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International policies on posthumous reproduction: a pilot survey study [Letter]

Lawrence, Morgan A; McLean, Laura; Sampson, Amani; Jalili, Dona; Caplan, Arthur; Salama, Mahmoud; Goldman, Kara N; Quinn, Gwendolyn P
PMID: 36208358
ISSN: 1573-7330
CID: 5351802

Disaster preparedness in assisted reproductive technology

Goldman, Kara N; McCaffrey, Caroline; Riley, Joan; Jungheim, Emily; Grifo, Jamie A
The American Society for Reproductive Medicine compels centers providing reproductive medicine care to develop and implement an emergency preparedness plan in the event of a disaster. Reproductive care is vulnerable to disruptions in energy, transportation, and supply chains as well as may have potential destructive impacts on infrastructure. With the relentless progression of events related to climate change, centers can expect a growing number of such disruptive events and must prepare to deal with them. This article provides a case study of the impact of Hurricane Sandy on one center in New York City and proposes recommendations for future preparedness and mitigation.
PMID: 35878943
ISSN: 1556-5653
CID: 5276282

A synopsis of global frontiers in fertility preservation

Ataman, L M; Laronda, M M; Gowett, M; Trotter, K; Anvari, H; Fei, F; Ingram, A; Minette, M; Suebthawinkul, C; Taghvaei, Z; Torres-Vélez, M; Velez, K; Adiga, S L; Anazodo, A; Appiah, L; Bourlon, M T; Daniels, N; Dolmans, M M; Finlayson, C; Gilchrist, R B; Gomez-Lobo, V; Greenblatt, E; Halpern, J A; Hutt, K; Johnson, E K; Kawamura, K; Khrouf, M; Kimelman, D; Kristensen, S; Mitchell, R T; Moravek, M B; Nahata, L; Orwig, K E; Pavone, M E; Pépin, D; Pesce, R; Quinn, G P; Rosen, M P; Rowell, E; Smith, K; Venter, C; Whiteside, S; Xiao, S; Zelinski, M; Goldman, K N; Woodruff, T K; Duncan, F E
Since 2007, the Oncofertility Consortium Annual Conference has brought together a diverse network of individuals from a wide range of backgrounds and professional levels to disseminate emerging basic and clinical research findings in fertility preservation. This network also developed enduring educational materials to accelerate the pace and quality of field-wide scientific communication. Between 2007 and 2019, the Oncofertility Consortium Annual Conference was held as an in-person event in Chicago, IL. The conference attracted approximately 250 attendees each year representing 20 countries around the world. In 2020, however, the COVID-19 pandemic disrupted this paradigm and precluded an in-person meeting. Nevertheless, there remained an undeniable demand for the oncofertility community to convene. To maintain the momentum of the field, the Oncofertility Consortium hosted a day-long virtual meeting on March 5, 2021, with the theme of "Oncofertility Around the Globe" to highlight the diversity of clinical care and translational research that is ongoing around the world in this discipline. This virtual meeting was hosted using the vFairs ® conference platform and allowed over 700 people to participate, many of whom were first-time conference attendees. The agenda featured concurrent sessions from presenters in six continents which provided attendees a complete overview of the field and furthered our mission to create a global community of oncofertility practice. This paper provides a synopsis of talks delivered at this event and highlights the new advances and frontiers in the fields of oncofertility and fertility preservation around the globe from clinical practice and patient-centered efforts to translational research.
PMCID:9307970
PMID: 35870095
ISSN: 1573-7330
CID: 5279432

Correction to: A synopsis of global frontiers in fertility preservation

Ataman, L M; Laronda, M M; Gowett, M; Trotter, K; Anvari, H; Fei, F; Ingram, A; Minette, M; Suebthawinkul, C; Taghvaei, Z; Torres-Vélez, M; Velez, K; Adiga, S K; Anazodo, A; Appiah, L; Bourlon, M T; Daniels, N; Dolmans, M M; Finlayson, C; Gilchrist, R B; Gomez-Lobo, V; Greenblatt, E; Halpern, J A; Hutt, K; Johnson, E K; Kawamura, K; Khrouf, M; Kimelman, D; Kristensen, S; Mitchell, R T; Moravek, M B; Nahata, L; Orwig, K E; Pavone, M E; Pépin, D; Pesce, R; Quinn, G P; Rosen, M P; Rowell, E; Smith, K; Venter, C; Whiteside, S; Xiao, S; Zelinski, M; Goldman, K N; Woodruff, T K; Duncan, F E
PMID: 35920992
ISSN: 1573-7330
CID: 5288072

