Reproductive Endocrinology Research Articles

Do LGTB people desire to have children? A Brazilian cross-sectional survey.

To identify whether the LGBT community desires to start a family and the major challenges they experience, especially in regards to assisted reproductive technology (ART) procedures in Brazil. This cross-sectional study invited individuals Brazilian, identified themselves as cisgender, and homosexual (male and female); aged 18-60, the study used an online questionnaire distributed through various platforms. Of the 698 respondents, mostly educated and Caucasian, 86.7% were female. While 69% expressed same-sex orientation, many were in long-term relationships. Family acceptance varied, with financial barriers (69.3%) and societal prejudices (73.1%) being significant concerns. Despite a desire for children (92% were childless), only 10% consulted infertility specialists, and 66.5% were unaware of ART legislation. Emotionally, 51.1% felt unprepared for parenthood. While societal acceptance of non-heteronormative families is perceived to be increasing (53%), unequal healthcare treatment (73.1%) and societal pressures (20% felt pressured towards adoption) remain prevalent. Over 90% of LGBT individuals contemplate having biological or adoptive children. There's notable ignorance about legislation and ART. Financial hurdles in ART are significant but manageable with proper planning. Prejudice also strongly influences their lives.

SURGICAL APPROACH IN THE TREATMENT OF DEEP ENDOMETRIOSIS

Deep endometriosis is a gynaecological condition characterized by the presence of endometrial tissue outside the uterus, involving organs such as the ovaries, intestines and bladder. The disease can cause chronic pain, infertility and additional complications, significantly affecting patients’ quality of life. Although clinical treatment, such as the use of hormones, is common, the surgical approach has become essential for cases of deep endometriosis, when symptoms are not effectively controlled. The aim of this study is to analyze the challenges and advances in surgical approaches to the treatment of deep endometriosis, focusing on innovative techniques, long-term efficacy and the multidisciplinary approach to managing the condition. This is a literature review with a qualitative approach, which will use the PubMed, Scopus and Web of Science databases to gather relevant articles on the surgical and psychological management of endometriosis. The search will be refined using health descriptors such as “Endometriosis Surgery,” “Deep Infiltrating Endometriosis,” “Psychological Impact,” among others, with a time frame between 2014 and 2021. The review aims to consolidate best practices and advances in the treatment of endometriosis, both in terms of surgical interventions and psychological approaches. Laparoscopic surgery has proven to be one of the main therapeutic options in the treatment of deep endometriosis, allowing precise removal of lesions with lower complication rates and faster recovery. Recent advances in robotic surgery have also contributed to greater precision and less tissue trauma. However, complete removal of lesions is not always possible, which can lead to recurrences. Treatment also requires a multidisciplinary approach, involving gynaecologists, urologists, proctologists and fertility specialists, for proper management and minimization of complications. The surgical approach to treating deep endometriosis continues to evolve, with technological innovations offering better results and recovery for patients. However, the complexity of the condition requires ongoing specialist follow-up and the combination of clinical and surgical treatments to ensure long-term efficacy and symptom reduction. Personalizing the treatment for each patient is fundamental to the successful management of the disease.

The perception of artificial intelligence and infertility care among patients undergoing fertility treatment.

To characterize the opinions of patients undergoing infertility treatment on the use of artificial intelligence (AI) in their care. Patients planning or undergoing in vitro fertilization (IVF) or frozen embryo transfers were invited to complete an anonymous electronic survey from April to June 2024. The survey collected demographics, technological affinity, general perception of AI, and its applications to fertility care. Patient-reported trust of AI compared to a physician for fertility care (e.g. gamete selection, gonadotropin doing, and stimulation length) were analyzed. Descriptive statistics were calculated, and subgroup analyses by age, occupation, and parity were performed. Chi-squared tests were used to compare categorical variables. A total of 200 patients completed the survey and were primarily female (n = 193/200) and of reproductive age (mean 37years). Patients were well educated with high technological affinity. Respondents were familiar with AI (93%) and generally supported its use in medicine (55%), but fewer trusted AI-informed reproductive care (46%). More patients disagreed (37%) that AI should be used to determine gonadotropin dose or stimulation length compared to embryo selection (26.5%; p = 0.01). In the setting of disagreement between physician and AI recommendation, patients preferred the physician-based recommendation in all treatment-related decisions. However, a larger proportion favored AI recommendations for gamete (22%) and embryo (14.5%) selection, compared to gonadotropin dosing (6.5%) or stimulation length (7.0%). Most would not be willing to pay more for AI-informed fertility care. In this highly educated infertile population familiar with AI, patients still prefer physician-based recommendations compared with AI.

