materials and Methods In this cross-sectional study, 46 women referred to the Cipto Mangunkusumo, Fatmawati, and Persahabatan Hospitals in Jakarta, Indonesia between July 2017 and April 2018 were enrolled, and their blood serum were taken a day before surgery. Calprotectin serum level was treated using the PhicalⓇ ELISA method. After the diagnosis of endometriosis was confirmed through pathological examination, the final diagnosis of endometriosis could be established. The degree of endometriosis was classified according to the revised American Society for Reproductive Medicine (ASRM) classification.ResultsThe prevalence of minimal, mild, moderate, and severe degrees of endometriosis were 15.2, 39.1, 34.8, and 10.9%, respectively. The median serum calprotectin levels for minimal, mild, moderate, and severe endometriosis were 138.98, 121.49, 124.16, and 122.82 mg/mL, respectively. No correlation was observed between calprotectin and the degrees of endometriosis (r = –0.16, p = 0.278).ConclusionThere is no correlation between calprotectin serum levels and the degrees of endometriosis.

Examining Diagnostic Options and Classification Systems Available for Endometriosis

Introduction: Endometriosis is characterised by the presence of endometrium-like tissue outside the uterus, and is often associated with chronic pelvic pain, infertility, and compromised quality of life. Development of reliable methods of early diagnosis, staging, and classification of endometriosis would allow for restriction of disease progression by its early detection and strategising towards its early treatment and management. Diagnostic options: Typically, diagnosis and staging of endometriosis include a history and physical examination followed by clinical, imaging, and laparoscopic findings. Surgical inspection of lesions at laparoscopy with histological confirmation remains the most reliable procedure towards the detection of endometriosis and its classification. Although there are many putative peripheral biomarkers having potential diagnostic values for endometriosis, further studies are necessary for their validation. Classification systems: Based on anatomical, clinical, imaging, and several pathophysiological findings, various classifications and staging systems of endometriosis, e.g., revised American Society for Reproductive Medicine (rASRM), ENZIAN, Endometriosis Fertility Index (EFI) and Foci–Ovarian endometrioma–Adhesion–Tubal endometriosis–Inflammation (FOATI) scoring systems, have so far been postulated. However, there is no fool-proof diagnostic and classification approach available for the disease due to the general failure of current systems to reflect reproducible correlation with the major symptoms of endometriosis. Conclusion: A ‘toolbox approach’, using all the available diagnostic and classification systems maximising the information available to healthcare providers and females, is a recent recommendation. Development of collaborative research networks for the harmonisation of patient information, biological sample collection, and its storage, and that of methodological and analytical tools in a wider patient base is necessary to discover reliable leads for future diagnostic options and a classification system for endometriosis.

P–790 Effects of COVID–19 quarantine period on Fertility Treatment and IVF Clinic management