Knowledge of Fertility and Perspectives About Family Planning Among Female Physicians

Smith, Kathryn S; Bakkensen, Jennifer B; Hutchinson, Anne P; Cheung, Elaine O; Thomas, Jessica; Grote, Veronika; Moreno, Patricia I; Goldman, Kara N; Jordan, Neil; Feinberg, Eve C
Importance/UNASSIGNED:Pervasive gender disparities exist in medicine regarding promotion, achievement of academic rank, and appointment to leadership positions. Fertility and childbearing concerns may contribute to these disparities. Objective/UNASSIGNED:To assess fertility knowledge and concerns and evaluate barriers to family building and impact on academic attrition reported by female physicians. Design, Setting, and Participants/UNASSIGNED:This qualitative study used mixed methods; first, structured 1:1 interviews exploring fertility knowledge and family-building concerns were conducted among 16 female physicians between November 2019 and May 2020. Transcripts were coded in Dedoose and used to develop a survey instrument with subsequent pilot testing conducted among 24 female physicians between April 2020 and September 2020. Data analysis was performed from January 2021 to March 2021. Main Outcomes and Measures/UNASSIGNED:Fertility knowledge, perceptions of peer and institutional support surrounding childbearing, factors contributing to delayed childbearing, and impact of family planning on career decisions. Results/UNASSIGNED:Among 16 women who completed qualitative interviews, 4 (25%) were Asian, 1 (6%) was Black, 1 (6%) was multiracial, and 10 (63%) were White; mean (SD) age was 34.9 (4.0) years. Evaluation of fertility knowledge revealed 3 notable themes: (1) inadequate formal fertility education, (2) informal learning through infertility experiences of patients, peers, or personal struggles, and (3) desire to improve medical education through early introduction and transparent discussions about infertility. Exploration of childbearing concerns similarly revealed several salient themes: (1) high incidence of delayed childbearing, (2) perceived lack of peer and administrative support, and (3) impact of family building on career trajectory. These themes were borne out in pilot testing of the survey instrument: of 24 female physicians (7 Asian women [27%], 1 Black woman [4%], 1 Hispanic or Latinx woman [4%], 1 multiracial woman [4%], 15 White women [58%]; mean [SD] age, 36.1 [6.7] years), 17 (71%) had delayed childbearing and 16 (67%) had altered their career for family-building reasons. Conclusions and Relevance/UNASSIGNED:Qualitative interviews identified fertility and family building concerns among female physicians and were used to develop a tailored survey for women in medicine. These findings suggest that female physicians may delay childbearing and make substantial accommodations in their careers to support family building. A large-scale national survey is needed to better characterize the unique fertility, childbearing, and parenting needs of women in academic medicine to better understand how these concerns may contribute to academic attrition.
PMID: 35583866
ISSN: 2574-3805
CID: 5235462

Guidelines informing counseling on female age-related fertility decline: a systematic review

