Faculty Bibliography

PURPOSE/OBJECTIVE:To improve access to fertility care at the largest safety net hospital in New York City, fellows and residents run a reproductive endocrinology and infertility clinic that supports an ovulation induction (OI) program under attending physician supervision. Our objective was to evaluate OI pregnancy outcomes to describe the program's efficacy and guide quality improvement. METHODS:We performed a descriptive study of patients who completed at least one OI cycle from 6/1/2019 to 4/1/2023. Fellows and residents managed patient care, including the prescription of an OI agent (clomiphene citrate or letrozole), ultrasound monitoring, and trigger (human chorionic gonadotropin) followed by timed intercourse (TIC) or intrauterine insemination (IUI). Primary outcomes included the overall pregnancy rate (PR) and live birth rate (LBR). RESULTS:Two hundred twenty-eight patients were prescribed OI agents during the study period. Of these, 161 patients (70.6%) completed at least one OI cycle and were not lost to follow up. The PR and LBR per patient were 21.1% (34/161) and 11.2% (18/161). The PR and LBR per cycle were 9.0% (34/379) and 4.7% (18/379). Patients who achieved a pregnancy were younger (median 32.5 years vs. 36 years, p < 0.002), had a higher AMH (median 3.2 vs. 2.1 ng/mL, p < 0.03), and were more likely to have PCOS (35.3% vs. 18.9%, p < 0.04). Among the 228 patients ever-prescribed an OI agent, there were 22 (9.6%) patients with pregnancies that occurred without OI treatment. CONCLUSIONS:PRs from this low-resource OI program are comparable to published data, demonstrating that fellow and resident-run initiatives can be successful in bridging the gap in fertility care.

The rapid evolution of generative artificial intelligence (AI) is poised to transform medicine and medical education. Large language models (LLMs) have begun to demonstrate capabilities in reasoning, diagnosis, documentation, and patient communication that can rival or exceed those of clinicians. In medical education, AI is reshaping how students learn and how faculty teach-offering individualized, context-sensitive guidance at scale. This article outlines the current state of AI integration in health care, examines how systems can responsibly implement it to enhance patient care and education, and raises critical questions about ethics and safety as we harness its transformative potential.

CONTEXT/UNASSIGNED:Plasticizers such as bisphenols and phthalates are endocrine-disrupting chemicals and lead to development of metabolic diseases. OBJECTIVE/UNASSIGNED:To examine associations of prenatal exposure to bisphenols and phthalates with metabolic dysfunction. DESIGN/UNASSIGNED:This study was nested in the New York University (NYU) Children's Health and Environment Study, a prospective birth cohort. SETTING/UNASSIGNED:Participants were recruited at three NYU-affiliated hospitals. PATIENTS OR OTHER PARTICIPANTS/UNASSIGNED:Eligible participants were ≥18 years old, <18 weeks pregnant, and had a medically stable pregnancy. EXPOSURES/UNASSIGNED:Twelve phthalate metabolites and two bisphenols were measured in early and mid-pregnancy (<18 and 18-25 weeks) urine samples. Bisphenols were summed, and phthalate metabolites were grouped based by molecular weights and relevant parent compounds. MAIN OUTCOME MEASURES/UNASSIGNED:Logistic and linear regression models assessed chemicals groups' associations with gestational diabetes mellitus (GDM), glucose disturbance (including impaired glucose tolerance (IGT)), and blood glucose response to glucose challenge test (GCT), adjusting for sociodemographic and pregnancy-related factors. RESULTS/UNASSIGNED:Seventy-nine (6.8%) had GDM, 303 (26.1%) had IGT, and blood glucose response to GCT ranged from 22-386 mg/dL. Bisphenol A (BPA) was negatively associated with blood glucose response to GCT (-1.47 [-2.84, -0.10]), while diethylhexyl phthalate (DEHP; 2.67 [0.98, 4.36]) and high molecular weight phthalates (1.94, [0.17, 3.71]) were positively associated with blood glucose response to GCT. DEHP was also linked to glucose disturbance (1.16 [1.02, 1.31]). CONCLUSION/UNASSIGNED:Our findings suggest that phthalate exposure is associated with GDM. Further mechanistic studies are warranted, particularly given the inverse associations with BPA exposure.

