D.E. Broughton

A Focused Look at Obesity and the Preimplantation Trophoblast

Obesity is associated with a myriad of adverse reproductive outcomes including miscarriage, fetal growth abnormalities, and preeclampsia. While the mechanisms involved are likely multifactorial, the potential impact of obesity on the preimplantation embryonic trophoblast cannot be overlooked-particularly given the role the trophoblast plays in endometrial invasion and implantation. Appropriate trophoblast function is critical in establishing a normal pregnancy. Insufficient or impaired trophoblast invasion is associated with early miscarriage, fetal growth abnormalities, and preeclampsia. Thus, any negative impact obesity may impose on the trophoblast may represent a root cause for several adverse reproductive outcomes seen more commonly among obese women. While little is known about obesitys specific impact on the human trophoblast, in vitro studies and animal models provide insight. In this article, we review what is known on this topic and provide a basis for future work, investigating therapeutic targets for improved reproductive outcomes in the setting of maternal obesity.

Multiple Gestations and Assisted Reproductive Technology

Abstract Many are aware of the recent “epidemic of multiples” in industrialized nations, with a multiple birth rate that has increased by 76% in the past three decades. The main contributors to this increase are increased utilization of assisted reproductive technologies and an increased risk of spontaneous twinning in women delaying childbearing. Multiple gestations are at high risk for both maternal and fetal morbidity and mortality, which increase as fetal number increases. Zygosity and chorionicity are important predictors of perinatal morbidity, with monochorionic diamniotic and monochorionic monoamniotic twins at higher risk. There is evidence that the risk of monozygotic twinning is increased in IVF, etiologies may include zona pellucida manipulation and extended in vitro culture. Most neonatal complications in multiple gestations are sequelae of prematurity, including low birth weight, respiratory distress syndrome, NICU admission, intraventricular hemorrhage, and necrotizing enterocolitis. Up to 80% of women with multiple gestations experience antepartum complications, which include preterm labor, PPROM, and placental abruption. Women carrying multiples are at increased risk for the three major causes of maternal mortality: postpartum hemorrhage, venous thromboembolism, and hypertensive disorders. Multiple gestations are also associated with increased financial and psychosocial costs. Strategies for decreasing the rate of multiples resulting from ART include increasing the number of single embryo transfers performed in IVF and using “low and slow” protocols for superovulation cycles with gonadotropins. Multifetal pregnancy reduction can be performed to decrease the fetal number and lower the risk of morbidity, although the procedure does involve some medical and psychological risk.

Social media in the REI clinic: what do patients want?

PurposeTo elicit patient preferences for social media utilization and content in the infertility clinic.MethodsThis was a cross-sectional survey study conducted in three US fertility practices. Women presenting to the infertility clinic for an initial or return visit were offered an anonymous voluntary social media survey. The survey elicited patient perception of whether social media use in the infertility clinic is beneficial, and preferences regarding topics of interest.ResultsA total of 244 surveys were collected during the study period, of which 54.5% were complete. Instagram is a more popular platform than Twitter across all age groups. Use of both platforms varies by age, with patients ≥ 40 less likely to be active users. The majority of respondents felt that social media provided benefit to the patient experience in the infertility clinic (79.9%). “Education regarding infertility testing and treatment” and “Myths and Facts about infertility” were the most popular topics for potential posts, with 93.4 and 92.0% of patients endorsing interest respectively. The least popular topic was “Newborn photos and birth announcements,” with only 47.4% endorsing interest. A little over half of respondents (56.3%) would feel comfortable with the clinic posting a picture of their infant. The vast majority of patients (96.2%) feel comfortable communicating electronically with their infertility clinic.ConclusionPatients are interested in the use of social media as a forum for patient education and support in the infertility clinic. Patient preferences regarding post topics should be carefully considered.

Care of the transgender or gender-nonconforming patient undergoing in vitro fertilization

ABSTRACT  Background: Assisted reproductive technologies, including in vitro fertilization (IVF), can be utilized for fertility preservation and family building in the transgender and gender-nonconforming population. Methods: This is a retrospective case series from an academic tertiary care center. Results: We present three couples with a transgender or gender-nonconforming member who pursued IVF to build their families. The first case involves a transgender man who suspends hormone therapy to undergo IVF. The second involves a transgender woman who uses her previously banked sperm to undergo IVF with her wife. The third involves a gender nonbinary patient and their cisgender wife who create and transfer embryos from both partners. Conclusion: IVF can provide unique family-building opportunities to transgender and gender-nonconforming patients, and providers should seek to broaden their clinical experience with this population.

Sex and gender: you should know the difference

Embryos do not have a ‘‘gender’’; rather, they have a ‘‘sex.’’ Gender refers to social and cultural distinctions between sexes, not biological ones. An embryos ‘‘maleness’’ or ‘‘femaleness’’ should therefore be defined by its biological sex (i.e., sex chromosome pair). We recognize that ‘‘sex’’ and ‘‘gender’’ are often synonyms in regular speech. But, as reproductive medicine specialists who might tout services in ‘‘gender selection/ determination’’ or even care for patients who are transgender, it is imperative that we dictate the use of the proper terminology, not just among ourselves, but also during dialogue with patients, policymakers, and other stakeholders. Failing to do so may have unintended consequences that we will attempt to point out.