Faculty Bibliography

OBJECTIVE:To compare characteristics between men and women as they seek medical care for their urinary incontinence (UI), examining patients' experience both with primary care (PCP) and UI specialists. METHODS:This is a cross-sectional study utilizing the National Association for Continence (NAFC)-sponsored adult patient-reported survey data from March 2020 to April 2020. Descriptive statistics were calculated as percentages, and comparisons were performed using a chi-squared test for categorical variables. The statistical significance level was set at p < 0.05. RESULTS:Two hundred sixty-six individuals with UI who had sought medical care completed the survey during the study period. One hundred twenty-four (47%) were women (W) and 142 (53%) were men (M). The study population was older, with the majority of respondents either 45-64 (35%) or 65+ (48%). Most participants sought care for their UI within 2 years of UI onset (59%) and first spoke to their PCP about their UI (64.7%). Women were more likely to endorse a severe emotional impact (OR 1.63, CI 1.04-2.56, p = 0.04) and physical impact (OR 1.90, CI 1.19-3.04, p = 0.01) of their UI on their life. In patients who spoke to their PCP about their UI, women were more likely to bring it up at a routine checkup, while men were more likely to make an appointment to discuss their UI. Men were more likely to endorse that their PCP had spoken to them about a wide range of treatment options and were more likely to have been started on a treatment plan. Men were also more likely to be started on a medication for their UI by their PCP compared to women. PCP referral rates to specialty care were higher amongst men. For those who received a referral, there was a high rate of specialist follow-up (94.0% vs. 98.5% p = 0.19). Men were mostly referred to urology (W 47% vs. 94% M, p < 0.01), with women more frequently referred to gynecology (W 15.9% vs. 0% M, p < 0.01) and urogynecology (W 25.0% vs. 0.9% M, p < 0.01). Specialists were more likely to speak about absorbent products with men compared to women (M 52.5% vs. W 30.7%, p = 0.002). CONCLUSIONS:Though women endorsed more severe impact of UI on their life, men were more likely to be counseled on a wide range of treatment options, started on a treatment plan, prescribed medication for their UI, and be referred to specialty care for treatment of their UI. TRIAL REGISTRATION/BACKGROUND:This study was not registered with clinicaltrials.gov because it used previously collected, deidentified data. CLINICALTRIALS/RESULTS:gov indicates that observational studies should be registered as a Patient Registry for prospective data collection, which does not apply to this study as the patients included in this survey are not followed.

OBJECTIVE:To evaluate the clinical outcome potential of embryos classified by preimplantation genetic testing for aneuploidy (PGT-A) as non-mosaic whole chromosome aneuploid (WCA) or segmental aneuploid (SA) in a large multicenter consortium study. DESIGN/METHODS:Multicenter retrospective cohort study. SUBJECTS/METHODS:Data were obtained from eight of the 26 fertility centers participating in the International Registry of Mosaic Embryo Transfers (IRMET) network that contributed non-mosaic WCA and SA embryo transfers between 2016 and 2026. The study included 250 embryo transfers (168 WCA and 82 SA) with complete clinical outcome documentation. Transfers were performed either with knowledge of the PGT-A result at the time of transfer or as non-selective transfers performed without knowledge of the PGT-A result. EXPOSURE/METHODS:Trophectoderm biopsy at blastocyst stage followed by PGT-A using whole-genome amplification (WGA) and next-generation sequencing (NGS). MAIN OUTCOME MEASURES/METHODS:Pregnancy and neonatal outcomes. RESULTS:Among 168 WCA transfers, including 111 performed without knowledge of the PGT-A result at the time of transfer, no live births occurred. Most transfers resulted in no pregnancy (78.6%), with smaller proportions showing biochemical pregnancy (8.3%), ectopic pregnancy (1.8%), early spontaneous abortion (9.5%), late spontaneous abortion (1.2%), or therapeutic termination (0.6%). In contrast, SA transfers (n = 82) resulted in a 17.1% live birth rate. Neonatal data available for 10 SA live births showed no differences in gestational age or birthweight compared with live births following euploid embryo transfer at the same centers, and prenatal or neonatal genetic testing were normal in all tested cases. CONCLUSIONS:In this large multicenter dataset of non-mosaic whole chromosome and segmental aneuploid embryo transfers, embryos classified as uniformly whole chromosome aneuploid produced no live births, whereas segmental aneuploid embryos retained a modest yet clinically meaningful potential for live birth. These findings support the biological validity of PGT-A classification of whole chromosome aneuploid embryos and highlight the distinct clinical implications of whole chromosome and segmental aneuploidies.