Fetoplacental ratio (FPR), the ratio of birthweight (BW) to placental weight (PW), indicates placental efficiency. Changes in FPR are linked to poor pregnancy outcomes and child health risks. Bisphenols and phthalates are endocrine disruptors found in plastics and personal care products that can cross the placenta and have been linked to pregnancy complications and adverse child health outcomes. We examined prenatal exposure to these chemicals in relation to FPR as a possible explanation for these risks. Our analysis included 393 participants in the New York University Children's Health and Environment Study with data on prenatal chemical exposure, BW, and PW from singleton live births. We calculated molar sums of bisphenols and of metabolites of low and high molecular weight (LMW, HMW) phthalates, diethylhexyl phthalate (DEHP), and antiandrogenic phthalates. Linear regression models were adjusted for maternal age, prepregnancy BMI, parity, gestational age at delivery, and fetal sex. Analyses were stratified by fetal sex. HMW were positively associated with FPR in the combined fetal sex sample (beta=0.26, [0.01, 0.50]) with a similar trend for DEHP and antiandrogenic phthalates (betas=0.21 [-0.04, 0.45] and 0.21 [-0.04, 0.45], respectively). Stratified analyses revealed that these results were driven by females, among whom LMW were also associated with higher FPR (beta=0.23 [0.003, 0.45]). No associations were observed between chemicals and BW in either combined or sex-stratified models. In contrast, HMW, LMW, DEHP, di-n-octylphthalate and bisphenols had negative associations with PW, suggesting placental growth as a target for phthalate-mediated endocrine disruption.

Preimplantation genetic testing for aneuploidy (PGT-A) has become a widely adopted component of in vitro fertilization (IVF) practice. However, PGT-A is not a single, uniform test; its predictive value and clinical utility remain highly dependent on test performance and interpretation, both of which vary substantially between laboratories and platforms. This article aims to define the intended goals of PGT-A, evaluate methods for proper test validation, and explore how validation data impacts clinical counseling and decision-making. Particular attention is given to newer diagnostic categories such as mosaicism and segmental aneuploidy, for which clinical validation is limited and inter-laboratory variability is high. While PGT-A can reduce futile embryo transfers and support elective single embryo transfer, misapplication of unvalidated results may reduce IVF success rates. To ensure responsible use of PGT-A, clinicians must demand transparent, assay-specific validation data and use this information to guide evidence-based counseling for embryo transfer, storage, and disposition.

OBJECTIVES/OBJECTIVE:To evaluate the feasibility and efficacy of a workflow designed to increase the number of patients counseled and initiated on the HPV vaccination series among an underserved patient population presenting for abortion care. METHODS:A retrospective chart review was conducted for 6 months before implementation to determine baseline rates of counseling and vaccine uptake. A workflow was prospectively implemented for 31 weeks at a resident-run urban safety net hospital abortion clinic. Rates of HPV vaccine-eligible patients who were counseled on vaccination were recorded along with rates of those accepting the vaccine who initiated and completed the series. RESULTS:Following implementation, the rate of eligible patients receiving counseling on the HPV vaccine increased from 23.8% to 68.7%. There was a 400% relative increase in the rate of patients receiving at least 1 dose of the vaccine from 6.8% to 34%. Forty-one (41.4%) patients due for a subsequent dose received at least 1 additional dose. Fifteen (14.7%) patients who received at least 1 dose of the HPV vaccine completed the series. The most common primary language among vaccinated patients was Spanish (66.7%). A majority (81.8%) identified their race as Hispanic or Latine, followed by Black (8%), and 13 ethnic backgrounds were self-identified. CONCLUSIONS:Implementation of an HPV vaccination workflow in an abortion clinic was feasible and resulted in substantial increases in counseling and uptake of the vaccine. Abortion care represents an opportunity to address HPV vaccination gaps, particularly among medically under-resourced populations most at risk for cervical cancer disparities.

OBJECTIVES/OBJECTIVE:To examine how media, geography, race, and social factors shaped patient experiences to inform strategies for improving trust and care. DESIGN/METHODS:We conducted a cross-sectional online survey of experiences and perceptions of OB/GYN care and medical mistrust using a stratified, randomised sampling approach. SETTING/METHODS:The survey was distributed through Prolific. POPULATION/METHODS:Inclusion criteria included assigned female at birth, age between 18 and 40 years, and residing in the United States. MAIN OUTCOME MEASURES/METHODS:Gender preference of OB/GYN clinician, demographic association with negative OB/GYN experiences, and degree of medical mistrust. RESULTS:Of 579 respondents, 93% identified as women, 33.9% as LGBTQIA+, and 45.2% had a history of pregnancy. Anxiety was the most common (46.4%) emotion experienced when receiving OB/GYN care, and 25.8% reported negative experiences, primarily from minimization of concerns (68.5%). A majority (65.3%) preferred receiving care from a female OB/GYN. Identifying as Republican was associated with higher odds of having had a negative experience with an OB/GYN, whereas Asian race and lower education were linked to lower odds. Black, Asian, and multiracial participants were more likely to have a racial preference for clinicians. Medical mistrust was higher among Black respondents and those with lower education. Feeling heard by a clinician was the strongest predictor of care satisfaction. CONCLUSION/CONCLUSIONS:Anxiety and negative experiences were prevalent among participants. Feeling heard was the strongest predictor of patient satisfaction, highlighting the importance of patient-centred OB/GYN care to reduce mistrust and improve patient experiences, particularly for marginalised groups.