FERTILITY CARE IN LOW AND MIDDLE INCOME COUNTRIES: Embryologists' practices of care in IVF-clinics in sub-Saharan Africa.

Despite the centrality of the role of embryologists in in vitro fertilization (IVF), there is relatively little literature on the nature of their work. In this article, we draw on results from a large ethnographic study on the emerging IVF industry in South Africa and reproductive travel in sub-Saharan Africa (SSA), where IVF clinics and embryologists are scarce. Drawing on qualitative interviews with 11 embryologists, who work(ed) in SSA, we illustrate how their care practices are produced through the interaction of people and things. We emphasize the importance of context in shaping their practices, including the shortage of embryologists, the need to set up 'first' clinics in their respective countries, the paucity of trained counsellors in clinics and the mobility of IVF staff. The embryologists we interviewed performed multiple tasks on top of their laboratory work, including entrepreneurial tasks, advocacy, training, development of regulations, mentoring and patient counselling. They enacted care in several ways, towards gametes and embryos, patients, clinics and the profession. These multiple tasks and care practices make for dynamic and fulfilling careers of the interviewed embryologists but also stretch their capacities. They also raise questions about their contribution to the scarcity of embryological work in SSA. If access to IVF is to be achieved in the SSA region, more embryologists need to be trained and retained. Embryologists play a central role in IVF. Yet, there is limited knowledge about the nature of their work. We examine the work of embryologists in SSA, where IVF clinics and embryologists are scarce. Based on qualitative interviews conducted with 12 embryologists, we illustrate the multiple tasks they perform on top of their laboratory work: entrepreneurial tasks, advocacy, training, development of regulations, mentoring and patient counselling. Context is important in shaping these practices. This includes the shortage of embryologists in the SSA region, the need to set up 'first' clinics in their respective countries, the lack of trained counsellors in clinics and the mobility of IVF staff. These multiple tasks, while professionally fulfilling, raise questions about their contribution to the scarcity of embryological work in SSA, which contributes to the limited access to IVF in this region.

TikTok as a Resource for Fertility Information and Support: A Patient Survey

Objective: TikTok is a rapidly growing social media platform with over 800 million users worldwide. Many patients access fertility-related content across social media platforms, however, this has never been studied related to TikTok. This study aimed to describe patient perspectives and experiences using TikTok for fertility-related content. Materials and methods: We conducted a cross-sectional web-based survey from April 1st 2023 to October 1st 2023 at a large fertility center in Toronto, Canada. Patients were eligible for inclusion if they self-identified that they use TikTok for fertility-related content and had pursued any form of fertility care. Results of the survey were described with descriptive statistics and thematic analysis. Results: A total of 23 patients with a mean age of 36.74±6.67 years participated in the online survey. Fertility-related TikTok content included lived experiences of fertility journeys descriptions of fertility treatments or procedures, live-streaming of fertility treatments or procedures, interactive questions and answers, and educational videos. Creators of fertility-related TikTok content include patients undergoing fertility treatments, physicians, naturopaths, counselors, and patient advocates. The most common reasons for liking TikTok for fertility content included empathy or shared experiences, stress relief, and self-education. Reasons for disliking TikTok for fertility information included misinformation, commercialization or advertisements, and negative emotions of stress, anxiety, or emotional upset. Misconceptions seen on TikTok included misinformation about complications and success rates for assisted reproductive therapy, as well as nutritional advice. Conclusion: Fertility providers should have a growing awareness of information available on TikTok for patients accessing fertility care and assisted reproductive technology.

Impact of cancer during reproductive age on the probability of livebirth after cancer: a register-based cohort study among Danish women aged 18-39 with and without cancer.

