Jennifer Kawwass

BackgroundThere are significant racial disparities in in vitro fertilization outcomes, which are poorly explained by individual-level characteristics. Environmental factors such as neighborhood-level socioeconomic factors may contribute to these disparities. However, few studies have directly addressed this research question in a large, racially diverse cohort.ObjectiveThis study aimed to investigate whether neighborhood deprivation is associated with differences in in vitro fertilization outcomes.Study DesignOur retrospective cohort study included 1110 patients who underwent 2254 autologous in vitro fertilization cycles between 2014 and 2019 at an academic fertility center in the Southeastern United States. Neighborhood deprivation was estimated using the Neighborhood Deprivation Index, a composite variable measuring community levels of material capital based on poverty, occupation, housing, and education …

ObjectiveTo describe characteristics, trends, and outcomes of international gestational surrogacy cycles in the United States (US).DesignRetrospective cohort study.SettingAll assisted reproductive technology cycles in the US reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting Systems that included an embryo transfer to a gestational carrier from 2014 to 2020.PatientsInternational vs. US intended parents.Main Outcome MeasuresCycle characteristics, geographic distributions, and obstetrical outcomes.ResultsOf 40,177 embryo transfers to a gestational carrier from 2014 to 2020, 32% were for international intended parents. The number and percent of international intended parents’ gestational carrier cycles increased each year from 2014 (n = 2758, 22.0%) to 2019 (n = 4905, 39.8%) with a decrease in 2020 (n = 4713, 31.8%). Compared with cycles for US intended parents, there …

PurposeOocyte cryopreservation (OC) is a medical intervention for reproductive-aged women, a demographic that uses social media heavily. This study characterizes the top TikTok videos and Instagram reels on OC.MethodsFive hashtags pertaining to OC were selected: #oocytepreservation, #oocytecryopreservation, #eggfreezing, #oocytefreezing, and #fertilitypreservation. Top videos for each hashtag were evaluated for source, content, impact, and quality on both platforms. Descriptive and inferential statistics were performed to analyze differences between laypeople and medical professionals.ResultsFrom March to April 2023, 332 posts were reviewed. The most popular hashtags on TikTok and Instagram were #eggfreezing (n = 5.6 million views, n = 68,500 + posts) and #fertilitypreservation (n = 9 million views, n = 20,700 + posts). Laypeople dominated as sources (57.8%, 35.2%), followed by …

OBJECTIVETo describe national trends in gestational carrier (GC) use and evaluate differences in outcomes between assisted reproductive technology (ART) cycles using a GC versus cycles that do not utilize a GC.MATERIALS AND METHODSUsing data from the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System, ART cycles between 2014–2020 involving an embryo transfer to a uterus were analyzed. Poisson and linear regression models were used to evaluate the annual number and percentage of ART GC cycles over the study period. Using log binomial regression models, we calculated adjusted relative risk (aRR) for pregnancy, clinical pregnancy, and live birth comparing cycles that did and did not use a GC. Among live births, aRRs for gestational age at birth and for multiple gestation were calculated comparing cycles that did and did not use a GC.RESULTSOf 1,008,205 ART …

BackgroundIn 2016, the US Food and Drug Administration amended existing regulations to increase access to donated embryos for reproductive use. Current information regarding the characteristics and outcomes of embryo donation cycles could benefit patients and providers during counseling and decision making.ObjectiveThis study aimed to examine the trends in the utilization of embryo donation, pregnancy rates, and live birth rates per transfer between 2004 and 2019 and to describe the recipients of donated embryos and outcomes of frozen donated embryo transfer cycles during the most recent time period, that is, 2016 to 2019.Study DesignWe conducted a retrospective, population-based cohort study of frozen donated embryo transfer cycles in United States fertility clinics reporting to the National Assisted Reproductive Technology Surveillance System during 2004 to 2019. The trends in the annual …

Significant racial and ethnic disparities in access and outcomes for assisted reproductive 17 technologies (ART) are well documented (1). In the preceding article by Liao et al.(2), the 18 authors utilized data from the Society for Assisted Reproductive Technology (SART) Clinic 19 Outcome Reporting System (CORS) to describe racial and ethnic disparities in utilization and 20 live birth rates from donor oocyte ART cycles, as well as the impact of state donor ART 21 insurance mandates (specifically, Massachusetts and New Jersey) in addressing these 22 disparities. This retrospective cohort study evaluated 44,033 donor oocyte ART cycles from 23 2014-2016. After stratifying cycles by race/ethnicity, the authors found that Black and Hispanic 24 patients were under-represented compared to their representation in the overall United States 25 (US) population; these disparities were diminished but persistent in states …

