Lusine Aghajanova

Purpose The purpose was to evaluate reproductive endocrinology and infertility (REI) physicians’ personal experience with infertility. Methods A 40-question cross-sectional survey addressing demographics, fertility choices, and types of infertility treatments undertaken by REI physicians was developed. A link to the anonymous survey was sent to the REI specialists via email, social media, and personal contacts. Statistical analysis also compared responses of participants ≤ 35 and > 35 years old regarding their experience with infertility. Results 165 respondents completed the survey. Most identified as heterosexual (93%) married (88%) women (82%) between ages 31 and 45 (73%). 44% of all respondents reported using infertility treatment to conceive. Most used in vitro fertilization (IVF, 51%), as well as intrauterine insemination (IUI, 14%), medicated timed intercourse (MTIC, 12%), oocyte cryopreservation (5%), and a gestational carrier (GC, 4%). For the 30% of respondents, the cause of infertility was anovulation/oligo-ovulation, followed by poor ovarian reserve/age (18%), male factor infertility (18%), and recurrent pregnancy loss (18%). 40% of respondents reported no insurance coverage while 30% endorsed partial coverage. 79% reported having shared their experiences with their patients. 47% said that their career choice possibly negatively affected their fertility (yes/maybe/not sure). This was significantly different between respondents ≤ 35 and > 35 years old (p = 0.0001). Conclusion While REI physicians have professional understanding of infertility, nearly half were affected by it needing to undergo treatment with minimal or no insurance coverage. The prolonged and demanding training is a likely contributor. The generalizability of our findings is limited by potential sampling and nonresponse biases inherent in voluntary survey designs.

Objective: The objective of this study is to examine the detailed pregnancy and neonatal outcomes of women without male partners undergoing intrauterine insemination (IUI) compared to women with male partners. Methods: This is a retrospective cohort study of all patients who completed an IUI cycle from 2017 to 2023. 2414 cycles were included in the study: 149 cycles for women without male partners (including single and lesbian women) and 2265 cycles for women with male partners. Primary outcomes were the rates of clinical pregnancy, miscarriage, and live birth. Secondary outcomes were obstetric complication rates and neonatal outcomes. Results: Women without male partners undergoing IUI were significantly older than the reference cohort (median age 42 years versus 38 years, p < 0.0001). 84.1% of women without male partners did not have a diagnosis of the common causes of female infertility. Both cohorts had similar cycle characteristics and number of IUI cycles until pregnancy and live birth. The mean clinical pregnancy rate per cycle for women without male partners was 11.4% versus 12.5% for the reference group (p = 0.56), and the mean live birth rate was 8.1% versus 8.2% (p = 0.95). Multiple pregnancy, cumulative pregnancy, and clinical miscarriage rates were also similar. Similarities persisted after adjusting for confounders: age, BMI, race, and infertility diagnosis. Importantly, there were no statistically significant differences in obstetric complications (such as hypertensive disorders of pregnancy, gestational diabetes, placental disorders) and neonatal outcomes. Conclusions: Compared to women with male partners undergoing IUI, women without male partners had similar rates of clinical pregnancy (per cycle and cumulative), miscarriage, and live birth; there were no significant differences in obstetric complications or neonatal outcomes.

