The Comprehensive REI Curriculum Guide for Residents

Developed under the guidance of the ASRM Resident Education Sub-Committee, 2023:

• Winifred Mak, Sub-Committee Chair; ASRM Education Committee Representative; REI Fellowship Program Director, UT Health San Antonio.
• Samir Babayev, IVF Clinic Director; OB/GYN Clerkship Director; Assistant Professor; Mayo Clinic, Rochester, Minnesota.
• Chelsea Fortin, Clinical Assistant Professor in OB/GYN, REI Division, University of Michigan, Ann Arbor, Michigan.
• Benjamin Harris, Assistant Professor of OB/GYN, Eastern Virginia Medical School (EVMS); Associate Program Director, SGF Jones Institute Fellowship for REI; Director of Research, SGF Southern Virginia region.
• Katherine Kostroun, REI Fellow, UT Health San Antonio.
• Michelle Landrum, ASRM Manager of Curriculum Development, Birmingham, Alabama.
• Daniel Miranian, ASRM Education Committee Representative; REI Fellow, University of Pennsylvania, Philadelphia, Pennsylvania.
• Julie Rios, ASRM Education Committee Representative; Associate Professor, Division and Fellowship Director, REI; Medical Director of the Center for Reproduction & Transplantation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
• Jared Robins, ASRM Executive Director, Birmingham, Alabama.
• Thalia Segal, SREI Resident Education Representative, REI Attending Physician Specialist, University of California in San Francisco.
• Chevis Shannon, ASRM Chief Education and Science Officer, Birmingham, Alabama.
• Maren Shapiro, REI Attending Physician Specialist, University of California in San Francisco.

Designed to guide learning during REI rotation and each residency year, regardless of institutional or programmatic schedules and expectations, this curriculum provides recommendations for expected outcomes, pacing and scheduling, resources to be utilized, and suggested assessment activities for resident learning for Reproductive Endocrinology and Infertility.

A. INTRODUCTION TO THE MENSTRUAL CYCLE AND PHYSIOLOGY OF THE HYPOTHALAMIC-PITUITARY AXIS

ASRM Practice & Ethics Documents

1. Fertility Evaluation Infertile Women
2. Current Evaluation Amenorrhea

ACOG Committee Opinions & Practice Bulletins & Practice Bulletins

1. Menstruation in girls & adolescents: Using the Menstrual Cycle as a VS (Reaffirmed 2015)

Textbooks

1. Speroff 9^th ed: The Uterus, Endometrial Physiology, and Menstruation (Chapter 3)
2. Speroff 9^th ed: Regulation of the Menstrual Cycle (Chapter 5)

Outcomes

• Describe the physiology of the hypothalamic-pituitary ovarian axis and the normal menstrual cycle
• Explain the “two cell, two gonadotropin” hypothesis
• Describe the interactions between the different hypothalamic-pituitary-target gland endocrine axes
• Outline the various deficiencies of the hypothalamic-pituitary system
• CREOG Objectives:
  • Unit 1: General Considerations - II. Basic Science – Overlapping Content:
    • Describe the physiology of the normal menstrual cycle, including:
      • Changes at puberty
      • Changes during perimenopause
      • Timing of fertilization

• ACGME Competencies/Milestones:
  • Medical Knowledge (MK) 1: Anatomy and pathophysiology of female reproduction

Recommended Activities & Assessments

• Online Activities with Assessments: http://www.asrm.org/asrm-academy/
  • Female Reproductive Anatomy and Physiology – online learning module(1A-1)
  • Basic Infertility for Healthcare Providers – online learning course (BIHCP001)

• ACGME Recommendations:
  • In-training examinations
  • Oral questioning methods (e.g., SNAPPS)
  • Direct observation (live or video)
  • Assessment of Reasoning Tool
    