PurposeTo analyze the geographic distribution of REI fellowships and clinics across the USA and to strategize ways to improve patient access to care.MethodsCross-sectional study using population data obtained from publicly available United States Census Bureau, Society for Assisted Reproductive Technology (SART), and National Resident Matching Program websites. Outcomes include the number of REI clinics, REI fellowship-trained physicians, and REI fellowship programs.ResultsIn 2020, there were 643 assisted reproductive technology (ART) clinics reporting to SART and 1351 fellowship-trained REI physicians. Most clinics are located in the south (n = 209); however, the northeast has the highest density of REI clinics. Out of 301,316 in vitro fertilization (IVF) cycles in the USA in 2020, northeastern states initiated the most cycles (n = 93,565), and Midwestern states initiated the fewest cycles (n = 50,000 …

BackgroundInsurance coverage for fertility services may reduce the financial burden of high-cost fertility care such as assisted reproductive technology and improve its utilization. Patients who exit care after failing to reach their reproductive goals report higher rates of mental health problems and a lower sense of well-being. It is important to understand the relationship between state-mandated insurance coverage for fertility services and assisted reproductive technology care discontinuation.ObjectiveThis study aimed to assess whether state-mandated insurance coverage for fertility services is associated with lower rates of care discontinuation after an initial assisted reproductive technology cycle that did not result in a live birth.Study DesignThis is a retrospective, population-based cohort study using data from United States fertility clinics reporting to the National Assisted Reproductive Technology Surveillance …

ObjectiveTo determine factors associated with a positive male patient experience (PMPE) at fertility clinics among male patients.Design: Cross-sectional studySetting: Not applicablePatients: Male respondents to the FertilityIQ questionnaire (www.fertilityiq.com) reviewing the first or only US clinic visited between June 2015 and August 2020.Interventions: NoneMain outcome measures: PMPE was defined as a score of 9 or 10 out of 10 to the question, “Would you recommend this fertility clinic to a best friend?”. Examined predictors included demographics, payment details, infertility diagnoses, treatment, and outcomes, physician traits, and clinic operations and resources. Multiple imputation was used for missing variables and logistic regression was used to calculate adjusted odds ratios (aORs) for factors associated with PMPE.ResultsOf the 657 men included, 60.9% reported a PMPE. Men who felt their doctor was …

Should menopause care be part of the skill set of a reproductive endocrinology and infertility specialist? Should menopause care be part of the skill set of a reproductive endocrinology and infertility specialist? Fertil Steril. 2023 Dec 13:S0015-0282(23)02006-X. doi: 10.1016/j.fertnstert.2023.11.018. Online ahead of print. Authors Sarah L Berga 1 , Jamie Merkison 2 , D Austin Schirmer 2 , Jennifer F Kawwass 2 , Nanette Santoro 3 Affiliations 1 Department of Obstetrics and Gynecology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo State University of New York, Buffalo, New York; Obstetrics and Gynecology and Women's Health Program Development, Oishei Children's Hospital, Kaleida Health, Buffalo, New York. 2 Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory Reproductive Center, Atlanta, Georgia. 3 Department of Obstetrics and …

Although the need for physicians is widely spread across the country in many specialties, there is an increased demand for physicians specializing in reproductive endocrinology and infertility (REI), especially in underserved areas. Over the past 20 years, the use of in vitro fertilization (IVF) has tripled (1). A part of the heightened demand stems from older age at the time of the first delivery; decline in sperm quality, resulting in more male factor infertility; expansion of insurance coverage, enabling greater access to care; increased Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQþ) family building; and growing interest in fertility preservation (2).

ObjectiveTo evaluate fertility clinic management of male factor infertility, including website educational content as well as factors associated with referral for urologic evaluation and care.Materials and MethodsUsing 2015-2018 Centers for Disease Control and Prevention Fertility Clinic Success Rates Reports, 480 operative fertility clinics in the United States were identified. Clinic websites were systematically reviewed for content regarding male infertility. Structured telephone interviews of clinic representatives were performed to determine clinic-specific practices for management of male factor infertility. Multivariable logistic regression models were used to predict how clinic characteristics (geographic region, practice size, practice setting, proximity to urologist, in-state andrology fellowship, state-mandated fertility coverage, annual in vitro fertilization cycles, and percentage of in vitro fertilization cycles for male factor …

METHODS:This study surveyed third-and fourth-year US medical students applying into US residency programs from August 6, 2022, to October 22, 2022. Participants were selected via convenience sampling through social media and direct outreach to US medical school admissions offices, medical student class presidents, and medical student organizations. 494 complete responses were analyzed.RESULTS:The majority (77.0%) of respondents across all medical specialties reported that access to abortion care, or lack thereof, affects the location of residency programs to which they apply. Over half (58.1%) of respondents said they are unlikely to apply to a residency program located in a state with abortion restrictions. The sample represented students applying to many specialties, with obstetrics and gynecology applicants comprising 21.6% of the sample.CONCLUSION:This study found that the majority of third …

