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Infertility is a common diagnosis: in its original, heteronormative definition, it is known to impact about 1 in 6 couples worldwide. Governments across Canada and beyond have been increasingly providing support for those undergoing fertility treatment, and BC is the most recent province to announce funding, beginning in 2025. As the amount of proposed funding is not sufficient to cover treatment for all who seek it, we look to examples from other provinces and countries to guide us in forming criteria that balance fair access with likelihood of successful treatment. A majority of Canadian provinces currently provide publicly funded fertility care, albeit with highly variable models. Quebec previously introduced a model with generous coverage, including up to three cycles of in vitro fertilization (IVF), along with medications, associated procedures, and embryo transfers for each live birth. Due to high costs, this funding was removed and reintroduced in 2021 with a more restrictive model, as well as age cutoffs for IVF and embryo transfers. In Ontario, the current funding model was introduced in 2015 and covers intrauterine insemination cycles and one cycle of IVF in patients younger than 43 years of age. Other provinces have offered a fertility treatment tax credit. While the BC announcement stated that one cycle of IVF with medications will be covered, the details on how this finite resource will be distributed are still unclear. We hope BC will consider the lessons learned from other provinces and countries and implement a program that is fair and accessible to those who need it. [ABSTRACT FROM AUTHOR]

Background: Caesarean scar disorders (CSDi) are an increasingly recognized consequence of caesarean sections, which can present with secondary infertility. Currently, there is limited data on the management of CSDi, and the subsequent fertility and pregnancy outcomes. Our aim was to examine different treatment methods and outcomes in a cohort of women with secondary infertility. Study design: This study involved a retrospective case series for patients (n = 26) diagnosed with and treated for a CSDi between 2008 and 2019 at a tertiary care centre in British Columbia, Canada, by one of three gynecologists with expertise in CSDi repair. Surgical repair was performed via laparoscopy for residual myometrial thickness (RMT) < 3.0 mm, and via hysteroscopy otherwise. Postoperative pregnancy rates and reproductive outcomes are reported. This study also included a search of the literature to gain an overview of the indications, outcomes, advantages, disadvantages, and risks associated with four surgical approaches (hysteroscopic, laparoscopic, vaginal, abdominal) used in the management of CSDi. A Medline and manual searches of referenced articles were conducted for this purpose. Results: Twenty-six patients with CSDi were diagnosed with secondary infertility (mean age = 36.4 years) during the study period. Twenty of these patients underwent surgical management, with 12 receiving hysteroscopic resection or ablation, and 8 receiving laparoscopic repair. Six patients had no treatment or are still awaiting management at this time. Postoperatively, 11/20 patients (55%) were able to successfully conceive at least once. 8/11 patients were from the hysteroscopy group (66% pregnancy rate) and 10/11 pregnancies resulted in live births at term. In the laparoscopy group, there were 3 pregnancies (37.5% pregnancy rate), including 2 term live births, and 1 preterm live birth at 26 weeks. With respect to our review of the literature, a total of 49 articles were included in our final review of surgical techniques used in the management of CSDi. Conclusions: This study suggests that surgical repair can improve pregnancy rates in patients with secondary infertility in the context of a confirmed CSDi. [ABSTRACT FROM AUTHOR]

Background: An assessment was conducted to determine whether the ongoing COVID-19 pandemic is associated with increased miscarriage rates in in vitro fertilization pregnancies. Methods: A retrospective quality assurance analysis with case-matched controls was conducted at a private fertility centre in BC. In vitro fertilization/intracytoplasmic sperm injection cycles between April and December 2020 (during the pandemic) were compared with cycles from April 2018 to March 2020 (prepandemic) to assess differences in pregnancy and miscarriage rates, including fresh transfer cycles, frozen donor egg cycles, and frozen embryo transfer cycles (with and without preimplantation genetic testing). The miscarriage rate was analyzed per pregnancy. Results: In total, 854 cycles that occurred during the pandemic were compared with 1852 cycles that preceded the pandemic. Patients' ages were similar between the two groups. The mean number of embryos transferred was similar in the donor egg cycles and frozen embryo transfer cycles (with and without preimplantation genetic testing). Significantly fewer embryos were transferred in the fresh transfer group than in the frozen transfer group (1.36 versus 1.54 [P < 0.0001]), which is likely attributed to a temporal change in practice. Overall, there were no significant differences in clinical pregnancy rates. In all treatment types, the biochemical loss per positive beta-human chorionic gonadotropin and the spontaneous miscarriage rate per clinical pregnancy were not significantly higher during the COVID-19 pandemic than prepandemic, nor was the total loss rate per positive beta-human chorionic gonadotropin. Conclusions: The COVID-19 pandemic and associated intangible factors do not appear to affect clinical pregnancy rates or miscarriage rates in in vitro fertilization patients. [ABSTRACT FROM AUTHOR]

