Siegel DR, Grau L, Sammel M, Nel-Themaaat L, Santoro N, Polotsky AJ. Anti-Müllerian Hormone and Follicle-Stimulating Hormone Are Poor Independent Predictors of Live Birth After Assisted Reproductive Technology. Reprod Sci. 2022 Oct 4. doi: 10.1007/s43032-022-01099-3. Epub ahead of print. PMID: 36194358.

Selter JH, Price TM, Harris BS. Fibroids in pregnancy: a growing or shrinking issue? Fertil Steril. 2022 Oct;118(4):666-667. doi: 10.1016/j.fertnstert.2022.08.001. Epub 2022 Sep 2. PMID: 36064663.

Dilday E, Gigg M, Hoyos L, Quinn M, Markovic D, Kroener L. Luteal phase support with progesterone does not improve pregnancy rates in patients undergoing ovarian stimulation with letrozole. Reprod Biomed Online. 2023 Jan;46(1):123-128. doi: 10.1016/j.rbmo.2022.09.012. Epub 2022 Sep 20. PMID: 36396533.

Supplemental progesterone is routinely used as luteal phase support in non-IVF fertility treatments, despite limited data to support its use. This was a retrospective cohort study that included 273 patients undergoing ovarian stimulation with letrozole paired with IUI or timed intercourse between January 2018 and October 2021. A total of 492 letrozole ovarian cycles were included. Ovulation stimulation protocol included baseline transvaginal ultrasound on cycle day 2 or 3, and letrozole (2.5, 5, or 7.5 mg) daily for five days. When given, vaginal progesterone (Prometrium, 200 mg) was initiated two days post-IUI or 4 days post-hCG trigger in timed intercourse cycles, twice or three times daily. Of these cycles, there was not a significant difference in multifollicular development between those who did and those who did not receive progesterone (P=0.337), as well as no difference in unadjusted clinical pregnancy rate between those who did and those who did not receive progesterone (P=0.645). Live birth rate and infant weight at delivery were similarly not significantly different between groups (P=0.599, 0.076, respectively).

Plowden TC, Mumford SL, Wild RA, Cedars MI, Steiner AZ, Franasiak JM, Diamond MP, Santoro N. Probability of Pregnancy With Mono vs Multiple Folliculogenesis in Women With Unexplained Infertility. J Endocr Soc. 2022 Sep 15;7(1):bvac142. doi: 10.1210/jendso/bvac142. PMID: 36447958; PMCID: PMC9692188.

This study was conducted as a secondary analysis of a randomized controlled trial that included 12 clinical sites across the US. The trial ‘Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation with 3 treatment arms: gonadotropins, clomiphene, or letrozole, combine with intrauterine insemination (AMIGOS trial)’ included women aged 18 to 40 years old with a normal uterine cavity, at least 1 patent fallopian tube, and male partners with ≥5 million total motile sperm. A total of 900 couples were enrolled. In the overall cohort, women with one mature follicle ≥16 mm at the time of hCG trigger were less likely to have a clinical pregnancy (RR, 0.70; 95% CI, 0.54-0.89) and live birth (RR, 0.67; 95% CI, 0.54-0.89) compared to women with ≥2 follicles larger than 16 mm. Comparable outcomes were observed when follicle size cutoff was ≥18 mm; women with one follicle were less likely to have a clinical pregnancy (RR, 0.77; 95% CI, 0.60-0.98) and live birth (RR, 0.75; 95% CI 0.58-0.97). When stratified by treatment modality, women using letrozole saw no difference in chance of live birth and follicle number, while women using clomiphene or gonadotropins were more likely to have a clinical pregnancy and live birth when having ≥2 follicles as opposed to one follicle.

Matevossian K, Rivelli A, Uhler ML. Fertility knowledge and views on egg freezing and family planning among surgical specialty trainees. AJOG Glob Rep. 2022 Sep 7;2(4):100096. doi: 10.1016/j.xagr.2022.100096. PMID: 36536848; PMCID: PMC9758326.

A survey was emailed to medical trainees across a broad range of medical specialties to gather information about US residents’ and fellows’ fertility knowledge and their views on family planning. The responses from those who completed the survey suggest that women physicians and Ob/Gyn trainees do not have greater knowledge of basic female fertility than males or those in other specialties. Female trainees were less likely to be married or have children and more likely to report postponing childbearing.

Romanski PA, Aluko A, Bortoletto P, Elias R, Rosenwaks Z. Age-specific blastocyst conversion rates in embryo cryopreservation cycles. Reprod Biomed Online. 2022 Sep;45(3):432-439. doi: 10.1016/j.rbmo.2022.04.006. Epub 2022 Apr 21. PMID: 35610153.

Romanski PA, Bortoletto P, Pfeifer SM. Cervical agenesis: surgical preservation of reproductive potential in spite of anatomic variation. Fertil Steril. 2022 Sep;118(3):596-597. doi: 10.1016/j.fertnstert.2022.07.004. PMID: 36116805.