This register-based study investigates the probability of a livebirth after cancer during the female reproductive age. The study population, derived from the DANAC II cohort, included women aged 18-39 diagnosed with cancer between 1978 and 2016, matched with 60 undiagnosed women each from the general population. Primary outcome was a livebirth after cancer with follow-up until death, emigration, or end of follow-up. Hazard ratios (HR) were calculated using multivariable Cox regression analyses. The population included 21,596 women with cancer and 1,295,760 without. The 20-year cumulative incidence of livebirth after cancer/study entry was lower among women with cancer (0.22 [95% CI 0.22-0.22]) compared to those without (0.34 [95% CI 0.34-0.34]). The HR of a livebirth after cancer was 0.61 [95% CI 0.59-0.63]; highest at age 18-25 (HR = 0.72 [95% CI 0.68-0.76]); and lowest at age 33-39 (HR = 0.50 [95% CI 0.47-0.54]). Nullipara women had higher HR of a livebirth than those with children (HR = 0.72 [95% CI 0.69-0.75] vs. HR = 0.48 [95% CI 0.46-0.51]). HR was lowest for women with breast, gynecological, central-nerve-system cancer, and leukemia. Women with/without cancer were comparable in assisted reproductive technology initiation after cancer/study entry, but HR was higher among nullipara than in those with prior children. Cancer during reproductive years significantly and negatively impacts HR of a livebirth after cancer, particularly as age at diagnosis increases. Low HR of livebirth is observed in specific cancer groups. Results underscore the importance of oncofertility counseling at diagnosis, referral to fertility specialist before treatment, and follow-up after cancer, focusing on cancer type, parity status, and age at diagnosis.

Infertility and lifestyle among Finnish men and women

BackgroundThe aim of this population-based study is to examine lifestyle factors (smoking and alcohol consumption) and body mass index (BMI) among fertile and infertile Finnish women and men.MethodsInfertility was defined based on reporting having ever tried to become pregnant or to get a child unsuccessfully over a year. Logistic regression analysis was used to investigate the association of smoking, alcohol consumption and BMI with infertility when adjusted first for age and then additionally for marital status, education and employment status. Men (n = 201) and women (n = 267) who had ever experienced infertility were compared to those with no experience of infertility (n = 1677 men and n = 1257 women) and further separately for those who had despite the infertility experience received a child or not.ResultsNo significant differences between smoking or BMI were found in men by the infertility experience, compared to childless infertile and infertile men with a child. However, men with infertility experience had higher total alcohol consumption (g/year) than fertile men (p = 0.005). The odds ratio for total consumption of alcohol at an average or high level was 2.49 (95% CI 1.39–4.45) in the age adjusted model and 2.01 (CI 1.11–3.67) in the fully adjusted model for males who had experienced infertility by using the fertile men as a reference group. No differences in smoking, alcohol consumption or BMI were found between women with or without infertility experience.ConclusionsThe results indicate that in fertility counselling and care given by midwifes and health care professionals, attention should be paid to men’s lifestyle, especially to alcohol consumption. The small numbers of those having experienced infertility limited analyses in this study.

To Assess the Impact of Smoking on Semen Quality: A Comprehensive Study of Semen Parameters in North Indian Men

Objectives Infertility affects a large proportion of couples worldwide, with male factors accounting for approximately half of the cases. Smoking and other lifestyle choices have been linked to decreased sperm quality, which includes factors such as sperm count, motility, and morphology. This study intends to assess the influence of smoking on sperm quality among north Indian males seeking reproductive treatment. Material and Methods A cross-sectional study was conducted at Matritava Advanced IVF and Maternity Centre in Gurugram, Haryana, India, from September 2023 to June 2024. The study comprised 100 men aged 21–55 years old who were coming for infertility treatment and inclined to participate in the study and were divided into two groups: smokers (n = 50) and non-smokers (n = 50). Semen samples were analysed according to WHO guidelines (2021) to evaluate parameters such as semen volume, sperm concentration, total sperm count, motility, and morphology. Statistical analysis was performed using SPSS software version 25.0. Results The average age of smokers and non-smokers was 35.10 ± 4.41 years and 35.72 ± 3.80 years, respectively (p = 0.45). Smokers showed more abnormalities in semen parameters compared to non-smokers. Key findings include semen volume of (2.86 ± 1.04 ml) in smokers as compared to non-smokers (2.40 ± 0.67 ml) (p = 0.01). Smokers exhibited lower average sperm concentration (51.91 ± 37.81 million/ml) than non-smokers (67.14 ± 56.76 million/ml) (p = 0.07). Smoking significantly reduced sperm morphology (2.70 ± 0.81%) compared to non-smokers (3.50 ± 0.76%) (p < 0.001). There were no significant differences between total and progressive motility between the two groups. Conclusion Smoking has a considerable negative impact on sperm quality, particularly morphology, in males seeking fertility treatment. These findings emphasise the necessity to incorporate smoking cessation 3 months before Starting the fertility treatment to improve reproductive outcomes. Healthcare organisations should emphasise the negative effects of smoking on male fertility and advocate lifestyle modifications as part of comprehensive fertility care.