ObjectiveSince the emergence of the coronavirus disease 2019 (COVID-19) pandemic, menstrual cycle changes have been reported in association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination and infection (

Residency selection is a challenging process for medical students, one further complicated in the USA by the recent Dobbs v Jackson Women’s Health Organization (Dobbs) decision over-ruling the federal right to abortion. We surveyed medical students to examine how Dobbs is influencing the ideological, personal and professional factors they must reconcile when choosing where and how to complete residency.Between 6 August and 22 October 2022, third-year and fourth-year US medical students applying to US residency programmes were surveyed through social media and direct outreach to medical schools. Analysis of quantitative and qualitative data from 494 responses was performed to assess downstream effects of Dobbs on residency applicants’ family, health and career choices.Most respondents said changes in abortion access would likely or very likely influence their decision regarding location of …

ObjectiveTo determine the prevalence of physical intimate partner violence (IPV) among postpartum women reporting preconception fertility treatment compared with those who conceived without the use of assisted reproduction.DesignRetrospective cross-sectional population-based study.SettingNot applicable.Patient(s)Postpartum respondents of the Centers for Disease Control Pregnancy Risk Assessment Monitoring System survey.InterventionPreconception fertility treatment utilization.Main Outcome MeasuresPhysical IPV.ResultsOf the 43,999 respondents included in this analytic sample, roughly 2% reported physical IPV. Respondents reporting preconception fertility treatment (12.6%) were less likely to endorse physical IPV than those who conceived without fertility treatment exposure (odds ratio, 0.5; 95% confidence interval, 0.4–0.7). In the multivariate regression model, the odds of physical IPV were similar …

PurposeEmerging data suggests improved obstetric outcomes with frozen embryo transfer (FET) in an ovulatory or natural cycle (NC-FETs), as compared to programmed endometrial preparation. The objective of this study is to better understand practice patterns and provider attitudes regarding the use of NC-FETs in the United States (U.S.).MethodsIn this cross-sectional study, an anonymous 22-question survey was emailed to 441 U.S. Assisted Reproductive Technology (ART) clinics to assess the utilization of NC endometrial preparation for FET, protocols used, restrictions to offering NC-FET, and providers’ perspectives on advantages and disadvantages of NC-FET. Descriptive statistics were used to analyze survey responses.Result(s)The survey response rate was 49% (216/441). Seventeen percent of responding clinics did not offer NC-FET. Of the clinics that did not offer NC-FET, 65% had only 1–2 physicians …

Methods| Deidentified data from the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System involving an embryo transfer between 2014 and 2020 were analyzed. This national surveillance system encompassed 90% of US assisted reproductive technology cycles. This study was exempted by the Emory University institutional review board.Poisson and linear regression models were used to evaluate the annual number and percentage of assisted reproductive technology cycles using a gestational carrier between 2014 and 2020. Using log binomial regression, we calculated the adjusted relative risk (RR) for pregnancy, clinical pregnancy, and live birth comparing assisted reproductive technology cycles that used vs did not use a gestational carrier, adjusting for age of oocyte donor or intended parent at time of retrieval, infertility diagnosis, donor oocyte use, intracytoplasmic sperm injection …

In their manuscript entitled “Insurance Coverage for Planned Oocyte Cryopreservation and Infertility across the US Medical, Law and MBA Schools”[1], Gupta et al. evaluate professional school health insurance policies to determine the presence and variability of coverage for planned oocyte cryopreservation (OC),“iatrogenic (IA)” oocyte cryopreservation, and infertility. In the United States, the average age at first birth has gradually increased over time [2] as more women delay childbearing for pursuit of professional goals. Given that fertility potential decreases with age, patients that delay conception are more likely to be diagnosed with infertility and subsequently use assisted reproductive technology, which is increasingly costly and less effective as reproductive age advances. As such, graduate students who are not yet ready to conceive comprise a unique population of individuals that may strongly consider …

PurposeTo determine the recurrence risk and risk factors for monozygotic splitting after elective single-embryo transfers (eSET).MethodsA retrospective cohort study was performed investigating 65,664 eSET cycles that resulted in a clinical pregnancy as reported in the Society for Assisted Reproductive Technology (SART) Clinical Outcomes Reporting System (CORS) between 2004 and 2017. Monozygosity was defined as more than one fetal heart tone by the first-trimester ultrasound and concordant sex at live birth. The primary outcome was recurrence risk, with recurrence defined as one patient having two or more cycles of eSET resulting in monozygotic multiples. The secondary objective was to identify factors associated with smonozygotic splitting, using a multivariable logistic regression model and a stepwise purposeful model selection.ResultsThere were 1355 (2.05%) pregnancies that resulted in two or more …