Cervical agenesis is a rare anomaly that occurs in 0.001% of the general population, granting even experienced reproductive physicians limited exposure to this congenital disorder. This editorial touches on the historical management, and poor associated outcomes, of the condition. Recent developments have determined that uterovaginal/vestibular anastomosis are the recommended treatment for this condition, but each case should be treated on a case-by-case basis, leading to variable surgical techniques per surgeon. The editorial continues a discussion of a recently developed surgical technique by Fedele et al. (Fertil Steril 2021) utilizing laparoscopically assisted uterovaginal/vestibular anastomosis for patients with cervical agenesis with complete or partial vaginal agenesis.

Hewitt SC, Wu SP, Wang T, Ray M, Brolinson M, Young SL, Spencer TE, DeCherney A, DeMayo FJ. The Estrogen Receptor α Cistrome in Human Endometrium and Epithelial Organoids. Endocrinology. 2022 Sep 1;163(9):bqac116. doi: 10.1210/endocr/bqac116. PMID: 35895287; PMCID: PMC9368022.

Women aged 19 to 34 years old, with regular intermenstrual interval between 25 and 35 days, and no history of infertility or pelvic disease were included in the study. Endometrial biopsies were collected and processed for ESR1 ChIPseq and isolation of epithelial cells for culture of organoids. Study findings include a preferential enrichment of HOX motifs in the mid-secretory ESR1 peaks, and bHLH motifs are enriched in proliferative and mid-secretory ESR1 peaks. Data presented in this study elucidates details of estrogen-mediated response in uterine tissue.

Siegel DR, Sheeder J, Kramer W, Roeca C. Are donor-conceived people willing to use donors themselves? Insights from individuals conceived via donor-assisted reproduction. Hum Reprod. 2022 Aug 25;37(9):2087-2094. doi: 10.1093/humrep/deac169. PMID: 35906918.

Utilizing a web-based survey that was distributed to users of the Sibling Donor Registry, this study found that 40.2% of people who were conceived using donor gametes would consider using donor gametes themselves and 24.6% were undecided. Those who were undecided or had already used donor gametes tended to be younger, and less likely to be married or identify as female than those who would not consider donor gametes.

Martin S, Deng J, Searl T, Ohlander S, Harrington DA, Stupp SI, Dynda D, McVary KT, Podlasek CA. Sonic Hedgehog Signaling in Primary Culture of Human Corpora Cavernosal Tissue From Prostatectomy, Diabetic, and Peyronie’s Patients. J Sex Med. 2022 Aug;19(8):1228-1242. doi: 10.1016/j.jsxm.2022.04.010. Epub 2022 Jun 23. PMID: 35752559; PMCID: PMC9329230.

Akers A, New EP, Plosker S, Silva CP, Sprague R, Imudia AN. Oocyte Retrieval in Asymptomatic Patients Positive for SARS-CoV-2. Case Rep Obstet Gynecol. 2022 Aug 12;2022:3107747. doi: 10.1155/2022/3107747. PMID: 35990707; PMCID: PMC9391171.

COVID-19 has created an additional barrier for women who wish to or are currently undergoing fertility treatment. Fertility centers should address asymptomatic, COVID-19 positive patients on a case-by-case basis in order to ensure safety to center staff and the patient, while also mitigating the dangers associated with cycle cancellation. This study is a discussion of two case studies where women underwent oocyte retrievals and were asymptomatic but tested positive for COVID-19. In both special cases, the risks of canceling the cycles were heavily considered by practice physicians and risk management, and extra precautions were taken to ensure no medical staff were also infected.

Peters BA, Santoro N, Kaplan RC, Qi Q. Spotlight on the Gut Microbiome in Menopause: Current Insights. Int J Womens Health. 2022 Aug 10;14:1059-1072. doi: 10.2147/IJWH.S340491. PMID: 35983178; PMCID: PMC9379122.

This review emphasizes the need to further study the gut microbiome, a key contributor to women’s health, in relation to a woman’s shift into a menopause. Authors include a discussion on the gut microbiome and hormonal transition through pregnancy, pre-menopause, and post-menopause. Particular attention is drawn to the influence of hormones on microbial translocation in the gut barrier, and the role of hormones, specifically estrogens and progesterone, as regulators of the immune system. Additionally, current studies of menopause and the gut microbiome are summarized, as well as the findings. This discussion prompts the need for further research on the influence of the gut microbiome’s ability to recycle sex hormones post-menopause.

Grimes NP, Bertone-Johnson ER, Whitcomb BW, Sievert LL, Crawford SL, Gold EB, Avis NE, Greendale GA, Santoro N, Habel LA, Reeves KW. Anti-Müllerian hormone levels and breast cancer risk in the study of women’s health across the nation. Cancer Causes Control. 2022 Aug;33(8):1039-1046. doi: 10.1007/s10552-022-01596-5. Epub 2022 Jun 29. PMID: 35768642.