Electronic health records (EHRs) present opportunities to study uterine fibroids uterine fibroids and endometriosis within diverse populations. When using EHR data, it is important to validate outcome classification via diagnosis codes. We performed a validation study of three approaches (1: ICD-10 code alone, 2: ICD-10 code + diagnostic procedure, and 3: ICD-10 code + all diagnostic information) to identify incident uterine fibroids and endometriosis patients among n=750 NYU Langone Health 2016-2023. Chart review was used to determine the true diagnosis status. When using a binary classification system (incident vs. non-incident patient), Approaches 2 and 3 had higher positive predictive values (PPVs) for uterine fibroids (0.86 and 0.87 vs. 0.78) and for endometriosis (0.70 and 0.73 vs. 0.66), but Approach 1 outperformed the other two in negative predictive values (NPVs) for both outcomes. When using a three-level classification system (incident vs. prevalent vs. disease free patients), PPV for prevalent patients was low for all approaches, while PPV/NPV of disease-free patients was generally above 0.8. Using ICD-10 codes alone yielded higher NPVs but resulted in lower PPVs compared with the other approaches. Continued validation of uterine fibroids/endometriosis EHR studies is warranted to increase research into these understudied gynecologic conditions.

OBJECTIVE:To propose a model of international meetings of minimally invasive gynecologic surgery to decrease the carbon footprint while preserving personal interactions and the financial stability of meetings and of medical societies. WHAT WE KNOW/UNASSIGNED:International medical society meetings create a substantial carbon footprint, with 95% generated by air travel. Meetings may be organized virtually or in-person with distinct benefits and drawbacks of each format. In-person meetings encourage personal interactions, sensitive discussions, and social exchanges which are important for learning and mental well-being. WHAT WE PROPOSE/UNASSIGNED:A collaborative effort of international societies to organize annual scientific meetings at one main venue per continent and regional hubs where participants, can come together in person. Presentations and session moderations will be possible from main venues and distant hubs. Carbon footprint from air travel would decrease, while the scientific contents would be improved by the collaboration between the societies. We theorize that local hubs, easier and less expensive to reach, will increase the number of participants who face economic, geopolitical, ecological and familial barriers to travel. Regional and time differences would allow each society to preserve the specific characteristics and sessions of its conference. The preservation of one main venue on each continent, will enable a gradual transition, allowing medical societies and corporate sponsors to take advantage of the enlarged audience, while measuring the desired outcomes and being able to adjust their management. Hubs participants will be actively involved reducing the burden of travel, transitioning to a preference of joining the main venue only every second or third year. CONCLUSION/CONCLUSIONS:An economically sustainable approach towards low carbon footprint, scientifically improved and more accessible meetings needs to be considered.

PURPOSE/OBJECTIVE:This study developed and validated algorithms to identify the incidence of endometrial cancer using ICD-9-CM and ICD-10-CM coding systems as part of a post-authorization safety study (EU PAS: EUPAS45602) of vaginal estrogen, estrogen and progestin combination hormone therapy, and non-users of vaginal estrogen. METHODS:Using national claims data in the HealthCare Integrated Research Database, provisional endometrial cancer cases were identified using a screening algorithm comprising at least one endometrial cancer diagnosis code at any location and position between January 1, 2007 and December 31, 2021. One medical record per case was obtained for 700 provisional cases. Two experts in obstetrics and gynecology adjudicated the medical records classifying each patient as a confirmed case, confirmed non-case, or unknown. Positive predictive value (PPV), conditional sensitivity assuming all cases were identified by the screening algorithm, and their respective 95% confidence intervals (CI) were calculated. Algorithms were generated by choosing the codes and number of encounters to balance endometrial cancer detection and false positives. Algorithms were trained in a sample of non-users of vaginal estrogen and tested across treatment groups. RESULTS:Among the non-user training set, two visits with ICD-9-CM code 182.0 or 182.8 had a PPV of 91.2% (85.4%-95.2%) and sensitivity of 99.3% (95.9%-100.0%). Two visits on separate days with ICD-10-CM code C54.1, C54.8, or C54.9 had a PPV of 97.0% (93.6%-98.9%) and sensitivity of 99.5% (97.2%-100.0%). PPVs and sensitivities were over 75% across testing set cohorts for both algorithms. CONCLUSION/CONCLUSIONS:Two visits with an endometrial cancer diagnosis code accurately identified endometrial cancer cases in both coding systems. There were very few false positive endometrial cancer diagnoses. PPVs and sensitivities were high and similar in all cohorts.