The American College of Obstetricians and Gynecologists (ACOG) recently revised its guidance regarding the evaluation of postmenopausal bleeding (PMB), recommending combined transvaginal ultrasonography (TV U/S) and endometrial (EM) sampling for most patients undergoing initial assessment. This perspective examines the evidence underlying these recommendations and considers their potential implications for clinical practice. Prior ACOG guidance recognized that, when the endometrium is fully visualized and measures ≤4 mm, TV U/S provides a highly effective means of excluding endometrial cancer (EC) in most women with PMB if the TV U/S is adequate and there is no persistent bleeding. Their revised recommendations place greater emphasis on EM sampling, including in several patient populations previously considered appropriate candidates for ultrasound-based evaluation. This perspective reviews the evidence this new guidance relied upon, as well as limitations of blind EM sampling, including published false-negative rates even in cases of known carcinoma, technical challenges associated with tissue acquisition, and potential procedural complications. Particular attention is given to women receiving menopausal hormone therapy, as well as nulliparous women in whom EM sampling may be technically difficult. My perspective is that former guideline-based approaches remain generally appropriate. The concern about the increasing mortality of EC in the United States is appropriate, as is the concern about racial disparities in the incidence and mortality of EC. However, the new ACOG revision will result in inappropriate, invasive EM sampling in a large number of women. The potential harms, as well as difficulties in obtaining tissue, will be substantial. Any real attempt to reduce the mortality of EC will require a better understanding of patient-specific risk factors, as well as information about less common non-EM type II cancers, especially in Black women, and better patient and practitioner education relative to PMB.

Reproductive health disparities disproportionately affect adolescents of color in the United States, particularly in contraceptive access, utilization, and knowledge. Because parents strongly shape adolescents' contraceptive behaviors, understanding their perspectives is essential for addressing inequities. This scoping review synthesized evidence on parental attitudes toward adolescent contraception in racially and ethnically diverse communities to inform culturally responsive interventions. Following PRISMA-ScR guidelines, seven databases were systematically searched for U.S.-based, peer reviewed studies (2008-2023) examining contraception-related perceptions among parents or guardians of adolescents of color. Twenty studies met inclusion criteria (cross-sectional surveys [n=4], focus groups [n=4], interviews [n=5], quasi-experimental controlled trial [n=1], mixed-methods [n=6]); most addressed contraception broadly rather than specific methods. Study quality, assessed using the Mixed Methods Appraisal Tool, was predominantly high (18/20). Key themes included limited parental contraceptive knowledge, reliance on schools or clinicians for sexual health education, gendered and indirect communication, and cultural or religious norms discouraging adolescent sexual activity. Mistrust of healthcare systems, safety concerns, fear of promoting sexual behavior, and the influence of structural inequities, stigma, and misinformation were common across communities. Addressing parental knowledge gaps, communication barriers, and systemic mistrust is critical to reducing contraceptive disparities through culturally tailored education and strengthened family-healthcare partnerships.

