Relevant, evidence based, and practical information for medical students, residents, and practicing healthcare providers regarding all things women’s healthcare...
The first successful births from frozen eggs were twins, born in Australia in 1986. IVF serves a valuable role for those with persistent infertility issues or other conditions where natural conception is hindered. Although oocyte cryopreservation was initially used as a fertility preservation strategy for medical indications, currently, it is increasingly used to circumvent age-related infertility. This process of elective egg retrieval and cryopreservation- targeting women in their 20s- has gotten out of hand! Mainly due to social media, Gen Z women are panicking about their fertility. Should They Be? For decades, the age of 35 has been seen as a “demarcation line” for female fertility. Before 35, the theory often goes, most women will have little trouble conceiving, but at that point, fertility falls off a cliff. This misunderstanding of natural fertility processes, spurred on by false information on social media, has led to 20-somethings calling for egg retrieval and egg freezing. The dread of age 35 is so pervasive that its effect bleeds backward in time, with women in their early 30s—and yes, sometimes even in their late 20s—already feeling as if they are behind in the race against their “biological clock.” But the reality of fertility “loss” is much more complicated then just “falling off a cliff” and should be viewed more as of a natural “slope” rather than a “cliff”. About a decade after it shed its “experimental” label from the ASRM, oocyte retrieval and cyropreservation has become ubiquitous in our social media culture and has ballooned in popularity, with over a million frozen eggs or embryos stored in the United States today. It has done little, however, to materially change women’s lives. The ASRM has an ETHICS COMMITTEE OPINION (2024) on this very thing. Is 35 really a fertility cliff? Or it it 32? Is egg freezing in late or early 30s the best way to go for delayed fertility? Listen in for details as we set the record straight.
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37:39
Avoiding Sex While Pregnant, To Avoid Pregnancy? And MORE!
Introducing one of our Senior Residents, Dr. Mauldin: Dr. Mauldin just told me of a real patient encounter she had just today, that I felt we HAD to share with everyone. This real encounter is WHY we are passionate about EVIDENCE-BASED medicine! PLUS, we will introduce our NEXT episode which will focus on "elective egg harvesting and freezing" for young women who may have "delayed fertility" due to career path. The social media influence on what has come t be called "social egg harvesting" by some, has gotten out of hand! Listen in to her personal history and perspective on this!
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9:50
Chewing Gum to Prevent Preterm Birth! Maybe.
In the United States, more than 400,000 babies are born
prematurely each year, which is about 1 in 10 babies. Over the last several decades, multiple studies have shown a link between poor oral health and increased occurrence of preterm birth. Researchers have looked at various ways
to improve dental health during pregnancy, including doing a “deep-teeth cleaning” (also called ‘scaling and planing’), which involves removing plaque and tarter on the teeth and below the gum line. However, despite improving
periodontitis, deep teeth cleaning approaches have not proven to be effective in the prevention of preterm birth. But now new data has discovered an easy and inexpensive way to improve oral health and potentially reduce preterm births. This data was originally presented at the annual Pregnancy meeting at SMFM, but now it is a peer reviewed publication. In this episode, we will review how chewing xylitol gum has promising results for preterm birth reduction. Nonetheless,
some important limitations must be reviewed. Listen In for details.
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31:37
Understanding Dual Stain in HPV Triage (ASCCP 2024 Update)
The U.S. Preventive Services Task Force and the World Health Organization recommend primary HPV screening, starting at age 25, as an option (some as preferred) for cervical cancer screening. Although primary HPV screening is as effective as cotesting at detecting cervical cancer, primary HPV screening decreases the number of lifetime screenings needed. The primary HPV screening tests approved by the U.S. Food and Drug Administration (FDA) are the Roche Cobas and BD Onclarity tests. HPV results for the Roche and BD tests can be reported as a pooled result. This means the physician receives a result of negative or positive, in which positive indicates that at least one, but possibly more, types of high-risk HPV were identified in the sample. HPV genotyping options differ by manufacturer. Roche Cobas reports HPV 16 and 18 individually and groups 12 other types (i.e., positivity means at least one of the 12 types triggered the positive result). BD Onclarity reports six individual HPV types (16, 18, 31 [the highest risk going immediately to colposcopy], 45, 51, and 52), and combined types (33/58), (35/39/68). Now, as of March/April 2024, the ASCCP has recognized another important and clinically useful HPV and co-test TRIAGE tool, the DUAL STAIN. This pertains only to the ROCHE COBAS HPV test. In this episode, we will review this latest ENDURING GUIDELINES update to the 2019 ASCCP management algorithms (already updated in the ASCCP app).
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30:58
New Data: Vaginal Estrogen Use in Breast CA Survivors
With an estimated 3.8 million breast cancer survivors in the United States, OBGYNs and other women's healthcare providers often are on the front lines of addressing survivorship issues, including the hypoestrogenic-related adverse effects of cancer therapies or early menopause in survivors. Although systemic and vaginal estrogen are used widely for symptomatic relief of genitourinary syndrome of menopause in the general population, among individuals with a history of hormone-sensitive cancer, there is uncertainty about the safety of hormone-based therapy, leading many individuals with bothersome symptoms to remain untreated, with potential negative consequences on quality of life. The term genitourinary syndrome of menopause (GSM) is the term used to describe to a constellation of symptoms that relate to hypoestrogenic effects on the genital epithelium, such as genital dryness, burning, and irritation; potential downstream effects of vulvar and vaginal atrophy such as dyspareunia; urinary symptoms such as urgency or dysuria; and recurrent urinary tract infections. Is vaginal estrogen or estrogen-like therapies safe in these patients? What about in those using aromatase inhibitors? A new Meta-Analysis (AJOG) provides insights. Listen in for details.
Relevant, evidence based, and practical information for medical students, residents, and practicing healthcare providers regarding all things women’s healthcare! This podcast is intended to be clinically relevant, engaging, and FUN, because medical education should NOT be boring! Welcome...to Clinical Pearls.
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