Background. Spontaneous rupture of benign uterine fibroids is extremely rare and has been associated with fibroid degeneration. It can cause acute intraperitoneal bleeding requiring immediate surgical intervention. Case. A previously healthy 50-year-old, Caucasian, nullipara presented with syncope, hemodynamic instability, and an acute abdomen. Noncontrast computed tomography images showed a positive sentinel clot sign in the pelvis as well as a large uterine fibroid with internal hyperdense clot suggesting acute rupture. Urgent laparotomy and hysterectomy confirmed a ruptured, actively bleeding, uterine fibroid with final pathological diagnosis of a benign leiomyoma. Conclusion. Prompt diagnosis and emergency surgical intervention were necessary to control acute hemorrhage from a ruptured uterine fibroid. Noncontrast computed tomography is an important adjunct to contrast-enhanced computed tomography and was vital for diagnosis in this case. [ABSTRACT FROM AUTHOR]

Introduction In 2010, British Columbia (BC) introduced new traffic laws designed to deter impaired driving, speeding, and distracted driving. These laws generated significant media attention and were associated with reductions in fatal crashes and in ambulance calls and hospital admissions for road trauma. Objective To understand the extent and type of media coverage of the new traffic laws and to identify how the laws were framed by the media. Methods We reviewed a database of injury related news coverage (May 2010–December 2012) and extracted reports that mentioned distracted driving, impaired driving, or speeding. Articles were classified according to: (i) Type, (ii) Issue discussed, (iii) ‘Reference to new laws’, and (iv) ‘Pro/anti traffic law’. Articles mentioning the new laws were reread and common themes in how the laws were framed were identified and discussed. Results Over the course of the study, 1848 articles mentioned distraction, impairment, or speeding and 597 reports mentioned the new laws: 65 against, 227 neutral, and 305 supportive. Reports against the new laws framed them as unfair or as causing economic damage to the entertainment industry. Reports in favor of the new laws framed them in terms of preventing impaired driving and related trauma or of bringing justice to drinking drivers. Growing evidence of the effectiveness of the new laws generated media support. Conclusions BC's new traffic laws generated considerable media attention both pro and con. We believe that this media attention helped inform the public of the new laws and enhanced their deterrent effect. [ABSTRACT FROM AUTHOR]

Introduction In 2010, British Columbia (BC) introduced new traffic laws designed to deter impaired driving, speeding, and distracted driving. These laws generated significant media attention and were associated with reductions in fatal crashes and in ambulance calls and hospital admissions for road trauma. Objective To understand the extent and type of media coverage of the new traffic laws and to identify how the laws were framed by the media. Methods We reviewed a database of injury related news coverage (May 2010–December 2012) and extracted reports that mentioned distracted driving, impaired driving, or speeding. Articles were classified according to: (i) Type, (ii) Issue discussed, (iii) ‘Reference to new laws’, and (iv) ‘Pro/anti traffic law’. Articles mentioning the new laws were reread and common themes in how the laws were framed were identified and discussed. Results Over the course of the study, 1848 articles mentioned distraction, impairment, or speeding and 597 reports mentioned the new laws: 65 against, 227 neutral, and 305 supportive. Reports against the new laws framed them as unfair or as causing economic damage to the entertainment industry. Reports in favor of the new laws framed them in terms of preventing impaired driving and related trauma or of bringing justice to drinking drivers. Growing evidence of the effectiveness of the new laws generated media support. Conclusions BC’s new traffic laws generated considerable media attention both pro and con. We believe that this media attention helped inform the public of the new laws and enhanced their deterrent effect. [ABSTRACT FROM AUTHOR]