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Better trophectoderm morphology, younger patient age and further blastocyst progression all result in higher clinical pregnancy and live birth rates. Therefore, trophectoderm morphology and blastocyst stage should preferentially be used as the most important factors in choosing the best embryo for transfer.

As the overall life span of both men and women increases, screening, diagnosis, and treatment of osteoporosis is of even greater importance than it has been in the past. It is estimated that more than 34 million Americans have low bone density, and 10 million suffer from osteoporosis. 1 Approximately 80% of these people are women, the majority of whom are postmenopausal. The major morbidity and mortality that occur as a result of osteoporosis are secondary to long bone fractures. Hip fractures cause the greatest morbidity and mortality, and are associated with a 30% risk of mortality in the first year for men and 17% for women. Osteoporosis may also be associated with vertebral and forearm fractures, which can similarly affect quality of life and activities of daily living. 2 There is a significant gap between the best-practice paradigm for the diagnosis and treatment of osteoporosis and actual clinical practice. The goal of this lesson is to help the obstetrician-gynecologist to better understand the pathophysiology of osteoporosis and to apply these principles to ensure appropriate screening, diagnosis, and treatment of patients at risk for this debilitating problem. DefinitionsOsteoporosis is defined as decreased bone mass with a normal ratio of mineral to bone matrix. The term osteopenia also indicates decreased bone mass, although to a lesser extent than osteoporosis. 3 The World Health Organization (WHO) uses axial skeleton measurements of bone density measured by dual-energy x-ray absorptiometry (DEXA) of the lumbar spine and/or hip to define osteopenia and osteoporosis. Bone mineral density (BMD) is expressed as a T score or Z score, both as standard deviations from the average value of the reference population.The reference population of the T score is the comparison of BMD to that of healthy 20 to 29 year olds of the same sex. The Z score refers to a reference population of the same sex, race, and age as the patient being tested. The T and Z scores can be applied to both the lumbar spine and hip BMD measurements. The T score is the parameter used by the WHO for diagnoses of osteopenia and osteoporosis. A normal T score is greater than or equal to Ϫ1 standard deviation below the young adult mean. Osteopenia is defined as Ϫ1 to Ϫ2.5 standard deviations below the mean, and osteoporosis is Ϫ2.5 or less. It is important to note that in premenopausal women, men younger than 50 years, and children, the Z score should be used instead of the T score. In these populations, a Z score of Ϫ2.0 or lower is considered

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