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Objective To determine the association between patient characteristics at diagnosis of premenopausal breast cancer, including gravidity, parity, age at menarche, age at first birth, alcohol use, smoking history, weight, height, and body mass index (BMI), with the development of persistent chemotherapy-related amenorrhea (CRA) in follow-up. Design Retrospective cohort study. Setting Dana Farber Cancer Institute and Brigham and Women’s Hospital. Patient(s) Premenopausal women with breast cancer. Intervention(s) We identified all premenopausal women who received standard adjuvant chemotherapy during 1997–2005 for whom menstrual data were available. Multivariable logistic regression models evaluating persistent amenorrhea at ≥6 month after completion of chemotherapy were conducted. Main Outcome Measure(s) Persistent chemotherapy-related amenorrhea (CRA) at ≥6 months from completion of chemotherapy. Result(s) A total of 431 women met eligibility criteria and had ≥6-months’ follow-up. Women with older (>13 years) vs. younger (12–13 years) age at menarche were more than twice as likely to remain amenorrheic. Current smokers had 2.4 greater odds of CRA vs. never smokers, although this association was not statistically significant (95% confidence interval, 0.86–6.75). Conclusion(s) Few identifiable factors contribute to the variability in CRA among premenopausal women after adjuvant chemotherapy for breast cancer. Further research to improve the prediction of CRA, premature menopause, and infertility in young breast cancer survivors is warranted.

Objective To compare markers of ovarian reserve between women exposed to cytotoxic chemotherapy for early stage breast cancer and matched controls. Design Cross-sectional evaluation of markers of ovarian reserve. Setting Dana-Farber/Brigham and Women's Cancer Center, Massachusetts General Hospital, and Faulkner Hospital in Boston, MA. Patient(s) Breast cancer survivors with continued menses after chemotherapy were compared with age-matched, gravidity-matched controls. Main Outcome Measure(s) Antral follicle count (AFC), anti-Mullerian hormone (AMH), FSH, inhibin B (InB), and E 2 on day 2, 3, or 4 of the menstrual cycle. A Bonferroni correction was performed to correct for multiple comparisons. Result(s) Twenty survivors and 20 controls were evaluated; 50% of survivors were currently on tamoxifen. Median AFC was 6 for survivors and 9.5 for controls. There were significant differences between the two groups in AFC, AMH, and nonsignificant differences in FSH and InB, all indicating better ovarian reserve in controls. The AFC and AMH levels were highly correlated ( r = 0.72). Survivors on tamoxifen had lower AFC, AMH, InB, and higher E 2 than nontamoxifen–treated survivors. Conclusion(s) Premenopausal breast cancer survivors have diminished ovarian reserve compared with controls.

Objective To evaluate SART-member fertility clinic websites for their compliance with the 2004 ASRM/SART guidelines for advertising (which is deemed mandatory for clinic membership), to survey the general characteristics of the websites, and to assess differences between academic and private clinic websites. Design Cross-sectional evaluation. Setting The Internet. Patients None. Interventions None. Main Outcome Measures Eleven objective criteria based on 2004 ASRM/SART guidelines for advertising and eight objective criteria for general characteristics of fertility clinic websites. Results All 384 SART-registered clinics were evaluated; 289 (75.3%) had functional websites (211 private, 78 academic). Success rates were published on 51% of websites (117 private, 31 academic), the majority of which were private clinics (p=.025). The percentage of fertility clinic websites adhering to ASRM/SART guidelines was low in all categories (ranging from 2.8%-54.5% in private centers and 1.3%–37.2% in academic centers). No statistically significant difference was found in the services offered at private versus academic clinics. Conclusion A significant proportion of SART-member fertility clinics, both private and academic, that have websites are not following the ASRM/SART guidelines for advertising. Increased dissemination and awareness of the guidelines is warranted.

Objective To determine if an automated time-lapse test (TL-test) combined with traditional morphology for embryo selection and day 3 transfer results in improved clinical outcomes. Design Prospective concurrent-controlled pilot study. Setting IVF clinic and laboratory. Patient(s) A total of 319 female patients Intervention(s) Automated time-lapse embryo assessment combined with morphologic assessment in the study (test) group compared with morphologic assessment only (control group). Main Outcome Measure(s) Embryo implantation, pregnancy, and multiple pregnancy rates. Subanalysis of implantation potential of embryos based on the TL-test (TL-high vs. TL-low) scores. Result(s) Implantation and clinical pregnancy rates were significantly higher in the test group compared with the control group (implantation rates 30.2% vs. 19.0%, clinical pregnancy rates 46.0% vs. 32.1%, respectively). Multiple pregnancy rates were not statistically different (26.7% vs. 18.3%). Test group patients receiving at least one TL-high embryo had significantly higher implantation rates than patients receiving only TL-low embryos (36.8% vs. 20.6%). TL-high compared with TL-low embryos had significantly higher implantation rates (44.7% vs. 20.5%). Among morphologically good embryos, TL-high embryos were more likely to implant than TL-low embryos (44.1% vs. 20.6%). Conclusion(s) This is the first report demonstrating improved implantation rates in patients receiving day 3 embryo transfers based on the combined use of a TL-test along and traditional morphology. Our findings confirm that the noninvasive TL-test adds valuable information to traditional morphologic grading. Clinical Trial Registration Number NCT01671657.

To examine in detail the geographic distribution of reproductive endocrinology and infertility (REI) fellowships in the United States.Ecological.University-based REI fellowship program.None.None.Number and location of REI fellowship positions.A significant association was found between the number of REI fellowship positions and the number of categorical postgraduate year-1 (PGY-1) obstetrics and gynecology (OBGYN) residency positions within states. No association was observed among the land area, population, or population density within states. However, despite the fact that in the East, as in the United States overall, there was no association between population density and number of fellowships, West of the Mississippi River, as the population density increased, the number of REI fellowships increased linearly (test for heterogeneity = 0.007).First-year REI fellowship positions in the United States are correlated with the number of categorical PGY-1 OBGYN residency positions within a state. The geographically uneven distribution of fellowship positions may limit the choices for OBGYN residents wishing to pursue further training in REI.