BACKGROUND: Contraceptive method choice is often strongly influenced by the experiences and opinions of one's social network. Although social media, including Twitter, increasingly influences reproductive-age individuals, discussion of contraception in this setting has yet to be characterized. Natural language processing, a type of machine learning in which computers analyze natural language data, enables this analysis. OBJECTIVE: This study aimed to illuminate temporal trends in attitudes toward long-and short-acting reversible contraceptive methods in tweets between 2006 and 2019 and establish social media platforms as alternate data sources for large-scale sentiment analysis on contraception. STUDY DESIGN: We studied English-language tweets mentioning reversible prescription contraceptive methods between March 2006 (founding of Twitter) and December 2019. Tweets mentioning contraception were extracted using search terms, including generic or brand names, colloquial names, and abbreviations. We characterized and performed sentiment analysis on tweets. We used Mann-Kendall nonparametric tests to assess temporal trends in the overall number and the number of positive, negative, and neutral tweets referring to each method. The code to reproduce this analysis is available at https://github.com/ hms-dbmi/contraceptionOnTwitter. RESULTS:We extracted 838,739 tweets mentioning at least 1 contraceptive method. The annual number of contraception-related tweets increased considerably over the study period. The intrauterine device was the most commonly referenced method (45.9%). Long-acting methods were mentioned more often than short-acting ones (58% vs 42%), and the annual proportion of long-acting reversible contraceptionrelated tweets increased over time. In sentiment analysis of tweets mentioning a single contraceptive method (n¼665,064), the greatest proportion of all tweets was negative (65,339 of 160,713 tweets with at least 95% confident sentiment, or 40.66%). Tweets mentioning longacting methods were nearly twice as likely to be positive compared with tweets mentioning short-acting methods (19.65% vs 10.21%; P<.002). CONCLUSION: Recognizing the influence of social networks on contraceptive decision making, social media platforms may be useful in the collection and dissemination of information about contraception.

Purpose Intrauterine insemination (IUI) is a frequently utilized method of assisted reproduction for patients with mild male factor infertility, anovulation, endometriosis, and unexplained infertility. The purpose of this review is to discuss factors that affect IUI outcomes, including infertility diagnosis, semen parameters, and stimulation regimens. Methods We reviewed the published literature to evaluate how patient and cycle specific factors affect IUI outcomes, specifically clinical pregnancy rate, live birth rate, spontaneous abortion rate and multiple pregnancy rate. Results Most data support IUI for men with a total motile count > 5 million and post-wash sperm count > 1 million. High sperm DNA fragmentation does not consistently affect pregnancy rates in IUI cycles. Advancing maternal and paternal age negatively impact pregnancy rates. Paternal obesity contributes to infertility while elevated maternal BMI increases medication requirements without impacting pregnancy outcomes. For ovulation induction, letrozole and clomiphene citrate result in similar pregnancy outcomes and are recommended over gonadotropins given increased risk for multiple pregnancies with gonadotropins. Letrozole is preferred for obese women with polycystic ovary syndrome. IUI is most effective for women with ovulatory dysfunction and unexplained infertility, and least effective for women with tubal factor and stage III-IV endometriosis. Outcomes are similar when IUI is performed with ovulation trigger or spontaneous ovulatory surge, and ovulation may be monitored by urine or serum. Most pregnancies occur within the first four IUI cycles, after which in vitro fertilization should be considered. Conclusions Providers recommending IUI for treatment of infertility should take into account all of these factors when evaluating patients and making treatment recommendations.

Introduction Reproductive injustices such as forced sterilization, preventable maternal morbidity and mortality, restricted access to family planning services, and policy-driven environmental violence undermine reproductive autonomy and health outcomes, with disproportionate impact on historically marginalized communities. However, curricula focused on reproductive justice (RJ) are lacking in medical education. Methods We designed a novel, interactive, case-based RJ curriculum for postclerkship medical students. This curriculum was created using published guidelines on best practices for incorporating RJ in medical education. The session included a prerecorded video on the history of RJ, an article, and four interactive cases. Students engaged in a 2-hour small-group session, discussing key learning points of each case. We evaluated the curriculum's impact with a pre- and postsurvey and focus group. Results Sixty-eight students participated in this RJ curriculum in October 2020 and March 2021. Forty-one percent of them completed the presurvey, and 46% completed the postsurvey. Twenty-two percent completed both surveys. Ninety percent of respondents agreed that RJ was relevant to their future practice, and 87% agreed that participating in this session would impact their clinical practice. Most respondents (81%) agreed that more RJ content is needed. Focus group participants appreciated the case-based, interactive format and the intersectionality within the cases. Discussion This interactive curriculum is an innovative and effective way to teach medical students about RJ and its relevance to clinical practice. Walking alongside patients as they accessed reproductive health care in a case-based curriculum improved students’ comfort and self-reported knowledge on several RJ topics.

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