Recent prohibitory reproductive legislation raises the question of whether preimplantation genetic testing for aneuploidy (PGT-A) reduces the need for abortion procedures. We compared incidence of abortion procedures among individuals who conceived via IVF with and without PGT-A. We conducted a retrospective cohort analysis of surgical and medical abortions or fetal reduction among individuals with clinical intrauterine gestations (CIG) after IVF with and without PGT-A between 2014 and 2021 using institutional data from a high-volume academic center in Illinois, submitted to the Society for Assisted Reproductive Technology (SART). Individuals using PGT-A for recurrent pregnancy loss or using gestational carriers or donor oocytes were excluded. Bivariate analyses were used to identify relevant covariates followed by regression and stratified analyses. P<0.05 was considered significant. 3203 individuals met study inclusion criteria. 39 (1.2%) had abortion/fetal reduction procedures—5 used PGT-A, and 34 did not. In bivariate analysis age and ICSI were associated with increased risk of abortion/fetal reduction procedures. PGT-A did not significantly reduce the odds of abortion or reduction procedures (OR 0.47, 95% CI 0.16-1.36) in the cohort, or in a smaller cohort of individuals 38 and older (OR 0.61, 95% CI 0.08-4.85). Abortion after IVF occurred rarely in this large cohort. PGT-A did not decrease the need for abortion or reduction procedures. Though this cohort is large and provides outcomes from a pro-choice state with relatively favorable access to reproductive health services, SART data are limited and the study is likely underpowered to see a significant association between PGT-A and reduced odds of abortion/reduction procedures. Further analyses using patient-level data and larger datasets are underway.

To demonstrate the efficacy of an intramyometrial injection of low-dose carboprost tromethamine (Hemabate) to facilitate hysteroscopic resection of partially intramural uterine fibroids. This video represents a case from a pilot study of low-dose Hemabate for hysteroscopic myomectomy, with the hypothesis that using this synthetic prostaglandin analog would increase the accessibility of the intramural portion of type 1 and 2 myomas during hysteroscopic resection. The Hemabate was constituted as a dilution of 80 mcg of carboprost tromethamine in 24 mL of normal saline, yielding 3.3 mcg per mL. Injections were performed using the Sidekick rigid needle from Boston Scientific, which was placed through the operative port of the Myosure XL hysteroscope. This video describes the case of a patient enrolled in the study, wherein a 4.6 x 4.5 x 4.1 cm FIGO type 2 fibroid is completely resected in a single procedure. The patient was a 31-year old who presented with heavy menses and dysmenorrhea. A pre-operative saline sonohysterogram showed a type 2 fibroid, with about one-third of the fibroid in the endometrial cavity and two-thirds in the myometrium. The surgical procedure took place under monitored anesthesia care. An initial cervical and paravaginal instillation of 10 mL of 1% lidocaine with epinephrine (1:100,000) was performed to minimize pain upon cervical manipulation. Uterine survey demonstrated that the type 2 uterine fibroid arose from the posterior wall and occupied the majority of the space in the uterine cavity. Given the fibroid was quite vascular, 1% lidocaine with epinephrine was injected beneath the capsule (18 mL total in 4 separate injections) to minimize bleeding and intravascular fluid absorption. Using the Myosure XL tissue removal device, the submucosal portion of the fibroid was resected. Next, the dilute Hemabate solution was injected, specifically between the edge of the open myoma capsule and the endometrium (the intramyometrial/endometrial junction). This was performed in three separate injections of 3-5 mL each for a total of approximately 50 mcg of instilled Hemabate. This yielded quick delivery of the intramural portion of the fibroid into the endometrial cavity, allowing the remainder of the fibroid to be quickly and completely resected. In this pilot study, an intramyometrial injection of dilute carboprost tromethamine assisted with complete hysteroscopic resection of a large type 2 uterine fibroid in a single procedure.

OBJECTIVE:To describe the participation of racial and ethnic minority groups (REMGs) in gynecologic oncology trials. METHODS:Gynecologic oncology studies registered on ClinicalTrials.gov between 2007 and 2020 were identified. Trials with published results were analyzed based on reporting of race/ethnicity in relation to disease site and trial characteristics. Expected enrollment by race/ethnicity was calculated and compared to actual enrollment, adjusted for 2010 US Census population data. RESULTS:2146 gynecologic oncology trials were identified. Of published trials (n = 252), 99 (39.3%) reported race/ethnicity data. Recent trials were more likely to report these data (36% from 2007 to 2009; 51% 2013-2015; and 53% from 2016 to 2018, p = 0.01). Of all trials, ovarian cancer trials were least likely to report race/ethnicity data (32.1% vs 39.3%, p = 0.011). Population-adjusted under-enrollment for Blacks was 7-fold in ovarian cancer, Latinx 10-fold for ovarian and 6-fold in uterine cancer trials, Asians 2.5-fold in uterine cancer trials, and American Indian and Alaska Native individuals 6-fold in ovarian trials. Trials for most disease sites have enrolled more REMGs in recent years - REMGs made up 19.6% of trial participants in 2007-2009 compared to 38.1% in 2016-2018 (p < 0.0001). CONCLUSION:Less than half of trials that published results reported race/ethnicity data. Available data reveals that enrollment of REMGs is significantly below expected rates based on national census data. These disparities persisted even after additionally adjusting for population size. Despite improvement in recent years, additional recruitment of REMGs is needed to achieve more representative and equitable participation in gynecologic cancer clinical trials.