ABNORMAL UTERINE BLEEDING

Classic / Original Research Articles

1. de Kroon CD, de Bock GH, Dieben SW, Jansen FW. Saline contrast hysterosonography in abnormal uterine bleeding: a systematic review and meta-analysis. BJOG. 2003 Oct;110(10):938-47. DOI:  https://doi.org/10.1111/j.1471-0528.2003.02472.x
2. Nieuwenhuis LL, Hermans FJ, Bij de Vaate AJM, Leeflang MM, Brölmann HA, Hehenkamp WJ, Mol BWJ, Clark TJ, Huirne JA. Three-dimensional saline infusion sonography compared to two-dimensional saline infusion sonography for the diagnosis of focal intracavitary lesions. Cochrane Database Syst Rev. 2017 May 5;5(5):CD011126. DOI:  https://doi.org/10.1002/14651858.CD011126.pub2
3. Tur-Kaspa I, Gal M, Hartman M, Hartman J, Hartman A. A prospective evaluation of uterine abnormalities by saline infusion sonohysterography in 1,009 women with infertility or abnormal uterine bleeding. Fertil Steril. 2006 Dec;86(6):1731-5. DOI:  https://doi.org/10.1016/j.fertnstert.2006.05.044

ASRM Practice & Ethics Documents

1. Current Evaluation Amenorrhea
2. Endometriosis and infertility: a committee opinion
3. Recommendations from the 2023 International Evidence based Guideline for the Assessment and Management of Polycystic Ovary Syndrome

ACOG Committee Opinions & Practice Bulletins

1. Committee on Practice Bulletins—Gynecology. Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol. 2012 Jul;120(1):197-206. DOI: https://doi.org/10.1097/AOG.0b013e318262e320
2. The Use of Hysteroscopy for the Diagnosis and Treatment of Intrauterine Pathology: ACOG Committee Opinion, Number 800. Obstet Gynecol. 2020 Mar;135(3):e138-e148. DOI: https://doi.org/10.1097/AOG.0000000000003712
3. Committee Opinion No. 557: Management of Acute Abnormal Uterine Bleeding in Nonpregnant Reproductive-Aged Women. Obstet Gynecol. 2013 Apr;121(4):p 891-896. DOI: https://doi.org/10.1097/01.AOG.0000428646.67925.9a
4. Practice bulletin no. 136: management of abnormal uterine bleeding associated with ovulatory dysfunction. Obstet Gynecol. 2013 Jul;122(1):176-185. DOI:  https://doi.org/10.1097/01.AOG.0000431815.52679.bb
5. Parkash V, Fadare O, Tornos C, McCluggage WG. Committee Opinion No. 631: Endometrial Intraepithelial Neoplasia. Obstet Gynecol. 2015 Oct;126(4):897. DOI:  https://doi.org/10.1097/AOG.0000000000001071
6. Screening and management of bleeding disorders in adolescents with heavy menstrual bleeding: ACOG Committee Opinion, Number 785 (Re-affirmed 2023). Obstet Gynecol. 2019 Sep;134(3):e71-e83. DOI: https://doi.org/10.1097/AOG.0000000000003411

Textbooks

1. Speroff 9^th ed: Abnormal Uterine Bleeding (Chapter 15)

Other Resources

1. Podcasts/CREOGS Over Coffee:
   • Episode 47-Abnormal Uterine Bleeding: The Basics (https://creogsovercoffee.com/notes/2019/7/28/abnormal-uterine-bleeding-the-basics)

Outcomes

• Describe the principal causes of abnormal uterine bleeding and the International Federation of Gynecology and Obstetrics (FIGO) classification system
• Elicit a pertinent medical history to evaluate abnormal uterine bleeding
• List the essential elements of a focused physical examination to investigate the etiology of abnormal uterine bleeding
• CREOG Objectives:
  • Unit 3: Gynecology - I. Benign Disorders of the Urogenital Tract
    • For the following presenting conditions, perform pertinent history and evaluation, including diagnostic procedures, consult subspecialists when appropriate, counsel, and manage medically and surgically:
      • Abnormal vaginal bleeding, including the following sources:
        • a) Premenopausal uterine (polyp, adenomyosis, leiomyoma, and malignancy/ hyperplasia– coagulopathy, ovulatory, endometrial, iatrogenic, not classified [PALM–COEIN]);
        • b) Postmenopausal uterine;
        • c) Nonuterine gynecologic (cervical, vulvovaginal);
        • d) Nongynecologic (gastrointestinal, genitourinary, bleeding disorders)