The presented study addresses the current lack of literature addressing the relationship between AMH levels with breast cancer in women who do not identify as non-Hispanic and white, and gathered information from Chinese, Japanese, Black, Hispanic, and white women. This SWAN study measured AMH level by ELISA, and breast cancer history was assessed during a series of interviews. AMH measurements were available for 1,529 SWAN participants, 84 of which reported an incident of a breast cancer diagnosis. Subgroup analysis revealed the hazard ratio for continuous AMH was 1.11 (95% CI 0.92–1.34) for White women, 1.04 (95% CI 0.86–1.27) for Black women and 1.07 (95% CI 0.85–1.33) for Asian women. This study was not able to accurately assess the hazard ratio for Hispanic women due to low incidence of breast cancer in this subgroup. A non-significant, positive association was observed between AMH level and risk of breast cancer in pre- and perimenopausal women.

Pal L, Morgan K, Santoro NF, Manson JE, Taylor HS, Miller VM, Brinton EA, Lobo R, Neal-Perry G, Cedars MI, Harman SM, James TT, Gleason CE. Cardiometabolic measures and cognition in early menopause – Analysis of baseline data from a randomized controlled trial. Maturitas. 2022 Aug;162:58-65. doi: 10.1016/j.maturitas.2022.04.004. Epub 2022 Apr 29. PMID: 35617770.

Data from the KEEPS (Kronos Early Estrogen Prevention Study) clinical trial suggests that recently menopausal women with higher waist circumferences (over 88 cm) and waist-to-hip ratios (over 0.8) were associated with lower cognitive function, assessed by lower Modified Mini Mental Status scores.

Doyle N, Combs JC, Jahandideh S, Wilkinson V, Devine K, O’Brien JE. Live birth after transfer of a single euploid vitrified-warmed blastocyst according to standard timing vs. timing as recommended by endometrial receptivity analysis. Fertil Steril. 2022 Aug;118(2):314-321. doi: 10.1016/j.fertnstert.2022.05.013. Epub 2022 Jun 13. PMID: 35710597; PMCID: PMC9329263.

Endometrial receptivity analysis (ERA) is an add-on tool used in the fertility practice to find the optimal timing of egg implantation into the endometrium during the menstrual cycle. This study found that in a pool of patients with previously unsuccessful frozen embryo transfers, live birth outcomes did not differ when ERA results deemed the endometrium receptive or nonreceptive. Patients who used ERA and those who underwent standard protocol did not have differences in live birth outcomes.

Chung A, Romanski PA, Bortoletto P, Spandorfer SD. Live birth outcomes are not associated with household income and insurance disparities following ART treatment. Reprod Biomed Online. 2022 Aug;45(2):410-416. doi: 10.1016/j.rbmo.2022.04.004. Epub 2022 Apr 20. PMID: 35610155.

Zanolli NC, Bishop KC, Kuller JA, Price TM, Harris BS. Fibroids and Fertility: A Comparison of Myomectomy and Uterine Artery Embolization on Fertility and Reproductive Outcomes. Obstet Gynecol Surv. 2022 Aug;77(8):485-494. doi: 10.1097/OGX.0000000000001052. PMID: 35932289.

Mima M, Huang JB, Andriole GL, Freedland SJ, Ohlander SJ, Moreira DM. The impact of smoking on sexual function. BJU Int. 2022 Aug;130(2):186-192. doi: 10.1111/bju.15711. Epub 2022 Mar 3. PMID: 35166438.

Fanton M, Nutting V, Rothman A, Maeder-York P, Hariton E, Barash O, Weckstein L, Sakkas D, Copperman AB, Loewke K. An interpretable machine learning model for individualized gonadotrophin starting dose selection during ovarian stimulation. Reprod Biomed Online. 2022 Jul 28:S1472-6483(22)00498-9. doi: 10.1016/j.rbmo.2022.07.010. Epub ahead of print. PMID: 36096871.

A machine learning model was developed using de-identified, electronic medical record data from three IVF clinics to determine the best starting dose of FSH during ovarian stimulation per individual. This tool uses historical FSH dosing and clinical outcomes as a guideline for new patients starting ovarian stimulation and may help standardize care across fertility practices.

Santoro N. A call to action to reproductive endocrinologists: we cannot avoid the culture wars. Fertil Steril. 2022 Jul;118(1):54-55. doi: 10.1016/j.fertnstert.2022.04.021. Epub 2022 May 21. PMID: 35610092.

Dr. Nanette Santoro shares her story of being raised in a religious household and discusses the damage brought unto women from the culture wars of abortion and the pro-life movement. Dr. Santoro goes on to discuss the need to disassociate a woman’s reproductive potential to her worth and remove religious ties from public policy.