Bortoletto P, Romanski PA, Petrozza JC, Pfeifer SM. Reproductive Surgery: Revisiting Its Origins and Role in the Modern Management of Fertility. Fertil Steril. 2023 Mar 2:S0015-0282(23)00164-4. doi: 10.1016/j.fertnstert.2023.02.031. Epub ahead of print. PMID: 36870592.

Reproductive surgery is often utilized adjunct to ART therapies to reduce the influence of reproductive pathologies and enhance success rates of fertility care. Due to a plateau in favorable clinical outcomes following IVF cycles, the influence of reproductive surgeries on fertility outcomes continues to gain interest. This review provides insight into the following surgeries and pathology treatments: uterine fibroids, endometriosis, adenomyosis, PCOS, endometriomas, tubal surgery, mullerian abnormalities, ectopic pregnancy, as well as emerging techniques and tools.

New EP, Kodama S, Devine K, Jahandideh S, Imudia AN, Plosker SM. Live birth associated with peak serum estradiol levels in letrozole intrauterine insemination cycles. Fertil Steril. 2023 Jan 10:S0015-0282(23)00006-7. doi: 10.1016/j.fertnstert.2023.01.003. Epub ahead of print. PMID: 36634734.

This retrospective cohort study included a total of 2,368 OI-IUI cycles, from 1,557 patients, that occurred between January 2014 and July 2019. Study participants were between the ages of 18 and 46 years old, underwent OI or controlled ovarian hyperstimulation with letrozole followed by IUI, had at least one patent fallopian tube documented by hysterosalpingography or laparoscopy, confirmation of premenopausal status, confirmation of sperm in semen analysis, and a BMI < 44 kg/m2. Results from the study suggest that mean peak E2 level on day of hCG trigger or LH surge was independent of positive or negative pregnancy test after IUI (192.12 ± 98.80 vs.181.97 ± 109.69, respectively, P=.123). After adjusting for BMI, age, largest follicle diameter, and number of follicles ≥ 14 mm in diameter, live birth rate and clinical pregnancy rate were reduced in women with lower E2 levels than those with higher E2 levels at the 25th (E2 level, lower mean, 82.1 ± 19.8 pg/mL, vs. higher mean, 218.1 ± 104.4 pg/mL), 50th (lower mean, 107.4 ± 30.9 pg/mL, vs. higher mean, 259.8 ± 104.6 pg/ mL), and 75th (lower mean, 134.6 ± 47.5 pg/mL, vs. higher mean, 331.0 ± 107.3 pg/mL) percentile E2 level quartiles. Live birth rate was not significant different between cycles with an endogenous LH surge and no hCG trigger (n=96) and those where an hCG trigger medication was administered (n=2,272). Those cycles with an endogenous LH surge had a higher E2 level (229.42 vs. 181.34, P<.001) and fewer follicles ≥ 14 mm in diameter (1.28 vs. 1.70, P<.001).

Bardos J, Kwal J, Caswell W, Jahandideh S, Stratton M, Tucker M, DeCherney A, Devine K, Hill M, O’Brien JE. Reproductive genetics laboratory may impact euploid blastocyst and live birth rates: a comparison of 4 national laboratories’ PGT-A results from vitrified donor oocytes. Fertil Steril. 2023 Jan;119(1):29-35. doi: 10.1016/j.fertnstert.2022.10.010. Epub 2022 Nov 29. PMID: 36460523.
Fertility and Sterility Seminal contribution.

This retrospective study gathered data from embryos of donor oocytes that underwent trophectoderm biopsy and PGT-A from four different laboratories to investigate variation in euploid blastocyst rate and live birth rate across different laboratories when controlling for blastocyst quality. Results from the study suggest that there are differences in euploid blastocyst rate and live birth rates for a young and healthy population between laboratories, suggesting that not all PGT-A laboratories provide comparable outcomes.

Adeleye AJ, Kawwass JF, Brauer A, Storment J, Patrizio P, Feinberg E. The mismatch in supply and demand: reproductive endocrinology and infertility workforce challenges and controversies. Fertil Steril. 2023 Jan 13:S0015-0282(23)00045-6. doi: 10.1016/j.fertnstert.2023.01.007. Epub ahead of print. PMID: 36642303.

Many factors are accredited to the increased rate of fertility care and use of IVF, such as women having their first delivery at an older age and a decrease in sperm quality, the demand for physicians specializing in Reproductive Endocrinology and Infertility continues to grow. REI practices must balance a heightened demand for services and a high standard of care. This article discusses potential solutions to address the disparity between demand and REI specialists. Authors delve into the inclusion of basic fertility care within the OB/GYN practice, leveraging REI services with advanced practice providers and technology, expanding REI fellowship programs, as well as allowing fellows to bypass an REI fellowship.

Poretsky L, Yeshua A, Cantor T, Avtanski D, Stojchevski R, Ziskovich K, Singer T. The effects of irisin and leptin on steroidogenic enzyme gene expression in human granulosa cells: In vitro studies. Metabol Open. 2023 Jan 13;17:100230. doi: 10.1016/j.metop.2023.100230. PMID: 36686605; PMCID: PMC9853360.

Irisin and leptin are hormones that dually influence metabolism and the reproductive system. This study was conducted to investigate the in vitro effects of irisin and leptin on the gene expression of steroidogenic enzymes in primary cultures of human granulosa cells. Study subjects were women aged 21-43 years old, were undergoing IVF, and had more than three oocytes retrieved during their IVF procedure. Granulosa cells were purified from leftover follicular fluid at oocyte retrieval, cultured, were supplemented with leptin and irisin, and RNA was extracted. Both leptin and irisin upregulated CYP11A1 mRNA levels and leptin upregulated HSD3B1 mRNA levels, suggesting that these hormones may directly affect steroid hormone production in the ovary at the level of gene expression.