When accounting for the effect of numerous pertinent demographic and clinical factors, the odds of undergoing minimally invasive hysterectomy were diminished in women of Hispanic ethnicity and in those enrolled in Medicaid but were not discrepant along racial lines. However, both racial and socioeconomic disparities were observed with respect to access to robot-assisted hysterectomy despite the availability of robotic assistance in all hospitals treating the study population. Strategies to ensure equal access to all minimally invasive routes for all women should be explored to align delivery of care with the evidence supporting the broad implementation of these procedures as safe, cost-effective, and highly acceptable to patients.
Robust angiogenesis in the corpus luteum is critical for maintenance of pregnancy and thus mammalian female fertility. During angiogenesis, blood vessels sprout from pre-existing vasculature and recruit pericytes to induce maturation and vessel quiescence. Pericytes are associated with capillaries and regulate endothelial cell proliferation, vessel diameter, and vascular permeability. Endothelial induction of Notch signaling in adjacent pericytes helps recruit and maintain pericyte coverage in some but not all tissue types. We have employed a Notch decoy, N1 10−24 , which blocks Notch signaling in a ligand-specific manner, and determined that pharmacological inhibition of Notch ligand Jagged blocks luteal angiogenesis after normal ovulation, resulting in reduced luteal vasculature. Conversely, after ovarian hyperstimulation, a condition which occurs during fertility treatments, Jagged inhibition causes vascular dilation and hemorrhage. These results indicate that Jagged inhibition has effects in different ovarian angiogenic conditions, promoting vascular growth in the corpus luteum and vascular stability in hyperstimulated ovaries.
Objective: To determine whether a higher body mass index (BMI) adversely affects endometrial receptivity. Design: Retrospective cohort study. Setting: Academic medical center. Patient(s): All donor egg recipients (DERs) who received fresh sibling-oocytes (oocytes from a donor that were retrieved from a single controlled ovarian hyperstimulation [COH] cycle and split between two recipients) at our center over a 7-year period were included. Intervention(s): COH of a donor with fresh embryo transfer to recipients of differing BMI. The two recipients of the sibling-oocytes were paired and categorized based on BMI: group A (normal weight, BMI 18.5À24.9 kg/m 2 ) and group B (overweight/obese, BMI >25.0 kg/m 2 ). Main Outcome Measure(s): The primary outcome was implantation rate. Secondary outcomes were positive pregnancy rate and live birth rate. Result(s): A total of 408 patients had received oocytes from a split donor oocyte cycle. There were 71 pairs of patients (142 recipients) that had discrepant BMI categories and were analyzed. Implantation rates were similar for the two groups (54.5%AE5.3% vs. 56.3%AE4.8% for group A and B, respectively, P¼0.72). The positive pregnancy rate (77.5% vs. 80.3%, P¼0.28) and live birth rate (54.9% vs. 60.6%, P¼0.33) for groups A and B were also found to be similar. Conclusion(s):In this idealized model that controls to the greatest degree possible for factors that would impact implantation, we found that a higher BMI did not reduce implantation, positive pregnancy, or delivery rates. These findings suggest that a higher BMI does not adversely affect uterine receptivity. (Fertil Steril Rep Ò 2020;1:25-9. Ó2020 by American Society for Reproductive Medicine.
Objective-Although 5-year survival for early-stage ovarian cancer is favorable, prognosis at recurrence is poor, necessitating appropriate initial management. We examined the patterns of care and the impact of the duration of chemotherapy on survival for women with early-stage ovarian cancer.Methods-We used the SEER-Medicare database to identify women ≥65 years of age with stage I ovarian cancer diagnosed from 1992-2009. Patients were categorized as low-risk (non-clear cell histology, stage IA or IB, grade 1 or 2) or high-risk (clear cell histology, grade 3, or stage IC). We used multivariable logistic regression models to determine predictors of chemotherapy use and duration and Cox proportional hazards models to evaluate the effect of chemotherapy use and duration on survival.Results-We identified 1394 patients. Among low-risk patients, 32.9% received adjuvant chemotherapy and the use of chemotherapy increased with time. Among high-risk patients, 71.9% received adjuvant chemotherapy; 44.2% had ≤ 3 months of treatment, and 55.8% had >3 months of treatment. Older patients were less likely to receive chemotherapy, while those with higher Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. HHS Public Access
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