Trawick, Emma; Pecoriello, Jillian; Quinn, Gwendolyn; Goldman, Kara N
PURPOSE/OBJECTIVE:To identify, appraise, and assess clinical practice guidelines informing patient counseling on female age-related fertility decline. METHODS:Searched electronic database records from January 1, 2006, to September 10, 2018, and professional society websites. The search terms included iterations of "guideline," "counseling," "preconception," "age-related fertility decline," and "reproductive life planning." English-language professional organization guidelines addressing patient counseling on age-specific reproductive health topics were included. Assessed the methodological quality of included guidelines using the AGREE II instrument. Guidelines were categorized as high quality or low quality based on AGREE II scores. Extracted age-specific reproductive health recommendations of high-quality guidelines. RESULTS:The search identified 2918 records. Nineteen records addressed counseling on age-related fertility decline; only 6 focused only on reproductive aging, with the remaining 13 covering related topics. Eleven met criteria for high quality. All high-quality guidelines had high "rigor of development" scores on AGREE II. Ten high-quality guidelines stated an age at which female fertility declines, ranging from 30 to "late 30s." One recommended a specific age at which patients should be counseled. Five of eleven high-quality guidelines did not discuss the obstetric and perinatal risks of advanced maternal age. CONCLUSIONS:Few high-quality guidelines address counseling on female age-related fertility decline, and existing guidance on reproductive aging counseling is inconsistent and incomplete. Greater rigor of development and incorporation of age-specific counseling recommendations into clinical practice guidelines could lead to improved patient anticipatory guidance and more informed reproductive choices.
PMID: 33188440
ISSN: 1573-7330
CID: 4676012

A View from the past into our collective future: the oncofertility consortium vision statement

Woodruff, Teresa K; Ataman-Millhouse, Lauren; Acharya, Kelly S; Almeida-Santos, Teresa; Anazodo, Antoinette; Anderson, Richard A; Appiah, Leslie; Bader, Joy; Becktell, Kerri; Brannigan, Robert E; Breech, Lesley; Bourlon, Maria T; Bumbuliene, Žana; Burns, Karen; Campo-Engelstein, Lisa; Campos, Jacira R; Centola, Grace M; Chehin, Mauricio Barbour; Chen, Diane; De Vos, Michel; Duncan, Francesca E; El-Damen, Ahmed; Fair, Douglas; Famuyiwa, Yemi; Fechner, Patricia Y; Fontoura, Paula; Frias, Olivia; Gerkowicz, Sabrina A; Ginsberg, Jill; Gracia, Clarisa R; Goldman, Kara; Gomez-Lobo, Veronica; Hazelrigg, Brent; Hsieh, Michael H; Hoyos, Luis R; Hoyos-Martinez, Alfonso; Jach, Robert; Jassem, Jacek; Javed, Murid; Jayasinghe, Yasmin; Jeelani, Roohi; Jeruss, Jacqueline S; Kaul-Mahajan, Nalini; Keim-Malpass, Jessica; Ketterl, Tyler G; Khrouf, Mohamed; Kimelman, Dana; Kusuhara, Atsuko; Kutteh, William H; Laronda, Monica M; Lee, Jung Ryeol; Lehmann, Vicky; Letourneau, Joseph M; McGinnis, Lynda K; McMahon, Eileen; Meacham, Lillian R; Mijangos, Monserrat Fabiola Velez; Moravek, Molly; Nahata, Leena; Ogweno, George Moses; Orwig, Kyle E; Pavone, Mary Ellen; Peccatori, Fedro Alessandro; Pesce, Romina Ileana; Pulaski, Hanna; Quinn, Gwendolyn; Quintana, Ramiro; Quintana, Tomas; de Carvalho, Bruno Ramalho; Ramsey-Goldman, Rosalind; Reinecke, Joyce; Reis, Fernando M; Rios, Julie; Rhoton-Vlasak, Alice S; Rodriguez-Wallberg, Kenny A; Roeca, Cassandra; Rotz, Seth J; Rowell, Erin; Salama, Mahmoud; Saraf, Amanda J; Scarella, Anibal; Schafer-Kalkhoff, Tara; Schmidt, Deb; Senapati, Suneeta; Shah, Divya; Shikanov, Ariella; Shnorhavorian, Margarett; Skiles, Jodi L; Smith, James F; Smith, Kristin; Sobral, Fabio; Stimpert, Kyle; Su, H Irene; Sugimoto, Kouhei; Suzuki, Nao; Thakur, Mili; Victorson, David; Viale, Luz; Vitek, Wendy; Wallace, W Hamish; Wartella, Ellen A; Westphal, Lynn M; Whiteside, Stacy; Wilcox, Lea H; Wyns, Christine; Xiao, Shuo; Xu, Jing; Zelinski, Mary
PURPOSE/OBJECTIVE:Today, male and female adult and pediatric cancer patients, individuals transitioning between gender identities, and other individuals facing health extending but fertility limiting treatments can look forward to a fertile future. This is, in part, due to the work of members associated with the Oncofertility Consortium. METHODS:The Oncofertility Consortium is an international, interdisciplinary initiative originally designed to explore the urgent unmet need associated with the reproductive future of cancer survivors. As the strategies for fertility management were invented, developed or applied, the individuals for who the program offered hope, similarly expanded. As a community of practice, Consortium participants share information in an open and rapid manner to addresses the complex health care and quality-of-life issues of cancer, transgender and other patients. To ensure that the organization remains contemporary to the needs of the community, the field designed a fully inclusive mechanism for strategic planning and here present the findings of this process. RESULTS:This interprofessional network of medical specialists, scientists, and scholars in the law, medical ethics, religious studies and other disciplines associated with human interventions, explore the relationships between health, disease, survivorship, treatment, gender and reproductive longevity. CONCLUSION/CONCLUSIONS:The goals are to continually integrate the best science in the service of the needs of patients and build a community of care that is ready for the challenges of the field in the future.
PMCID:7786868
PMID: 33405006
ISSN: 1573-7330
CID: 4771062

