Patients receiving treatment that has the potential to negatively affect their gonads, including chemotherapy, surgery, and radiation therapy, should be informed of options for fertility preservation and future reproduction before initiating treatment. Reproduction in the context of fertility-affecting treatment raises a number of ethical issues related to the welfare of both patients and offspring. This document replaces the document titled, "Fertility preservation and reproduction in patients facing gonadotoxic therapies: an Ethics Committee opinion," last published in 2018. (Fertil Steril (R) 2026;125:260-6. (c) 2025 by American Society for Reproductive Medicine.) El resumen est & aacute; disponible en Espa & ntilde;ol al final del art & iacute;culo.

OBJECTIVE:To investigate the relationship between platelet indices (count, size and production/immaturity) and hypertensive disorders of pregnancy. STUDY DESIGN:This was a secondary analysis of a prospective cohort of pregnant individuals followed from first trimester through delivery at an academic tertiary care institution. Routine platelet indices obtained prospectively during prenatal care and delivery were compared between those who developed a hypertensive disorder of pregnancy and those who did not. We assessed platelet count (by trimester), mean platelet volume, and immature platelet fraction measured as percent (%) and absolute count. Data were analyzed using Fisher's Exact test, chi-square test, and multivariable logistic regression. P < 0.05 was considered statistically significant. RESULTS:Among 459 participants enrolled, 78 (17.0 %) developed a hypertensive disorder of pregnancy. Pregnant individuals who developed a hypertensive disorder of pregnancy had significantly higher mean platelet volume (11.7 fL [10.8,12.4] vs. 11.1 fL [10.5,12.0], Padj < 0.01), percent immature platelet fraction (7.3 % [4.9,10.7] vs. 5.9 % [4.2,9.2], Padj = 0.01) and absolute immature platelet fraction (16.4 × 109 [11.2,20.4] vs. 13.3 × 109 [9.3,17.4], Padj = 0.01) compared to those without a hypertensive disorder of pregnancy, after adjusting for age, race/ethnicity, obesity, nulliparity, and chronic hypertension. The prevalence and likelihood of a hypertensive disorder of pregnancy increased with increasing mean platelet volume, as well as with both the percent and absolute immature platelet fraction. There was no difference between groups in platelet count in the first trimester, second trimester, or at delivery. CONCLUSIONS:An increase in platelet size and immaturity was observed in those with a hypertensive disorder of pregnancy. These data support further investigation of platelets in the mechanisms of the development of hypertensive disorders of pregnancy and the use of platelet indices to better identify high risk groups in pregnancy.

OBJECTIVE:To obtain perspectives about existing compensation structures in gynecologic oncology, including common challenges and successful strategies within diverse systems. METHODS:Electronic mail was used to recruit OB/GYN department chairs and directors of cancer centers who were gynecologic oncologists and responsible for administering compensation structures at their institution. Using a semi-structured guide, three interviewers conducted 30-min qualitative interviews, which were recorded and transcribed. Two coders used the constant comparative method to summarize key themes. RESULTS:Response rate was 65 %, resulting in 17 interviewees. Participants were a third women and in their current position for a median of 7 years. The most prominent theme was the tension of balancing reimbursement for revenue-generating clinical activities with non-clinical work in research and education. Chair discretionary funds were useful to offset unfunded responsibilities. Broad clinical productivity measures were used: from more traditional work Relative Value Units (wRVUs) to measures that captured downstream impact, such as number of new patients or surgeries. Even in institutions with centralized funds flow systems, disparities were frequently noted for the monetary value assigned per wRVU. Academic scorecards were described as a method to ascribe value for academic work, often for bonus incentives. Another common stressor unique to gynecologic oncology was low reimbursement for chemotherapy-related services compared to surgery. Provision of regular productivity reports was common, but full transparency was controversial. CONCLUSIONS:Our inquiry demonstrates that our academic leaders are unable to use compensation to fully support areas they deem important.

Objective: To systematically review disparities in surgical outcomes for uterine fibroids among Black women compared to non-Black women and identify contributing factors. Data sources: Systematic searches of PubMed, Embase, and Scopus from January 2010 to May 2024 were conducted. Study eligibility criteria: Included studies focused on surgical interventions for uterine fibroids in diverse populations, evaluating outcomes such as efficacy, safety, and complications. Excluded studies lacked racial stratification or reported non-surgical treatments. Study appraisal and synthesis methods: Study quality was assessed using the Methodological Index for Nonrandomized Studies (MINORS). Data synthesis adhered to PRISMA guidelines. Results: Of 1,063 studies screened, 14 met inclusion criteria. Black women faced higher rates of open hysterectomy (OR 1.65; 95% CI, 1.02–2.68), longer hospital stays (+0.6 days, p<0.001), and greater perioperative complications (OR 1.54; 95% CI, 1.31–1.80) compared to White women. Disparities persisted across socioeconomic strata. Conclusions: Systemic inequities underlie significant disparities in surgical outcomes for uterine fibroids among Black women. Expanding access to minimally invasive techniques and addressing socioeconomic barriers are critical to reducing these disparities.