Purpose To evaluate the feasibility and potential therapeutic effect of intrauterine platelet-rich plasma (PRP) infusion in patients with recurrent implantation failure (RIF) undergoing frozen embryo transfer (FET); to characterize PRP cytokine/growth factor profiles by cycle phase and pregnancy outcomes. Methods In this single-blinded, pilot randomized controlled trial, 52 women with unexplained RIF, normal uterine cavity, and endometrial thickness > 7 mm were enrolled. Eleven did not complete the FET cycle, leaving 33 patients in the intention-to-treat analysis (PRP: n = 13; control: n = 20). Eight additional patients received PRP in a subsequent cycle. Participants were randomized to intrauterine PRP or saline infusion in the follicular phase (cycle day 9–12 or days 10–14 of estradiol) and luteal phase (2 days before FET). PRP was isolated from autologous peripheral blood, and 1 mL was infused. Standard treatments were continued. PRP cytokine profiling was performed via Luminex analysis. Primary outcome: pregnancy rate (PR). Secondary: clinical PR, miscarriage rate (MR), live birth rate (LBR), and cytokine correlations. Results Baseline and embryo-related variables were similar between groups. In the intention-to-treat analysis, PR was 69% in the PRP group vs 50% in controls (p = 0.27); LBR was 46% vs 25% (p = 0.27); MR was 22% vs 50% (p = 0.35). PRP was well tolerated. Eight cytokines differed by cycle phase. Lower luteal levels of CCL1, CCL26, and IL-23 correlated with live birth; higher CCL1 and CCL26 correlated with miscarriage. Conclusion While not statistically significant, PRP showed trends toward improved outcomes in RIF and was safe. Cytokine profiles varied by cycle phase and may reflect markers of fertility or treatment response. Trial registration The study was prospectively registered in the ClinicalTrials.gov Protocol Registration System (NCT03379649, https://clinicaltrials.gov/search?locStr=Sunnyvale,%20CA&country=United%20States&state=California&city=Sunnyvale&cond=Recurrent%20Implantation%20Failure&intr=Platelet%20Rich%20Plasma). The study was activated on 01/16/2019 and closed on 12/20/2023. The first patient was enrolled on 1/20/2019 and last patient was enrolled on 1/25/2023.

Basran SS, et al. World J Mens Health. 2026 Jan;44:e4. https://doi.org/10.5534/wjmh.250281

Women with hypopituitarism have lower fertility rates and worse pregnancy outcomes than women with normal pituitary function. These disparities exist despite the use of assisted reproductive technologies and hormone replacement. In women with hypogonadotropic hypogonadism, administration of exogenous gonadotropins can be used to successfully induce ovulation. Growth hormone replacement in the setting of growth hormone deficiency has been suggested to potentiate reproductive function, but its routine use in hypopituitary women remains unclear and warrants further study. In this review, we will discuss the clinical approach to fertility in a woman with hypopituitarism.

Purpose To study effect of intrauterine infusion of platelet-rich plasma (PRP) on endometrial growth in the setting of thin endometrial lining in patients with prior cancelled or failed frozen embryo transfer (FET) cycles. Materials and methods Single-arm cohort study of forty-six patients (51 cycles) with endometrial lining thickness (EMT) < 6 mm in prior cancelled or failed FET cycles requesting intrauterine PRP treatment in upcoming FET cycle. The primary outcomes were final EMT in FET cycle and change in EMT after PRP. The secondary outcomes were overall pregnancy rate, clinical pregnancy rate, miscarriage rate, ongoing pregnancy, and live birth rates. Results The mean pre-PRP EMT in all FET cycles was 4.0 ± 1.1 mm, and mean post-PRP EMT (final) was 7.1 ± 1.0 mm. Of 51 cycles, 33 (64.7%) reached ≥ 7 mm after PRP administration. There was a significant difference between pre-PRP EMT and post-PRP EMT in all FET cycles, with mean difference of 3.0 ± 1.5 mm. Three cycles were cancelled for failure to reach adequate lining. Total pregnancy rate was 72.9% in our cohort of 48 cycles that proceeded to transfer. Clinical pregnancy rate was 54.2% (26/48 FET cycles); clinical miscarriage rate was 14.3% (5/35 pregnancies). Twenty six women had live birth (18 with EMT ≥ 7 mm and 8 with EMT < 7 mm). Response to PRP was not correlated with any pre-cycle characteristics. Conclusion We demonstrate a significant improvement in lining thickness and pregnancy rates in this challenging cohort of women after PRP infusion, with no adverse events. Cost-effectiveness of PRP with benefits and alternatives should be carefully considered.