GYNs at the REI gates: unsolvable conundrum or unambiguous opportunity?

Contemporary fertility care has matured from a restricted, special interest in women's health care where success sometimes made magazine covers to a well-honed start-to-finish process with ever-improving success rates and an ever-expanding panoply of treatment options. Innovations in both lab and clinic have been exponential and game changing. The specialty now finds itself in the enviable position of an extensive menu of highly successful treatment options but a complicated set of circumstances of access to these options. Emerging technology such as artificial intelligence could facilitate this transition and improve access. But a key corollary to access and leveraging new technology relates to having a credentialed team to deliver care on scale and maintain best practices and outcomes. The current debate focuses on this Rubik's cube of personnel needs in reproductive endocrinology (REI) and weighs how best to expand access and maintain the culture and spirit of REI. A model to include providers other than REI viz, GYNs or APPs is now front and center. The objective of this Opinion is to define the current context for fertility care and within that context evaluate options and consider what a collaborative model that incorporates a spectrum of non-REI providers including GYNs might look like. Such a model may be feasible (or not) to expand access to care on scale while maintaining high standards and best outcomes.

Fertility potential in patients with ovarian cancer

Malignant neoplasms of the reproductive system are the most common form of oncological morbidity in women, accounting for over 30% of all cancer cases. Most antineoplastic agents act by inducing DNA damage in highly proliferating cancer cells, resulting in oocyte death. Ovarian toxicity is the most common side effect of cancer treatment in young women. Both chemotherapy and radiotherapy have been shown to be toxic to the ovaries, increasing the risk of premature ovarian failure, early menopause, endocrine disorders, and infertility. Patients who have undergone cancer treatment have severe follicular atresia, even if they have a regular menstrual cycle. Currently, the most effective methods of preserving fertility in cancer patients include cryopreservation of oocytes and embryos after ovarian hyperstimulation. Other fertility preservation methods include ovarian tissue cryopreservation, follicle or embryo maturation in vitro, ovarian transposition, ovarian suppression, and adjuvant therapy. Despite promising fertility prospects, iatrogenic infertility is one of the most undesirable adverse effects of cancer therapy for young women. Timely referral to a gynecologist prior to chemotherapy or radiation therapy is key to successful fertility preservation. Women should be aware of the available opportunities of assisted reproductive technologies, along with potential risks and failures with regard to their age, stage of disease, and treatment method. At this stage, it is necessary to develop well-defined and effective algorithms for oncologists, obstetrician-gynecologists, fertility specialists, and embryologists.

Diagnostic and therapeutic hysteroscopy in Ethiopia: a retrospective study on practice and outcomes

BackgroundHysteroscopy is considered the standard for evaluating the uterine cavity. Limited data exists regarding hysteroscopy in Ethiopia. Therefore, the objective of the study was to describe the diagnostic and operative hysteroscopic procedures at St. Paul’s Hospital.MethodologyA three-year retrospective descriptive study examined patients who underwent diagnostic and therapeutic hysteroscopy at the Center for Fertility and Reproductive Medicine, St. Paul’s Hospital Millennium Medical College in Addis Ababa, Ethiopia, from June 2018 to June 2021. Descriptive statistics were employed to summarize the findings observed during the hysteroscopy procedures.ResultA total of 328 patient records underwent review and analysis in the study. The mean participant age was 31.9 years (31.9 ± 5.1 years), with about 81.4% being nulliparous. Primary infertility (48.5%) was the leading indication for hysteroscopic evaluation, followed by secondary amenorrhea (18%), secondary infertility (17.4%), and abnormal uterine bleeding (8.8%). Concerning hysteroscopic procedures, 6.1% of participants exhibited no uterine cavity abnormalities. Primary hysteroscopy findings comprised intracavitary adhesions (48.2%), endometrial polyps (18%), and submucosal myomas (9%). Adhesiolysis stood out as the foremost surgical procedure, conducted in 48.2% of patients, followed by polypectomy in 20.7%, and fibroid removal in 9%. The complication rate was 2.4%, exclusively during operative hysteroscopy, with uterine perforation observed in six patients.ConclusionOur hysteroscopic evaluation was predominantly requested for primary infertility cases, with secondary amenorrhea, secondary infertility, and abnormal uterine bleeding also being commonly encountered indications. Adhesiolysis was the leading intervention during hysteroscopy, while uterine perforation was the main complication. The hysteroscopy procedures exhibited a strong safety profile, with few complications noted. Future studies should address factors affecting outcomes in diagnostic and operative hysteroscopy, and common factors linked to intrauterine adhesions.