BACKGROUND:Lack of sexual orientation and gender identity (SOGI) collection hinders the ability to identify cancer disparities, create opportunities for improvement, and reveal the burden of cancer among sexual and gender minority (SGM) populations. Our institution is one of the first NCI-Designated Comprehensive Cancer Centers to collect SOGI as standard-of-care demographics. METHODS:This analysis includes 118 320 patients who came to the H. Lee Moffitt Cancer Center & Research Institute ("Moffitt") between January 1, 2016 and December 31, 2023 and completed the institutional standard-of-care electronic patient questionnaire. Descriptive analyses were conducted to assessed overall and age-specific differences between SGM and non-SGM patients (ie, cisgender-heterosexual) for demographics, SOGI disclosure, clinical covariates, and psychosocial and quality-of-life needs. RESULTS:Compared with non-SGM patients, SGM patients were statistically significant younger, single, self-identified as racial and ethnic minorities, reported higher psychosocial and quality-of-life needs, and had higher-than-expected rates for several specific cancer sites. CONCLUSIONS:Revealing these real-world cancer disparities among SGM patients based on only 7 years of SOGI data collection highlights the fundamental importance of systematic collection of this demographic information for identifying and eventually mitigating health disparities.

BACKGROUND/OBJECTIVES:The Family-centered Adolescent Sperm banking values clarification Tool (FAST) was developed to facilitate sperm banking communication and decision-making pre-cancer treatment. The FAST was tested in a pilot parallel randomized controlled trial (Fertility Preservation Discussions And Decisions: "FP-DAD"-NCT04268004), aiming to (i) assess feasibility/acceptability of FP-DAD; and (ii) examine efficacy regarding banking attempts (yes/no) and decision quality. Differences in decision quality by banking attempt were explored. DESIGN/METHODS:Males (12-25 years, new cancer diagnosis) and caregivers were randomized to standard of care (fertility consult) or FP-DAD (fertility consult + FAST + interventionist-led discussion). One month later, FP-DAD participants completed acceptability surveys. Both arms completed the Brief Subjective Decision Quality measure. Descriptive statistics, chi-square, and independent samples t-tests/mixed-models examined relationships between variables. RESULTS:Acceptability ratings of FP-DAD were high (88%-100%). Recruitment and participation challenges limited the final sample size (21 adolescents and 32 caregivers). Banking attempts (67% in standard of care vs. 82% in FP-DAD) did not differ by arm. While decision quality was not significantly different between groups, effect sizes were medium-large for four of six items for adolescents (d = 0.6 to -0.90) and two of six for caregivers (d = 0.36 to -0.78). Decision quality was significantly higher across several domains among those who banked. CONCLUSIONS:FP-DAD had high acceptability, though feasibility challenges (e.g., time contraints) limited full family participation. Findings showed limited efficacy, but effect sizes suggest this may be due to sample size. Relationships between banking attempts and decision quality emphasize banking benefits. Findings will inform adaptations to the FAST for clinical implementation.

OBJECTIVE:This study aimed to identify facilitators and barriers among sexual and gender minority (SGM) individuals in receiving reproductive healthcare. METHODS:Participants were recruited through social media and university groups across the US. Inclusion criteria consisted of self-identified SGM community members; aged 18-40. This included: cisgender women whose sexual orientation included gay, lesbian, bisexual, and/or queer and / or individuals whose gender identity does not align with their sex assigned at birth; transgender men, non-binary people with a uterus, cisgender queen woman, and transgender woman. An initial codebook was developed utilizing inductive coding to identify key themes. RESULTS:A total of 9 focus groups were held with 67 people,5-10 people per group. Six themes were identified: 1) Barriers to high quality reproductive care, 2) Facilitators to high quality reproductive care, 3) Negative prior experiences, 4) Physical/logistical access to adequate care, 5) Emotions/trust in disclosing SGM status, and 6) Knowledge levels on SGM reproductive healthcare. CONCLUSION:Quality reproductive health care for SGM individuals is hindered by individual, clinician, and institutional factors. The factors include individual barriers of knowledge, distrust, and dysphoria; clinician barriers knowledge gaps or discomfort; and institutional factors of false advertising of LGBTQ+ friendly practices. PRACTICE IMPLICATIONS:This study impacts clinical practice through providing focused areas to better improve training and education for healthcare providers. Findings support improving clinical training on cultural humility, creating a welcoming environment, maintaining trust, and utilizing sensitive terminology.

INTRODUCTION:Incidence rates for cancer among adolescent and young adults (AYA) have increased 30% since 1970. Declines in mortality underscore the importance of discussing fertility preservation (FP) options prior to receiving gonadotoxic treatments. National guidelines outline FP options including oocyte (OC), embryo (EC), and ovarian tissue cryopreservation (OTC) for female AYA patients. Significant progress has led to changes in FP practices, initially limited to EC. Subsequently, OC was deemed non-experimental in 2013, followed by OTC in 2020. Despite these advancements and guideline recommendations, the availability and utilization of FP services vary. AREAS COVERED:Rapid review methodologies were employed to classify trends in female AYAs utilization of FP cryopreservation options following guideline updates. FP options reviewed include OC, EC, and OTC. Additionally, the review examined if aspects of the decision-making process relevant to FP were present. EXPERT OPINION:Ten articles met inclusion criteria. Results suggest that the declassification of OTC has not necessarily increased its use and OC and EC appear to be most frequently used. The factors associated with decision making appear to have remained consistent with financial constraints having the most impact, followed by partner status and concerns about recurrence.