Abstract Study question What are the effects of the initial COVID–19 response on the management of fertility clinics and clinical practice around the world? Summary answer In the COVID–19 outbreak, the large majority of fertility clinics worldwide suspended fertility treatments. In cycles that continued, there was a shift to frozen embryo-transfer. What is known already After the initial months of 2020 showed a rapid spread of the new Coronavirus SARS-CoV–2, the World Health Organisation declared a global pandemic on 11 March 2020. Occupation of health care facilities with acutely sick patients and the need to reduce infection transmission led to a reduction in capacity to perform elective medical procedures. Little was known on the global impact of COVID–19 on fertility care. With the implication of ‘lockdowns’ in different countries around the world to stop the spread of the virus, the question was posed on how fertility clinics and treatments would proceed moving forward. Study design, size, duration We surveyed fertility clinics with an online questionnaire developed through the platform RedCap (HELIX). The questionnaire contained 33 questions focused on the differences of country responses to different body guidelines including American Society for Reproductive Medicine (ASRM) and European Society of Human Reproduction and Embryology (ESHRE). Fertility clinic associates were contacted through the use of a known contact list comprising scientific directors, medical directors and lab managers. Participants/materials, setting, methods Study participants were individuals associated with fertility clinics around the world with at least one representative from each country. The questionnaire was active from 13th October 2020 until 21st January 2021. The time frame was specific to the country’s response to their first lockdown. The survey was approved by Monash Health Human Research Ethics Committee(#65223). All survey answers were anonymous with only the countries’ name as a reference for analysis. Main results and the role of chance There were 34 individual country responses,Asia(11), Europe(10), Africa(3), North America(3), Oceania(2) and South America(5). Of the 34 countries, 7 countries did not experience a complete stop of all procedures. Most countries (18) followed their government body recommendations. One country followed local recommendations, 3 followed local and international recommendations, 3 countries changed by clinic initiative and 7 countries did not specify. ASRM and ESHRE were the two most common guidelines mentioned. IVF/ICSI treatment had delays in 28 countries ranging from 14 (Scotland) to 160 (Egypt) days. FETs were delayed in 29 countries ranging from 15 (Pakistan) to 228 (Scotland) days. Couples undergoing timed intercourse experienced the least delay in treatment (13 countries). AI/OI (artificial insemination/ovulation induction) patients were delayed treatment in 25 countries, fertility consultations were delayed in 20 countries. During the quarantine period, the amount of freeze-all cycles increased in 16 countries with the ratio of IVF-ICSI remaining constant pre and post lockdown. Patients were reported to undergo a SARS-CoV–2 test in 17 countries. 11 countries reported having a procedure in place for patients whom tested positive, 6 countries reported no procedure in place for positive patients. Additional support counselling was offered for patients during the pandemic in 22 countries. Limitations, reasons for caution Our survey does only represent a minute sample of countries. As only one representative from each country was used, the results obtained are specific to the individual’s anonymous clinic. However, the questionnaire includes questions that specifies if the clinic was performing outside the country’s scientific society recommendations. Wider implications of the findings: During the COVID–19 pandemic most fertility services were suspended, providing insight to the implications of a shutdown and whether a protocol for scenarios of this nature could benefit outcomes for future events. A protocol that allows continuation of care,including telehealth and guidelines for prioritizing couples who need care most urgently. Trial registration number N/A

Assessment of oncofertility content on reproductive endocrinology and infertility clinic websites

<h3>Objectives:</h3> As the age of first pregnancy increases in the United States, young individuals with a cancer diagnosis are often challenged with time-sensitive issues surrounding fertility preservation and cancer treatment. Oncofertility has become increasingly important in the care of these individuals. The purpose of this study is to assess oncofertility content on fertility clinic websites as indicated by relevant keywords. Additionally, we sought to describe the relationship between oncofertility content and fertility clinic characteristics, including: private vs academic, size (cycles/year), state-mandated fertility insurance coverage, type of National Cancer Institute (NCI) designated cancer center, and distance from a NCI designated cancer center. <h3>Methods:</h3> In the Fall of 2020, websites of 381 fertility clinics that are members of the Society for Associated Reproductive Technology (SART) were surveyed. Each clinic website was reviewed systematically by two authors (K.S. and R.M) and discrepancies adjudicated by a third author (V.M). Extracted data included: clinic location, practice type (private vs academic), size (small ≤ 500 cycles/year, medium 501-1,000 cycles/year, and large >1000 cycles/year), type of NCI designated center (cancer center vs comprehensive cancer center), and the distance from an NCI cancer as determined by Google Maps. Additionally, we documented whether the clinic was located in a state that mandated reproductive & infertility services and/or included fertility preservation for "iatrogenic infertility" as reported by the American Society for Reproductive Medicine. The primary outcome was mention of keywords referring to oncofertility, including: oncofertility, fertility preservation, cancer, chemotherapy, ovarian suppression/shielding/preservation/transposition. Data were summarized using descriptive statistics and compared using chi-squared or t-test as appropriate. <h3>Results:</h3> Of the 381 fertility clinic websites analyzed, 322 (85%) contained at least one keyword regarding oncofertility. Most frequently used terms included cancer (79%), fertility preservation (78%), ovarian preservation (69%), chemotherapy (63%); while less used terms included oncofertility (24%), transposition (12%), suppression (9.4%), shielding (5.0%). There was an association between practice size and inclusion of onocofertility content (<i>p</i><.01). Practices that did ≥501 cycles per year were more likely to mention one of the oncofertility keywords (RR 1.2; 95% CI 1.1-1.3). The association of oncofertility website content with practice type, state-mandated fertility insurance coverage, and distance from an NCI designated cancer center were not statistically significant. <h3>Conclusions:</h3> Large clinic size was the only predictive factor for inclusion of oncofertility website content. Further studies are required to evaluate whether inclusion of oncofertility content on clinic websites impacts the use of these services by patients with cancer.