While preimplantation genetic testing for aneuploidy (PGT-A) is intended to identify euploid embryos for single embryo transfer, many patients and providers cite a desire for a good perinatal outcome as rationale for PGT-A. Given this gap between patient perception and evidence-based practice, we investigated the likelihood to achieve a good perinatal outcome among individuals with a clinical intrauterine gestation (CIG) after in vitro fertilization (IVF) with and without PGT-A. We conducted a retrospective cohort analysis of all individuals with clinical intrauterine gestations (CIG) after IVF with and without PGT between 2013 and 2020 using institutional data from a high-volume academic center submitted to the Society for Assisted Reproductive Technology (SART). Individuals using donor oocytes and/or gestational carriers were excluded. The primary outcome of interest was good perinatal outcome, defined as a singleton live birth at 37+ weeks of gestation with birth weight between 2,500 g and 4,000 g (1). Secondary outcomes included live birth, clinically-detected early pregnancy loss (SAB), stillbirth, and route of delivery. Bivariate statistics were performed to identify important covariates followed by regression analyses to control for these covariates. P<0.05 was significant. A post-hoc power calculation was performed. 3,479 individuals met study criteria including 2,172 IVF cycles without PGT-A and 1307 cycles with PGT-A. In bivariate analyses, good perinatal outcomes were positively associated with single embryo transfer (SET) and PGT-A, but negatively associated with frozen embryo transfer (FET) and body mass index (BMI). In a regression analysis adjusting for SET, FET, and BMI, PGT-A remained associated with good perinatal outcome (OR 1.55, 95% CI 1.26-1.91). Limiting the analysis to individuals who underwent FET or SET, PGT-A remained associated with good perinatal outcome (OR 1.6, 95% CI 1.28-2.02 and OR 1.65, 95% CI 1.3-2.08 respectively). In regression analyses, PGT-A was also positively associated with live birth (OR 1.6 95% CI: 1.2-2.1), and negatively associated with SAB (OR 0.63, 95% CI 0.47-0.84). This large cohort study suggests use of PGT-A has favorable pregnancy outcomes, including a significantly higher rate of a good perinatal outcome, when compared to IVF without PGT-A. Subsequent analyses are planned to compare rates of prenatally diagnosed fetal anomalies and maternal outcomes between the cohorts.

To compare odds of pregnancy following intrauterine insemination (IUI) timed by frequent ultrasound monitoring and hCG administration versus monitoring LH levels.

For patients with cancer undergoing fertility preservation, a careful balance exists between cryopreserving all oocytes, including immature oocytes, and providing realistic expectations regarding future reproductive potential of cryopreserved gametes. The objective of this study was to characterize oocyte maturity and success with in vitro maturation (IVM) prior to oocyte cryopreservation by age and medical diagnosis. Retrospective cohort study. Oncology-indicated fertility preservation cycles completed between Jun/2011 and Dec/2018 were reviewed. Maturation stage of oocytes retrieved and cryopreserved were recorded. 149 stimulation cycles were available for analysis. Data are presented as mean±SD (p<0.05). One-way ANOVA or Kruskal-Wallis test were used for statistical analysis. The mean age was 29±6, BMI 27±8, AMH 3.0±2.6 ng/ml, with a mean 11±2 days of ovarian stimulation, 3685±1751 units of total gonadotropin used, and peak estradiol level 1959±1237 pg/ml. As expected, the number of retrieved and cryopreserved oocytes per cycle decreased with age. All GV oocytes were cryopreserved on the day of retrieval and comprised 8-15% of all cryopreserved oocytes. Metaphase I (MI) oocytes were either frozen on the day of retrieval (3-6% of all cryopreserved oocytes) or in vitro matured overnight. The proportion of cryopreserved oocytes at metaphase II stage (MII) on the day of retrieval (Day 0, range 71-82% of all oocytes) or following IVM (Day 1, 1-5% of all oocytes), as well as the proportion of MI and GV oocytes were not different across age groups. The proportion of frozen eggs at different maturation stages also did not differ by diagnosis.Tabled 1<25yo (n=37)25-34yo (n=74)35-37yo (n=20)>38yo (n=18)p valueOocytes retrieved16±916±913±78±6p=0.002Oocytes frozen15±814±910±57±5p=0.0001Metaphase II frozen on D0 (%) of total frozen80±16%76±23%82±19%71±28%p=0.6Metaphase II frozen on D1 (%) of total frozen1±3%5±11%5±14%2±6%p=0.5MI % of total frozen6±9%6±12%3±8%5±9%p=0.6GV (%) of total frozen11±15%11±16%8±13%15±27%p=0.7 Open table in a new tab Our data did not demonstrate a difference in maturation stage of cryopreserved oocytes by age or clinical diagnosis. Notably, in a large fertility preservation program approximately 20% of oocytes are cryopreserved at the GV or MI stage or following IVM. Studies suggest that patients undergoing medically indicated fertility preservation may overestimate their likelihood of success with cryopreserved gametes; this may be of particular consequence among patients freezing immature or in vitro matured oocytes with lower pregnancy potential. Patients must be carefully counseled to ensure realistic expectations of success with cryopreserved gametes.