, over 7 million confirmed cases and over 400,000 deaths had been recorded across 213 countries and territories [3]. In outbreaks, epidemics, and pandemics, epidemiologists aim to quantify the spread of a disease within a population across space and time. In addition, epidemiologists aim to quantify the rate of disease transmission. This information is then used to inform prevention and mitigation strategies. Although aggressive prevention strategies may be disruptive and costly, such measures may ultimately reduce the burden of morbidity and mortality within a population, as has been demonstrated in previous pandemics, such as the 1918-1920 influenza and the 2009 influenza A (H1N1) pandemics [4, 5]. The first tier of response is containment to prevent the spread of disease before it has a chance to take hold in the community [6]. This may include contact tracing, surveillance in the community through widespread testing, and quarantine measures. However, once a disease has spread through the community, the second tier, mitigation strategies, are necessary to reduce transmission. Interventions include social distancing measures; closure of schools, workplaces, and community facilities; travel restrictions; and individual-level hygiene measures, such as wearing a mask and washing hands [6]. Without mitigation efforts in place, healthcare systems risk being stretched beyond capacity in, for example, intensive care unit (ICU) beds, personal protective equipment (PPE), and ventilators for treating patients with COVID-19. This is why countries who were in the mitigation phase of the pandemic conducted communication campaigns imploring individuals to engage in behaviors to "flatten the curve." Beyond the mitigation tier, state-level actors may put lockdowns in place to further curb transmission. Scope of the problem Asia Countries across Asia were some of the first to experience the outbreak of COVID-19. Many had already had previous experiences dealing with epidemics, including severe acute respiratory syndrome (SARS) from 2002 to 2003, H1N1 flu in 2009, and Middle East Respiratory Syndrome (MERS) in 2014, 2015 and 2018 [7]. Such experiences had prepared governments to respond and made their populations more receptive to restrictive public health measures. Some entities, including South Korea, Mongolia, Hong Kong, and Singapore, initially succeeded in containing the virus through aggressive preemptive measures: transparency in communication, ubiquitous testing, strict quarantine, and thorough disinfectant protocols [7, 8]. South Korea used such measures without ever putting a lockdown in place. After failures in communication during the MERS epidemic in 2015, new standard operating procedures were put in place. By the time COVID-19 arrived, Koreans were willing to

Dimethandrolone (DMA, 7α,11β-dimethyl-19-nortestosterone) has both androgenic and progestational activities, ideal properties for a male hormonal contraceptive. In vivo, dimethandrolone undecanoate (DMAU) is hydrolyzed to DMA. We showed previously that single oral doses of DMAU powder-in-capsule taken with food are well-tolerated and effective at suppressing both LH and testosterone (T), but absorption was low. We compared the pharmacokinetics and pharmacodynamics of two new formulations of DMAU, in castor oil and in SEDDS, with the previously tested powder formulation. DMAU was dosed orally in healthy adult male volunteers at two academic medical centers. For each formulation tested in this double-blind, placebo-controlled study, ten men received single, escalating, oral doses of DMAU (100 mg, 200 mg, and 400 mg) and two subjects received placebo. All doses were evaluated both fasting and with a high fat meal. All three formulations were well tolerated without clinically significant changes in vital signs, blood counts, or serum chemistries. For all formulations, DMA and DMAU showed higher maximum (p< 0.007) and average concentrations (p<0.002) at the 400mg dose, compared with the 200mg dose. The powder formulation resulted in a lower conversion of DMAU to DMA (p=0.027) compared with both castor oil and SEDDS formulations. DMAU in SEDDS given fasting resulted in higher serum DMA and DMAU concentrations compared to the other two formulations. Serum LH and sex hormone concentrations were suppressed by all formulations of 200 and 400mg DMAU when administered with food but only the SEDDS formulation was effectively suppressed serum T when given fasting. We conclude that while all three formulations of oral DMAU are effective and well-tolerated when administered with food, DMAU in oil and SEDDS increased conversion to DMA, and SEDDS may have some effectiveness when given fasting. These properties might be advantageous for the application of DMAU as a male contraceptive.

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Objective To investigate the association of non-cavity distorting uterine fibroids and pregnancy outcomes following ovarian stimulation-intrauterine insemination (OS-IUI) in couples with unexplained infertility. Design Secondary analysis from a prospective, randomized, multicenter clinical trial investigating fertility outcomes following OS-IUI. Setting Reproductive Medicine Network clinical sites Patients Nine-hundred couples with unexplained infertility who participated in the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) clinical trial. Intervention Participants were randomized to one of three arms (clomiphene citrate, letrozole, or gonadotropins) and treatment was continued for up to four cycles or until pregnancy was achieved. Main outcomes measures Conception (serum hCG increase), clinical pregnancy (fetal cardiac activity), and live birth rates. Results 102/900(11.3%) participants had at least one documented fibroid and a normal uterine cavity. Women with fibroids were older, more likely to be African American, had a greater uterine volume, lower serum anti-Mullerian hormone levels, and fewer antral follicles than women without fibroids. In conception cycles, clinical pregnancy rates were significantly lower in participants with fibroids than those without uterine fibroids. Pregnancy loss prior to 12-weeks was more likely in African American women with fibroids compared to non-African American women with fibroids. There was no difference in conception and live birth rates in subjects with and without fibroids respectively. Conclusions No differences were observed in conception and live birth rates in women with non-cavity distorting fibroids and those without fibroids. These findings provide reassurance that pregnancy success is not impacted in couples with non-cavity distorting fibroids undergoing OS-IUI for unexplained infertility.