Reproductive Health in Women with Major β-Thalassemia: Evaluating Ovarian Reserve and Endocrine Complications.

Thalassemia is an autosomal recessive hereditary chronic hemolytic anemia characterized by a partial or complete deficiency in the synthesis of alpha- or beta-globin chains, which are essential components of adult hemoglobin. Mutations in the globin genes lead to the production of unstable globin chains that precipitate within cells, causing hemolysis. This shortens the lifespan of mature red blood cells (RBCs) and results in the premature destruction of RBC precursors in the bone marrow. Regular red blood cell transfusions are the standard treatment for thalassemia. However, these transfusions can lead to increased iron overload, which can impair vital systems such as the liver, heart, ovaries, and endocrine system. Focusing on female reproductive endocrinology, recurrent blood transfusions can cause iron accumulation in the pituitary and hypothalamus, leading to hypogonadotropic hypogonadism (HH), the most common endocrinopathy in these patients, affecting 40-91% of women. Recurrent transfusions and the resulting iron overload can also lead to oxidative stress and ovarian damage in patients with beta-thalassemia major (BTM). Despite advancements in iron chelation therapy, hypothalamic-pituitary damage associated with HH contributes to subfertility and sexual dysfunction, often with little to no recovery. In women exposed to gonadotoxic drugs, particularly those with BTM, anti-Mullerian hormone (AMH)-a marker of ovarian reserve-is frequently used to assess ovarian damage. This review aims to explore the pathophysiology of β-thalassemia and its major clinical manifestations, with a focus on endocrine complications and their impact on ovarian reserve. It also investigates how metabolomics can provide insights into the disease's metabolic alterations and inform current and emerging therapeutic strategies to mitigate complications and optimize patient outcomes, potentially leading to more effective and personalized treatments.

LncRNA-MSTRG.19083.1 Targets NTRK2 as a miR-429-y Sponge to Regulate Circadian Rhythm via the cAMP Pathway in Yak Testis and Cryptorchidism.

Long noncoding RNAs (LncRNAs) play essential roles in numerous biological processes in mammals, such as reproductive physiology and endocrinology. Cryptorchidism is a common male reproductive disease. Circadian rhythms are actively expressed in the reproductive system. In this study, a total of 191 LncRNAs were obtained from yak testes and cryptorchids. Then, we identified NTRK2's relationship to circadian rhythm and behavioral processes. Meanwhile, the ceRNA (LncRNA-MSTRG.19083.1/miR-429-y/NTRK2) network was constructed, and its influence on circadian rhythm was revealed. The results showed that NTRK2 and LncRNA-MSTRG.19083.1 were significantly upregulated, and miR-429-y was obviously decreased in cryptorchid tissue; NTRK2 protein was mainly distributed in the Leydig cells of the testis. In addition, the upregulation of the expression level of miR-429-y resulted in the significant downregulation of LncRNA and NTRK2 levels, while the mRNA and protein levels of CREB, CLOCK, and BMAL1 were significantly upregulated; the knockdown of miR-429-y resulted in the opposite changes. Our findings suggested that LncRNA-MSTRG.19083.1 competitively binds to miR-429-y to target NTRK2 to regulate circadian rhythm through the cAMP pathway. Taken together, the results of our study provide a comprehensive understanding of how the LncRNA-miRNA-mRNA networks operate when yak cryptorchidism occurs. Knowledge of circadian-rhythm-associated mRNAs and LncRNAs could be useful for better understanding the relationship between circadian rhythm and reproduction.