Posthumous assisted reproduction policies among a cohort of United States' in vitro fertilization clinics

Trawick, Emma; Sampson, Amani; Goldman, Kara; Campo-Engelstein, Lisa; Caplan, Arthur; Keefe, David L; Quinn, Gwendolyn P
Objective/UNASSIGNED:To assess the presence and content of policies toward posthumous assisted reproduction (PAR) using oocytes and embryos among Society for Assisted Reproductive Technology (SART) member clinics in the United States. Design/UNASSIGNED:Cross-sectional questionnaire-based study. Setting/UNASSIGNED:Not applicable. Patients/UNASSIGNED:A total of 62 SART member clinics. Interventions/UNASSIGNED:Questionnaire including multiple choice and open-ended questions. Main Outcome Measures/UNASSIGNED:Descriptive statistics regarding presence and content of policies regarding PAR using oocytes and embryos, consent document content regarding oocyte and embryo disposition, and eligibility of minors and those with terminal illness for fertility preservation. Results/UNASSIGNED:Of the 332 clinics contacted, 62 responded (response rate 18.7%). Respondents were distributed across the United States, and average volume of in vitro fertilization (IVF) cycles per year ranged from <250 to >1,500, but 71.2% (n = 42) reported a volume of <500. Nearly one-half (42.4%, n = 25) of clinics surveyed reported participating in any cases of posthumous reproduction during the past 5 years, and 6.8% (n = 4) reported participation in >5 cases. Participation in cases of posthumous reproduction was not significantly associated with practice type or IVF cycle volume among those surveyed. Only 59.6% (n = 34) of clinics surveyed had written policies regarding PAR using oocytes or embryos, whereas 36.8% (n = 21) reported they did not have a policy. Practice type, IVF cycle volume, fertility preservation volume, and prior participation in cases of PAR were not significantly associated with the presence of a policy among respondent clinics. Of those with a policy, 55.9% (n = 19) reported they had used that policy, 59.1% (n = 13) without a policy reported they had considered adopting one, and 63.6% (n = 14) reported they had received a request for PAR services. Only 47.2% (n = 25) of clinics surveyed specified that patients not expected to survive to use oocytes due to terminal illness are eligible for oocyte cryopreservation, whereas 45.3% (n = 24) did not specify. Conclusions/UNASSIGNED:Respondent clinics reported receiving an increasing number of requests for PAR services, but many also lacked PAR policies. Those with policies did not always follow ASRM recommendations. Given the low response rate, these data cannot be interpreted as representative of SART clinics overall. As PAR cases become more common, however, this study highlights poor reporting of PAR and institutional policies toward PAR, suggesting that SART clinics may not be equipped to systematically manage the complexities of PAR.
PMCID:8244314
PMID: 34223220
ISSN: 2666-3341
CID: 4932912

