Faculty Bibliography

OBJECTIVE: COVID-19 has influenced family building, delayed fertility care, and affected people's decisions about where to live.We sought to understand differences in movement of cryopreserved reproductive tissue before and during the pandemic. MATERIALS AND METHODS: This was a retrospective cohort study of patients who transported tissue into or out of a single academic fertility center in New York City (NYC). Tissue transport was compared the year before (PRE, 4/1/2019-3/31/2020) and after (DUR, 4/1/2020-3/31/2021) the height of the COVID-19 pandemic in NYC, an epicenter. The primary outcome was the number of patients transporting tissue DUR compared to PRE. Secondary outcomes were the number of geographic changes, type of tissue, geographic origin/destination, and type of movement (in or out). Statistical analyses were performed using Kolmogorov-Smirnov, Wilcoxon Signed Rank Sum, Chi-Square, and Fisher's Exact tests with p<0.05 considered significant.
RESULT(S): A total of 367 tissue transports were included, with similar rates between cohorts (PRE 46.3% (170/367) vs DUR 53.7% (197/367), p=0.16). The median age at transport was the same (PRE 41 (range 29-54) vs DUR 41 (range 28-54) years, p=0.54). A similar amount of tissue was transported in (PRE 30.0% (51/170) vs DUR 35.0% (69/197)) and out (PRE 70.0% (119/170) vs DUR 65.0% (128/197), p=0.32). Patients were more likely to transport embryos pre-pandemic (37.6% (64/170) oocytes vs 61.8% (105/170) embryos, PRE) and oocytes during COVID-19 (51.8% (102/197) oocytes vs 44.2% (87/197) embryos, DUR) (p<0.01). A subgroup analysis excluding tissue moved for a gestational carrier or donor gametes found a similar number of transports were due to patient geographic relocation (PRE 50.0% (61/122) vs DUR 40.5% (60/148), p=0.12). Examination of geographic origin and destination of tissue PRE vs DUR produced no identifiable trends (p=0.38). Timing of tissue transport varied. The monthly transport rates were relatively even PRE (average 8% per month). However, during the pandemic, there were few transports in the beginning (April-May 2020, 0-1% per month) followed by a peak of transports in June-August 2020 (10-11% per month) and February-March 2021 (11-16% per month) (p<0.01). Transport activities were impacted by closure of clinics and courier service availability.
CONCLUSION(S): The rate of cryopreserved tissue movement did not differ in the year before versus during the pandemic at our center, despite being in a COVID-19 epicenter, although transport activities were concentrated into fewer days. There was peak movement of tissue three months after the pandemic onset and roughly one year from the start of the pandemic. The type of tissue transported shifted to favor oocytes during the pandemic, warranting more investigation in how COVID-19 impacted family building activities. IMPACT STATEMENT: Despite the impact of COVID-19 on reproductive and place of living choices, the pandemic did not affect the amount of cryopreserved tissue that was relocated. However, insight into the increased movement of oocytes and potential impacts on warming outcomes or timelines is necessary

BACKGROUND:Gender disparities exist in the careers of women in medicine. This review explores the qualitative literature to understand how gender influences professional trajectories, and identify opportunities for intervention. METHODS:A systematic review and thematic synthesis included articles obtained from PubMed, Cochrane Central Register of Controlled Trials (Ovid), EMBASE (Ovid), APA PsycInfo (Ovid), and GenderWatch (ProQuest) on June 26 2020, updated on September 10, 2020. Included studies explored specialty choice, leadership roles, practice setting, burnout, promotion, stigma, mentoring, and organizational culture. Studies taking place outside of the USA, using only quantitative data, conducted prior to 2000, or focused on other health professions were excluded. Data were extracted using a standardized extraction tool and assessed for rigor and quality using a 9-item appraisal tool. A three-step process for thematic synthesis was used to generate analytic themes and construct a conceptual model. The study is registered with PROSPERO (CRD42020199999). FINDINGS/RESULTS:Among 1524 studies identified, 64 were eligible for analysis. Five themes contributed to a conceptual model for the influence of gender on women's careers in medicine that resembles a developmental socio-ecological model. Gender influences career development externally through culture which valorizes masculine stereotypes and internally shapes women's integration of personal and professional values. CONCLUSION/CONCLUSIONS:Medical culture and structures are implicitly biased against women. Equitable environments in education, mentoring, hiring, promotion, compensation, and support for work-life integration are needed to address gender disparities in medicine. Explicit efforts to create inclusive institutional cultures and policies are essential to support a diverse workforce.