Assessment of Reproductive Endocrinology and Infertility Fellowship Programs Website.

The aim of the study was to assess the comprehensiveness of the Reproductive Endocrinology and Infertility (REI) fellowship program websites in North America. All active REI fellowship program websites in the United States of America (USA) and Canada were evaluated and assessed using 72-point scoring criteria. Any fellowship programs without publicly accessible websites were excluded. The scoring criteria consisted of the following domains - recruitment, faculty information, fellow information, research and education, surgical program, clinical work, benefits and career planning, wellness, and environment. We identified 49 REI fellowship programs in the USA and ninein Canada of which 47 A programs and all Canadian programs had an accessible website. The mean score was significantly higher for USA program websites (61.5% (USA) versus 47.7% (Canada); p<0.001). The "wellness" domain had the highest prevalence of criteria (85.3% of websites) across all program websites, whereas the "fellow information" domain had the lowest (20.0% of websites). In conclusion, American REI fellowship program websites included more program-related content, compared to Canadian program websites.

Management and Counselling of Patients with Recurrent Pregnancy Loss Presenting to an Infertility Specialist – A Review Article

Background: Recurrent pregnancy loss (RPL) is defined as the occurrence of two or more consecutive miscarriages before 20 weeks of gestation. It affects approximately 1-2 % of couples trying to conceive and be a devastating experience for those affected. The etiology of RPL is multifactorial, encompassing genetic, anatomical, hormonal, immunological and environmental factors. Genetic abnormalities, such as chromosomal rearrangement, are implicated in a significant proportion of cases. Uterine anomalies and hormonal imbalances also contribute to pregnancy loss, while autoimmune disorders and blood clotting abnormalities play a role in some cases. Diagnostic approaches involve a comprehensive evaluation including karyotyping, imaging studies and screening for autoimmune disorders. Management strategies are tailored to the underlying causes when identified and may include surgical interventions, medical therapies and lifestyle modifications. Despite advancements in understanding the causes and treatment of RPL, the condition remains a challenging area of reproductive medicine. This purpose of this review study is to address the etiology and pathology of RPL in women presenting with sub fertility and infertility in an infertility clinic which will encourage other researchers. Early detection and intervention of the factors responsible of RPL will help the patient suffering from RPL and will achieved a successful reproductive life. J Com Med Col Teachers Asso July 2024; 28(2):100-104

Navigating an uncertain future: a qualitative study exploring thoughts about fertility and oncofertility counseling among young men with cancer.

This study aimed to explore the thoughts and experiences of young men with cancer regarding the risk of infertility and the oncofertility counseling they received at diagnosis and during their cancer trajectory. This qualitative study was conducted from October 2023 to February 2024 at the Copenhagen University Hospital-Rigshospitalet. Inclusion criteria were male adolescents and young adults with cancer aged 15-29 years. We conducted fourteen individual, semi-structured, qualitative interviews with male adolescents and young adults with either leukemia, lymphoma, or testicular cancer. Data were analyzed using thematic analysis. Three themes were identified: (1) Young men with cancer have existential thoughts about future children; (2) young men call for information and communication about the risk of reduced fertility chances after cancer; (3) young men experience challenges related to cryopreservation of semen. Young men desire children after cancer and fertility preservation offers reassurance. Psychological and physical fertility issues often impact body image and masculinity during cancer. Oncofertility counseling is limited, usually brief at diagnosis; however, discussions on treatment-related fertility challenges remain sparse during follow-up. Young men often experience stress related to fertility preservation at diagnosis, which they feel is not recognized by healthcare professionals. This underscores the need for better oncofertility education for healthcare professionals and closer collaboration between oncologists, hematologists, and fertility specialists.

Estimating the public economic gains in Taiwan from in vitro fertilization (IVF) subsidy changes implemented in 2021.