Access to infertility care in a low-resource setting: bridging the gap through resident and fellow education in a New York City public hospital

Blakemore, Jennifer K; Maxwell, Susan M; Hodes-Wertz, Brooke; Goldman, Kara N
PURPOSE/OBJECTIVE:Improving access to care is an issue at the forefront of reproductive medicine. We sought to describe how one academic center, set in the background of a large and diverse metropolitan city, cares for patients with extremely limited access to reproductive specialists. METHODS:The NYU Reproductive Endocrinology and Infertility (REI) Fellowship program provides a "fellow-run clinic" within Manhattan's Bellevue Hospital Center, which is led by the REI fellows and supervised by the REI attendings of the NYU Langone Health system. A description of the history of the hospital as well as the logistics of the fertility clinic is provided as a logistical template for implementation. RESULTS:The fellow-run fertility clinic at Bellevue hospital is held on two half days per month seeing approximately 150 new patients per year. The fertility workup, counseling, surgery, as well as ovulation induction, and early pregnancy management are offered within the construct of the fellowship and residency at NYU. Barriers to care and ways to circumvent those barriers are discussed in detail. CONCLUSION/CONCLUSIONS:By utilizing the ambition and construct of the OB/GYN programs, we greatly improve care for an otherwise underserved patient population by offering an efficient and optimal infertility workup and treatment in a population that would otherwise be without care. We utilize the framework of graduate medical education to provide autonomy, experience, and mentorship to both residents and fellows in our programs in an effort to provide a solution to combating inequity in infertility care.
PMID: 32409983
ISSN: 1573-7330
CID: 4431622

Prognostic role of preimplantation genetic testing for aneuploidy in medically indicated fertility preservation

Blakemore, Jennifer K; Trawick, Emma C; Grifo, James A; Goldman, Kara N
OBJECTIVE:To investigate the use of preimplantation genetic testing for aneuploidy (PGT-A) among patients pursuing embryo banking (EB) for medically indicated fertility preservation (FP). DESIGN/METHODS:Retrospective cohort. SETTING/METHODS:University-affiliated fertility center. PATIENTS/METHODS:All patients who underwent in vitro fertilization with or without PGT-A for medically indicated FP between January 2014 and April 2018. INTERVENTIONS/METHODS:None MAIN OUTCOME MEASURES: EB cycle characteristics, subsequent cycle pursuit/outcomes, and frozen embryo transfer (FET) outcomes. RESULTS:A total of 58 medical EB cycles were compared; 34 cycles used PGT-A. Of the EB patients with breast cancer, 67% used PGT-A; other indications were evenly divided between PGT-A (FP/PGT-A) and no PGT-A (FP). PGT-A use increased over the study period. Groups were similar in age, days of stimulation, and days from initial FP consultation to treatment initiation. Number of oocytes (14.5 [2-63] FP vs. 17.5 [1-64] FP/PGT-A), 2PN zygotes (7 [1-38] FP vs. 9 [0-36] FP/PGT-A), and blastocysts (5.5 [0-22] FP vs. 5 [0-18] FP/PGT-A) cryopreserved were similar between groups. Equal numbers cryopreserved both oocytes and embryos (5 vs. 3). Five FP/PGT-A patients underwent a second EB cycle. Among FP/PGT-A patients, an average of 6.7 ± 5 blastocysts underwent PGT-A, with 3.5 ± 3 (48.2%) euploid embryos cryopreserved for future FET compared to an average of 7.2 ± 7 untested embryos in the FP group. CONCLUSION/CONCLUSIONS:PGT-A in medical EB cycles increased over time and did not limit the use of other FP methods such as oocyte cryopreservation. In some cases, poor PGT-A results informed patients to pursue a second EB cycle. When counseling patients, the prognostic benefits of PGT-A must be weighed against the financial costs and potential for "terminal" fertility diagnosis.
PMID: 31973902
ISSN: 1556-5653
CID: 4273382