Guidance on the limits to the number of embryos to transfer: a committee opinion

On the basis of American Society for Reproductive Medicine and Society for Assisted Reproductive Technology data, the American Society for Reproductive Medicine's guidelines for the limits on the number of embryos to be transferred during invitro fertilization cycles have been further refined in continuing efforts to promote singleton gestation and reduce the number of multiple pregnancies. This version replaces the document titled "Criteria for number of embryos to transfer: a committee opinion" that was published most recently in August of 2017 (Fertil Steril 2017;107:901-3).

Reproductive Ethics and Family

Reproductive Ethics and Family

GESTATIONAL CARRIERS WEIGH IN ON WHETHER NON-ASRM APPROVED INDICATIONS FOR SURROGACY ARE ACCEPTABLE

Viewpoints regarding the ethical boundaries surrounding gestational surrogacy vary throughout the country and across the globe. In the United States, guidelines from American Society for Reproductive Medicine (ASRM) outline indications for use of gestation carriers (GCs): absence of uterus, irreparable uterine anomaly, maternal medical contraindication to pregnancy, serious risk to fetus from maternal medical condition, biologic inability to bear a child, or unidentified endometrial factor [1]. Although these are the predominant indications for GC utilization, there are social situations that may arise in practice that deviate from these guidelines: intended mother has career concerns with pregnancy (i.e: model, athlete, etc…), or intended mother is a transgender person.

LOWER INCOME IS ASSOCIATED WITH GREATER PANDEMIC RELATED INFERTILITY STRESS DURING THE COVID-19 PANDEMIC

The emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) which is responsible for the COVID-19 infection quickly became a global public health emergency due to its profound virulence and infectivity [1]. As of March 17, 2020, the American Society for Reproductive Medicine published recommendations with the intent to minimize virus transmission [2]. While many of these initial restrictions have been tempered, there is still much to learn about the COVID-19 infection which likely impacts the utilization of fertility treatment.

Evidence-based outcomes after oocyte cryopreservation for donor oocyte in vitro fertilization and planned oocyte cryopreservation: a guideline

To provide evidence-based recommendations to practicing physicians and others regarding the efficacy of oocyte cryopreservation (OC) for donor oocyte invitro fertilization and planned OC. The American Society for Reproductive Medicine conducted a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 1986 to 2018. The American Society for Reproductive Medicine Practice Committee and a task force of experts used available evidence and through consensus developed evidence-based guideline recommendations. Outcomes of interest included live birth rate, clinical pregnancy rate, obstetrical and neonatal outcomes, and factors predicting reproductive outcomes. The literature search identified 30 relevant studies to inform the evidence base for this guideline. Evidence-based recommendations were developed for predicting the likelihood of live births after planned OC, autologous OC in infertile women, and donor OC, as well as factors that may impact live birth rates. Recommendations were developed regarding neonatal outcomes after using fresh vs. cryopreserved oocytes in cases of autologous or donor oocytes. There is insufficient evidence to predict live birth rates after planned OC. On the basis of limited data, ongoing and live birth rates appear to be improved for women who undergo planned OC at a younger vs. older age. Although there are no significant differences in per transfer pregnancy rates with cryopreserved vs. fresh donor oocytes, there is insufficient evidence that the live birth rate is the same with vitrified vs. fresh donor oocytes. Neonatal outcomes appear similar with cryopreserved oocytes compared with fresh oocytes. Future studies that compare cumulative live birth rates are needed.

SARS-CoV-2 vs. human gametes, embryos and cryopreservation

ABSTRACT The COVID-19 pandemic, caused by the SARS-CoV-2 virus, is an unprecedented global situation, and all countries have adopted their own measurements to mitigate the spread of the virus in the first as well as in the subsequent waves of infection. All measures, especially in the first wave of the pandemic, were in combination with recommendations provided by professional and scientific organizations. Similar measures were applied to specific procedures, such as the management of infertility, including in vitro fertilization-embryo transfer (IVF-ET) treatments. Although there is no clear scientific evidence yet that the SARS-CoV-2 may exert negative effects on IVF outcome, especially at the early stages, several clinical reports indicate that the virus may impact male fertility through specific receptors presented at the somatic cells of the testis and used by the virus in order to gain entry to the respective cells. Nevertheless, it is not unreasonable to suspect that the virus may affect sperm function as well as oocyte performance directly through specific receptors or indirectly through other signaling pathways. Despite the good practice of IVF laboratory techniques, culture media may also be contaminated during equilibration when airborne virus’s particles can contaminate culture media from an already infected embryology area or staff. Furthermore, although there is no clinical evidence, liquid nitrogen could be a route of infection for gametes and embryos when it has been contaminated during production or transportation. Therefore, cryopreservation of gametes and embryos must be virus-free. This communication aims to provide some aspects of the possible impact of the virus on gametes and embryos and how it may affect the cryopreservation procedures. Abbreviations: ACE2: angiotensin- converting enzyme 2; ART: assisted reproductive technology; ASRM: American Society for Reproductive Medicine; CDC: Centers for Disease Control and Prevention; COVID-19: coronavirus disease 2019; ESHRE: European Society of Human Reproduction and Embryology; ET: embryo transfer; FSH: follicle stimulating hormone; IFFS: International Federation of Fertility Societies; IVF: in vitro fertilization; LH: luteinizing hormone; LN: liquid nitrogen; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; T: testosterone; WHO: World Health Organization.