What is the governmental fiscal impact of a new assisted reproduction subsidy scheme based on projected lifetime net taxes attributed to resulting live births in Taiwan? We estimate that the new fertility reimbursement scheme has generated favorable lifetime fiscal gains for the Taiwanese government, resulting in a return on investment (ROI) of NT$5.6 for every NT$1.0 spent based on those families receiving public subsidies for fertility care under the new scheme. Globally, there is variation in the amount of public reimbursement for assisted reproduction provided to infertile couples. Cost is an important consideration for many infertile couples that can influence the amount of services provided and the types of services used. The analysis is based on the number of live births resulting from those couples receiving public subsidies for assisted reproduction. The cohort is based on those children born between March 2022 and July 2023. A lifetime fiscal model was developed to project age-specific lifetime tax revenue and age-dependent benefits likely received from government attributed to the children born. The analysis is based on age-specific projected earnings adjusted for work activity and applied to published income tax burden data, in addition to estimated indirect consumption taxes paid. Furthermore, we estimate the lifetime national insurance contributions per worker, including employer contributions. To account for changes over the modeling period, we increased wages based on historical economic growth, government benefits were increased based on the rate of consumer price inflation rate, and all costs and taxes were discounted at 3.5%. A child born in Taiwan in 2022 is expected to pay discounted gross tax revenues of NT$7257438 and receive NT$5373730 in discounted future benefits from the government. Following implementation of the new funding policy, based on the number of resulting births, the cost per live birth is NT$331918. Applying the cost per live birth, we estimate the discounted net tax revenue to be NT$1551789 for each child born from the subsidy. The ROI for the Taiwanese government is estimated at 568% over the lifetime of the IVF-conceived children. Several assumptions are applied in making long-term financial projections. Should economic conditions change dramatically, this could influence the projections described in our work. The results suggest the government benefits from public subsidy for fertility services when taking into consideration the long-term work activity of these children and future tax revenue generated for government. The results are broadly applicable to other markets, although variations in wages, lifetime work activity, and taxation rates would influence the conclusions reported here. The work was sponsored by the Merck Group in Singapore (funding to N.K. and M.P.C.). The sponsoring organization was given an opportunity to review the final manuscript; however, the authors retained full editorial control over the final published materials. The authors hold no financial interests in the sponsoring company. N.K. and M.P.C. have received consulting fees from Merck and Organon and payment/honoraria from Merck. M.-J.C. received no funding for this work but has received honoraria for lectures from the Taiwanese Society for Reproduction Medicine, Taiwanese Association of Obstetrics and Gynecology, Japanese Society of Obstetrics and Gynecology, The Endocrine Society of the ROC, Merck, Organon, and Ferring; attendance fees for expert meetings from Health Promotion Administration, Ministry of Health and Welfare, Taiwan, and the National Science and Technology Council of Taiwan; and support for attending meetings and/or travel from the National Science and Technology Council of Taiwan and Merck. None of the other authors report any conflicts in relation to this work. N/A.

Women's healthcare providers' knowledge and practices surrounding fragile-X associated primary ovarian insufficiency (FXPOI).

This study investigates the knowledge gaps about fragile X-associated primary ovarian insufficiency (FXPOI) among women's healthcare providers. Previous research highlighted a lack of awareness regarding FXPOI as a cause of primary ovarian insufficiency (POI) and its diagnosis. The objective of this study was to describe these gaps and explore demographic factors influencing FXPOI knowledge in women's healthcare practitioners. A survey assessed familiarity with primary ovarian insufficiency and FXPOI knowledge among 107 women's healthcare providers and 14 medical students in the USA. Knowledge Scores, ranging from 0 to 16, were assigned, and demographic data, including healthcare provider type, specialty, and genetics exposure in education or training, were collected. Participants scored an average of 6.92 (± 2.19) out of 16 (42%) despite 88% of participants reporting genetics exposure in training. Maternal fetal medicine (MFM) and reproductive endocrinology (REI) providers significantly outperformed general obstetrics and gynecology (OBGYN) practitioners (p = 0.0186 and 0.0125, respectively). Participants with a genetic counselor in their clinic scored 8% higher (p = 0.0083) than those without. Additionally, medical school graduation year was a significant predictor for knowledge score (p = 0.0397). This study underscores limited FXPOI knowledge among women's healthcare providers, aligning with patient reports. Notably, medical specialty and the presence of a genetic counselor impacted knowledge, emphasizing the urgency for broader education in women's healthcare, particularly among OBGYNs, the initial point of contact for patients with POI symptoms.