BACKGROUND:Competency-based medical education aims to ensure that physicians develop the skills and knowledge necessary for independent clinical practice through graduated autonomy. Existing competencies in obstetrics and gynecology (OBGYN) residency often fail to capture higher-order transformations in clinical reasoning, professional identity, and emotional maturity. A more nuanced, applicable, and valid articulation of these developmental transitions is needed to better support resident growth and assessment. OBJECTIVE:To identify OBGYN-specific threshold concepts that represent transformative developmental milestones in training, as perceived by leaders in residency education. DESIGN/METHODS:This qualitative study used a constructivist, inductive thematic analysis approach. Interviews explored moments of significant developmental transition, areas of learner struggle, and examples of transformative learning during residency. Audio-recorded interviews were transcribed, deidentified, and independently coded by 2 reviewers using line-by-line analysis. Codes were iteratively organized into themes through consensus, with thematic saturation reached after 9 interviews. Credibility was supported through expert review, member checking, and iterative refinement. SETTING/METHODS:Semistructured, one-on-one interviews were conducted with 11 attending physicians holding formal educational leadership roles within OBGYN residency programs at 4 academic institutions in the New York City metropolitan area. RESULTS:Six threshold concepts were identified that characterize developmental transitions into OBGYN practice: recognition of clinical severity, anticipation and adjustment of surgical technique, ownership of patient care in dynamic settings, empathic collaboration and team management, confidence in independent decision-making, and advanced emotional regulation. These concepts reflected observable shifts in judgment, responsibility, teamwork, and emotional processing that educators consistently associated with readiness for independent practice. In a subsequent survey of n = 78 medical education leaders at a national conference, 90% of respondents endorsed incorporating these threshold concepts into resident assessment frameworks. CONCLUSIONS:This study identifies 6 threshold concepts that capture essential, yet under-recognized, developmental milestones in OBGYN residency training. These concepts offer a complementary framework to existing assessment systems by emphasizing transformative growth in clinical judgment, professional identity, and emotional resilience. Integrating threshold concepts into curriculum design and evaluation may enhance the ability of educators to support learners, identify developmental challenges, and promote readiness for independent practice.

BACKGROUND:Non-English-speaking individuals have noted disparities in health outcomes in the United States, but the role of language in obstetric settings is not well characterized. OBJECTIVE:We examined the association between primary spoken (preferred) language and the risk of nulliparous, term, singleton vertex cesarean delivery. STUDY DESIGN/METHODS:We conducted a retrospective cohort study of nulliparous, term, singleton vertex deliveries in California (2016-2021) using birth certificates linked to hospital discharge records. The primary outcome was the risk of cesarean delivery. Poisson log-linear regression was used to estimate the association between preferred language and cesarean delivery overall, adjusted for demographic, hospital, and obstetric factors. Analyses were stratified by labor type (pre-labor versus intrapartum), risk characteristics (standard versus high risk), and hospital characteristics (hospital type [academic versus nonacademic], setting [urban versus non-urban], and annual hospital cesarean delivery volume by sample tertiles). RESULTS:Among 721,263 birthing people in California, 87,538 (12.1%) indicated that their preferred language was not English and 359,988 (49.9%) had no measured medical comorbidities (termed standard risk). Non-English speaking patients had a decreased risk of cesarean delivery (adjusted relative risk 0.94, 95% confidence interval 0.92-0.96), including among Chinese- (adjusted relative risk 0.83, 95% confidence interval 0.79-0.86) and Spanish-speaking patients (adjusted relative risk 0.94, 95% confidence interval 0.93-0.97), although non-English speaking birthing people who preferred languages other than Spanish or Chinese had slightly higher risk of cesarean delivery (adjusted relative risk 1.06, 95% confidence interval 1.02-1.10). There was a decreased cesarean risk among non-English speaking patients across labor types (spontaneous labor or prelabor rupture of membranes: adjusted relative risk 0.94, 95% confidence interval 0.89-1.00; induced labor: adjusted relative risk 0.90, 95% confidence interval 0.87-0.93; no indication of either: adjusted relative risk 0.97, 95% confidence interval 0.95-1.00), among standard risk patients (adjusted relative risk 0.95, 95% confidence interval 0.92-0.97), and across hospital type, setting, and annual cesarean delivery volume tertile. A small decrease in cesarean risk was also observed in teaching (adjusted relative risk 0.93, 95% confidence interval 0.91-0.96) and non-teaching hospitals (adjusted relative risk 0.95, 95% confidence interval 0.92-0.97), urban settings (adjusted relative risk 0.93, 95% confidence interval 0.92-0.95), and highest volume tertile (adjusted relative risk 0.93, 95% confidence interval 0.91-0.95), though there was no increase risk in non-urban settings (adjusted relative risk 1.02, 95% confidence interval 0.95-1.11) and across lowest and middle volume tertiles (adjusted relative risk 1.01, 95% confidence interval 0.92-1.11; and adjusted relative risk 0.95, 95% confidence interval 0.91-0.98, respectively). CONCLUSION/CONCLUSIONS:Non-English language preference was associated with a slight decreased risk for cesarean delivery among nulliparous, term, singleton, and vertex presenting patients, and an increased risk among people who spoke other languages (i.e., not Chinese or Spanish). Our findings suggest that populations that speak less common non-English languages in California may be at elevated risk of disparate cesarean delivery outcomes.