Editorial introductions.

Current Opinion in Obstetrics and Gynecology was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of obstetrics and gynecology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Emre SeliEmre SeliEmre Seli, MD, is Professor of Obstetrics, Gynecology, and Reproductive Sciences at Yale School of Medicine, USA. Dr Seli received his medical degree from the University of Istanbul, Turkey, and completed his residency in obstetrics and gynecology at Yale University. His postdoctoral training included a fellowship in reproductive endocrinology and infertility as well as a research fellowship in molecular biology, both at Yale University. The primary focus of his research program is to understand and treat infertility. His laboratory characterized mechanisms regulating translational activation of gene expression in the oocyte. Dr Seli and his colleagues also made seminal contributions to our understanding of oocyte and embryo competence in IVF and the potential role of non-invasive diagnostic technologies in this context. Dr Seli is the recipient of many National Institutes of Health (NIH) and pharmaceutical industry-sponsored research grants. He has trained more than 50 pre- and post-doctoral fellows, published more than 100 scientific articles, and received numerous research awards, including the Ira and Ester Rosenwaks New Investigator Award from the American Society for Reproductive Medicine (ASRM), and the President's Achievement Award from the Society for Reproductive Investigation (SRI). Dr Seli's current research focuses on determinants of oocyte and embryo health, and mechanisms of ovarian ageing. Dr Seli is actively involved in professional societies and scientific journals. He served as the Program Director for SRI in 2016, where he is now the Program Committee Chair (2016–2021). He has also been a member of the ASRM Research Committee for the past five years, and served as a member of the SSR Program Committee, where he organized the Ovarian Workshop in 2016 and 2018. He is the Associate Editor for Molecular Human Reproduction, Reproductive Sciences, Journal of Assisted Reproduction and Genetics, and Reproductive Biomedicine Online, and is currently co-editor of Current Opinion in Obstetrics and Gynecology. As an educator, Dr Seli delivered more than 150 invited lectures nationally and internationally, and he is the recipient of the Association of Professors of Gynecology and Obstetrics (APGO) Excellence in Teaching Award based on evaluations of his lectures by Yale Medical Students. Dr Seli edited four books (Non-invasive Management of Gynecologic Disorders, Infertility, Fertility Preservation, and Human Gametes and Pre-implantation Embryos: Assessment and Diagnosis) and is currently co-authoring the 9th edition of the Speroff's Clinical Gynecologic Endocrinology and Infertility. Juan A. Garcia VelascoJuan A. Garcia VelascoProfessor Juan A. Garcia Velasco is Director of IVI RMA-Madrid, Spain. He gained his degree in medicine at Complutense University, Spain, in 1990, before going on to train as a specialist in obstetrics and gynecology at La Paz Hospital, Spain, between 1992 and 1995. Professor Garcia Velasco gained his PhD in medicine and surgery at Autónoma University, Spain, in 1995. He then became a sub-specialist in reproductive endocrinology and infertility at Yale University, USA, in 1998. Professor Garcia Velasco has published 122 scientific articles in impact journals along with 22 chapters and four books. He is the Principal Investigator of projects funded by the Ministry of Education and the Ministry of Health. He is the Co-Editor of Reproductive Biomedicine Online (RBMO) and a member of the Editorial Committee of Fertility & Sterility (ASRM), Society for Gynecologic Investigation (SGI), European Society of Human Reproduction and Embryology (ESHRE), Spanish Society of Obstetrics (SEGO) and Gynecology and Spanish Society of Fertility (SEF).