Study of alteration of reproductive cycle and hematological parameters of pcosinduced mus musculus

Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder affecting reproductive and metabolic health in females. This study investigates the effects of PCOS induction on the reproductivecycle and haematological parameters in Mus musculus (laboratory mice). PCOS was induced using both androgen (dihydrotestosterone) and letrozole (an aromatase inhibitor), two widely accepted methods for modelling the disorder. Vaginal cytology was performed to monitor the estrus cycle, while blood samples were analyzed for haematological alterations. Results indicated a significant disruption of the estrus cycle in PCOS-induced mice, characterized by prolonged diestrus and anovulation, mirroring reproductive dysfunctions observed in human PCOS. Hematologically, PCOS mice exhibited leukocytosis, elevated neutrophil counts, and alterations in red blood cell (RBC) parameters, suggesting a state of chronic inflammation and metabolic stress. These findings underscore the systemic nature of PCOS, affecting both reproductive and haematological functions, and reinforce the value of mice models in studying the complex interplay between reproductive endocrinology and systemic metabolic disturbances. The study enhances our understanding of the pathophysiological changes in PCOS and provides a foundation for future investigations into potential therapeutic interventions targeting both the reproductive and metabolic aspects of the disorder.. KEYWORDS :PCOS, Mice, Estrus, Hematological, Weight, RBC, WBC

Principal investigator gender and clinical trial success: Analysis of over 3000 obstetrics and gynecology trials

In obstetrics and gynecology (OBGYN) research, gender disparities permeate through leadership, funding, promotion, mentorship, publishing, compensation, and publicity. Few studies have investigated OBGYN clinical trial leadership as it relates to investigator gender. Thus, we undertook an investigation of principal investigator (PI) gender and clinical trial success. To characterize United States (US) OBGYN clinical trials by PI gender and analyze the association between PI gender and features of trial success. This is a cross-sectional study of all US-based obstetric and gynecologic clinical trials registered on ClinicalTrials.gov (2007-2020). We examined associations between PI gender (ie, led by women, men, or both) and four primary outcomes that capture clinical trial success: early discontinuation (ie, absence of early discontinuation is a feature of success), reporting of complete trials to ClinicalTrials.gov, publication in a peer-reviewed journal, and clinical trial participant diversity (reporting of racial and ethnic diversity data and representation of diverse cohorts). Multivariable analyses controlled for subspecialty, multiple PI status, source of funding, primary purpose, phase, number of arms, enrollment, year of trial registration, blinding, oversight by a Data Safety Monitoring Committee, and number of study sites. Sensitivity analysis accounted for individual PI who led multiple clinical trials. Univariable and multivariable logistic regression analysis models were applied. We conducted multiple imputation for missing covariable data. There were no missing exposure or outcome data in the final cohort. We reviewed 12,635 clinical trials focused on OBGYN. Of the 4342 trials with at least one site in the US, PI names were available for 3087 trials (71.1%). The majority of OBGYN trials were women-led (women 1696, 54.9%; men 1272, 41.2%, coled 119, 3.9%). A greater proportion of obstetrics trials (617, 60.0%) were women-led than gynecology trials (1079, 52.4%). Family planning had the greatest proportion of women-led trials (145, 74.7%), whereas reproductive endocrinology and infertility had the lowest (50, 30.9%). A greater proportion of industry-funded trials were led by men (123, 64.7%). In adjusted analysis, women-led trials had lower odds of early discontinuation (men-led reference; women-led adjusted odds ratio [aOR] 0.58, 95% confidence interval [CI] 0.44, 0.77). Women-led trials reported results less frequently (men-led reference; women-led aOR 0.52, CI 0.40-0.62) but no significant difference was seen in publication (men-led reference; women-led aOR 1.02, CI 0.57, 1.81). Women-led trials had greater odds of reporting race and ethnicity participant data (men-led reference; aOR 1.87, CI 1.27-2.47) but there was no difference in cohort diversity by PI gender. Women investigators lead approximately half of OBGYN clinical trials in the US. Women-led trials discontinue less frequently, publish at similar rates, and include data on diversity more frequently than men-led trials. Women are as successful as men in conducting clinical trials and, in certain domains, more successful. Our findings place the impetus on the OBGYN professional ecosystem to support women's academic careers.