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Objective: To characterize the frequency of diversity elements (DEs) in reproductive endocrinology and infertility (REI) fellowship websites and analyze these elements according to program characteristics. Design: Forty-nine REI fellowship websites were assessed for 20 DEs that represent programmatic commitments to diversity, equity, and inclusion (DEI). Program websites were categorized by the number of discrete DEs featured: low (0–6); moderate (7–13); or high (14–20). Data were analyzed via R statistical software. Setting: Not applicable. Patient(s): Not applicable. Exposure: Not applicable. Main Outcome Measure(s): The primary outcome was the level of DEs featured within REI fellowship websites. The secondary outcome was the association between DEs and program geographic region and accreditation status. Result(s): Program websites had a mean of 3 DEs. No program had a high number of DEs. Eighty-four percent of programs were low in DEs, with 16% exhibiting moderate DEs. Within the moderate group, most programs featured photographs of faculty (63%) and fellows (88%), commitment to DEI message (88%), diversity-specific language (88%), DEI webpage (88%), and DEI-related resources/opportunities (100%). In the low group, most programs presented photographs of faculty and fellows (71%). Programs did not feature active recruitment strategies (unconscious bias, holistic application review, DEI statistics, and implicit bias training). Diversity element category was not associated with program location. Programs with “initial accreditation” had the highest mean DEs. Conclusion(s): None of the REI fellowship websites demonstrated high levels of DEs. We speculate that by intentionally incorporating DEs into fellowship websites, programs can more effectively recruit underrepresented fellows and enhance the diversity of REI practitioners.

Uterus transplantation (UTx) is a rapidly evolving treatment for uterine factor infertility. New centers offering this treatment must decide whether to utilize living donors, deceased donors, or both. Although limiting UTx to deceased donors eliminates the surgical risks for living donors, an adequate supply of suitable deceased uterus donors in the United States is an emerging concern. Previous studies describing the paucity of deceased uterus donors failed to consider key donor characteristics, potentially overestimating the available organ pool. To estimate the United States’ supply of deceased donor uteri; we extrapolated detailed clinical and demographic information from the regional donor datasets available from three organ procurement organizations to the national Organ Procurement and Transplantation Network donor pool. We estimate there are approximately 3700 possible and 400 optimal uterus donors annually in the United States. Given these projections and the number of women with uterine factor infertility in the U.S. who pursue parenthood through alternative strategies, we conclude that, as uterus transplant transitions from research to established clinical care, demand could quickly exceed the deceased donor supply. The liberalization of deceased donor selection criteria may be insufficient to address this imbalance; therefore, fulfilling the anticipated increased demand for uterus transplantation may require and justify greater use of living donors.

Single embryo transfer (SET) is a technique used in assisted reproductive treatment (ART) that is used to promote singleton pregnancies. To date, there are five reported cases of dizygotic twin pregnancies with mothers who underwent SET. Here, we present a sixth case of a dichorionic, diamniotic twin pregnancy with sex discordance. The patient is a 34-year-old woman with unexplained secondary infertility who underwent in vitro fertilization (IVF) and frozen-thawed embryo transfer from a SET. The ultrasonographic images from the first and second trimester scans identified dichorionic, diamniotic twin gestations. The delivery was full term and postnatal genetic testing confirmed 46, XX, and 46, XY offspring. Pathology reports of the placental and membrane findings reported diamniotic, dichorionic twins. There was no zygosity testing conducted, thus it is unknown if the twins are monozygotic or dizygotic. Two possible etiologies for sex-discordant twins, in this case, are concurrent natural conception via breakthrough ovulation at the time of SET, or discordant postzygotic nondisjunction of a single embryo. Multiple gestations may still occur in the setting of SET and zygosity testing in these instances would better elucidate our understanding of this occurrence. Moreover, improved data on the zygosity of multiple gestations following SET may enhance patient counseling.