To our knowledge, this is the first documented case of presumed recurrent monozygotic (MZT) dichorionic diamniotic (DCDA) twin gestations following programmed single thawed euploid embryo transfer (STEET) cycles in an individual who is herself a MZT twin. This report presents a 34-year-old nulligravid female patient and her 33-year-old male partner with unexplained infertility who underwent in vitro fertilization with preimplantation genetic testing for aneuploidy followed by subsequent embryo transfers, resulting in a presumed MZT DCDA twin gestation (STEET #1), a singleton gestation (STEET #2) and a confirmed MZT DCDA twin gestation (STEET#3). Monozygosity was confirmed for the second twin gestation (STEET #3) via single nucleotide polymorphism (SNP)-based cell-free DNA screening; the first twin gestation (STEET#1) is presumed to be MZT with high likelihood given that it resulted from a STEET performed in the setting of confirmed ovulation suppression. Chorionicity was confirmed via first-trimester ultrasound in both twin gestations (STEET #1 and #3). Nevertheless, this case shows that recurrent MZT DCDA twinning may be possible even after single blastocyst transfer and that observed chorionicity may not always conform to traditional twinning. Further research is needed to better understand the mechanisms and predisposing factors underlying MZT twinning as well as the development of DCDA twin gestations after single blastocyst transfers in assisted reproduction. Specific factors contributing to early embryo splitting may relate to the individual person, the embryo cohort or laboratory techniques. Informed consent counseling should include a discussion that MZT DCDA twinning remains a rare but real possibility despite single embryo transfer.

BACKGROUND:Medical training is a high-stress period, and residents in surgical specialties face elevated risk for depression due to demanding schedules, intensity of training, persistent mistreatment, and long work hours. Obstetrics and gynecology is the only surgical specialty predominantly composed of women, who face higher rates of depression than men and greater increases in depressive symptoms during internship. These challenges, compounded by work-family conflict and policy pressures, contribute to workforce strain in a specialty already facing a projected shortage. Understanding the mental health burden is critical to supporting both trainee well-being and long-term workforce sustainability, yet depressive symptoms, risk factors, and treatment-seeking have not been systematically studied in obstetrics and gynecology trainees. OBJECTIVE:To assess the prevalence of depressive symptoms and mental health treatment-seeking among obstetrics and gynecology first-year residents and identify associated demographic, psychological, and workplace factors. STUDY DESIGN/METHODS:tests, stepwise linear regression, and generalized estimating equation models were used to identify baseline and internship-related predictors of depressive symptoms. Sample weights were applied to address nonrepresentative sampling and attrition biases. RESULTS:Of 1603 enrolled obstetrics and gynecology interns (86.5% women; median age 27 years), 1271 (79.3%) completed at least one internship assessment and were included in the analysis. During internship, 35.6% screened positive for depression on the 9-item Patient Health Questionnaire at one or more assessments, yet less than one-third of those affected sought mental health treatment. Baseline predictors of increased depressive symptoms included history of depression, higher baseline depressive symptoms, neuroticism, a difficult early family environment, and not being in a committed relationship. Internship-related factors associated with worsening symptoms included fewer sleep hours, longer work hours, and reported medical errors. CONCLUSION/CONCLUSIONS:More than one-third of obstetrics and gynecology residents screened positive for depression on the 9-item Patient Health Questionnaire during their first year, yet treatment-seeking remained critically low. Both preexisting vulnerabilities and modifiable workplace stressors contributed to depressive symptoms. These findings are particularly notable given the female-predominant composition of the obstetrics and gynecology field and the growing representation of women in surgical specialties. The low treatment-seeking rate highlights the urgent need for improved mental health access, including opt-out service models. Structural interventions targeting workload and sleep are essential to support trainee well-being and long-term workforce sustainability in obstetrics and gynecology.