Patients' preferences for distributing limited government-funded IVF cycles.

Objective: On December 21, 2015, Ontario began funding one cycle of IVF for each resident with a uterus under the age of 43, but with a program cap that is insufficient to meet the annual demand. Our objective was to determine how fertility patients believe that the limited number of funded IVF cycles should be distributed.

Methods: A survey was distributed to patients attending a university affiliated hospital-based fertility clinic in downtown Toronto, including its associated peripheral satellite clinics.

Reducing day 3 baseline monitoring bloodwork and ultrasound for patients undergoing timed intercourse and intrauterine insemination treatment cycles.

Background: In the current context of a global pandemic it is imperative for fertility clinics to consider the necessity of individual tests and eliminate those that have limited utility and may impose unnecessary risk of exposure. The purpose of this study was to implement and evaluate a multi-modal quality improvement (QI) strategy to promote resource stewardship by reducing routine day 3 (d3) bloodwork and transvaginal ultrasound (TVUS) for patients undergoing intrauterine insemination (IUI) and timed intercourse (IC) treatment cycles.

Methods: After literature review, clinic stakeholders at an academic fertility centre met to discuss d3 testing utility and factors contributing to d3 bloodwork/TVUS in IC/IUI treatment cycles.

Fertility patients' use and perceptions of online fertility educational material.

Background: Online educational information is highly sought out by patients with infertility. This study aims to assess patient-reported usage and helpfulness of fertility educational material on a clinic website and social media accounts.

Methods: Educational material was created on common fertility topics in text and video format and posted on the clinic website and social media accounts.

The Impact of the Ontario Fertility Program on Duplicate Fertility Consultations.

Objectives: The Ontario Fertility Program (OFP) funds 5,000 annual in vitro fertilization (IVF) cycles. We hypothesized that after introduction of the OFP, there would be an increase in duplicate infertility consultations by patients attempting to increase chances at obtaining publicly funded IVF through enlisting at multiple fertility clinics.

Methods: This retrospective observational study included women eligible for healthcare services in Ontario from 2014 to 2016 and compared infertility consultations pre- and post-initiation of the OFP.

Randomized Trial Comparing the Effect of Endometrial Shedding With Medroxyprogesterone Acetate With Random Start of Clomiphene Citrate for Ovulation Induction in Oligo-ovulatory and Anovulatory Women.

Objective: A recent retrospective study demonstrated that anovulatory infertile women who did not have a progestogen-induced withdrawal bleed before treatment with clomiphene citrate (CC) had higher pregnancy rates than women who had a withdrawal bleed and those who had spontaneous menstrual bleeding. We sought to assess endometrial thickness at the time of ovulation in oligo-ovulatory and anovulatory women who took CC with or without a preceding progestogen-induced withdrawal bleed.

Methods: We conducted a pilot randomized trial in which women with infertility and oligomenorrhea or amenorrhea were randomly assigned to take either CC after a withdrawal bleed induced by medroxyprogesterone acetate (MPA) 10 mg daily for 10 days or to take CC without such a bleed.

Bon voyage: an update on safe travel in pregnancy.

Travel in pregnancy is common, particularly as international travel for work and leisure has become more commonplace. Few women are fully aware of the potential risks of travelling while pregnant, particularly the risk of delivering abroad. We describe here the medical risks and the many social, financial, and logistical considerations for travelling during pregnancy.

PGD for a carrier of an intrachromosomal insertion using aCGH.

Intrachromosomal insertions are rare and difficult to diagnose. However, making the correct diagnosis is critical for genetic risk assessment, and prenatal and preimplantation genetic diagnosis outcomes. We present a case of preimplantation genetic diagnosis (PGD) using array comparative genomic hybridization (aCGH) following trophectoderm biopsy of embryos created after in vitro fertilization for a carrier of an intrachromosomal insertion on chromosome 1 [46,XX, ins(1)(q44q23q32.

Fertility treatment decision-making: the effect of insurance coverage for fertility medications.

Objective: To analyze the perceived impact of insurance coverage for fertility medications on patients' fertility treatment decision-making.

Methods: We conducted a cross-sectional study involving a patient survey and chart review of women at a Canadian university-affiliated fertility centre. The primary outcome was to determine whether women with self-reported insurance coverage for fertility medications perceived the impact of insurance coverage for fertility medications differently from women without coverage or those who do not know their extent of coverage.