• ACGME Competencies/Milestones:
  • Patient Care (PC) 7: Peri-Procedural care
  • Patient Care (PC) 8: Endoscopic procedures
  • Patient Care (PC) 9: Laparoscopic procedures
  • Patient Care (PC) 11: Open surgical procedures
  • Patient Care (PC) 13: Ambulatory GYN
  • Patient Care (PC) 14: Consultations
  • Medical Knowledge (MK) 1: Anatomy & pathophysiology of female reproduction
  • Medical Knowledge (MK) 2: Differential diagnosis
  • Practice-based Learning and Improvement (PBL&I) 1: Evidence-based and informed practice
  • Interpersonal and Communication Skills (I&CS) 2: Patient counseling and decision making
  • Interpersonal and Communication Skills (I&CS) 4: Communication within healthcare settings

Recommended Activities & Assessments

• “Abnormal Uterine Bleeding, Part 1” Lesson(s) PowerPoint and case scenarios by Dr. Winifred Mak, REI Fellowship Program Director, UT Health San Antonio. R2 AUB 2020.ppt
• ASRM Academy Online Resident CREOG Module “Abnormal Uterine Bleeding” (RES006) with assessments http://www.asrm.org/asrm-academy/
• ACGME Recommendations:
  • Patient Care (PC):
    • Direct observation (live or video)
    • Rating scales/evaluation forms
    • Audit of clinical practice (e.g., quality performance measures)
    • Simulation (including standardized patients)
    • Case logs/registries
  • Medical Knowledge (MK):
    • In-training examinations
    • Oral questioning methods (e.g., SNAPPS)
    • Direct observation (live or video)
    • Assessment of Reasoning Tool
  • Practice-based Learning and Improvement (PBL&I):
    • Audit of clinical practice (e.g., quality performance measures)
    • Evidence-based medicine logs
    • Case logs
    • Rating scales/evaluation forms
    • Reflective practice rubrics
  • Interpersonal and Communication Skills (I&CS):
    • Multi-source feedback
    • Patient surveys (can be part of multi-source feedback)
    • Direct observation (live or video)
    • Simulation (including standardized patients)

AMENORRHEA

Classic / Original Research Articles

1. Chou SH, Chamberland JP, Liu X, Matarese G, Gao C, Stefanakis R, Brinkoetter MT, Gong H, Arampatzi K, Mantzoros CS. Leptin is an effective treatment for hypothalamic amenorrhea. Proc Natl Acad Sci U S A. 2011 Apr 19;108(16):6585-90.  DOI: https://doi.org/10.1073/pnas.1015674108
2. De Vos M, Devroey P, Fauser BC. Primary ovarian insufficiency. Lancet. 2010 Sep 11;376(9744):911-21. DOI:  https://doi.org/10.1016/S0140-6736(10)60355-8
3. Fourman LT, Fazeli PK. Neuroendocrine causes of amenorrhea--an update. J Clin Endocrinol Metab. 2015 Mar;100(3):812-24.  DOI:  https://doi.org/10.1210/jc.2014-3344
4. Gravholt CH, Andersen NH, Conway GS, Dekkers OM, Geffner ME, Klein KO, Lin AE, Mauras N, Quigley CA, Rubin K, Sandberg DE, Sas TCJ, Silberbach M, Söderström-Anttila V, Stochholm K, van Alfen-van derVelden JA, Woelfle J, Backeljauw PF; International Turner Syndrome Consensus Group. Clinical practice guidelines for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner Syndrome Meeting. Eur J Endocrinol. 2017 Sep;177(3):G1-G70. DOI:  https://doi.org/10.1530/EJE-17-0430
5. Rebar, Robert W. MD. Premature Ovarian Failure. Obstetrics & Gynecology 113(6):p 1355-1363, June 2009.  DOI:  https://doi.org/10.1097/AOG.0b013e3181a66843
6. Sullivan SD, Sarrel PM, Nelson LM. Hormone replacement therapy in young women with primary ovarian insufficiency and early menopause. Fertil Steril. 2016 Dec;106(7):1588-1599. DOI:  https://doi.org/10.1016/j.fertnstert.2016.09.046

ASRM Practice & Ethics Documents

1. Current Evaluation of Amenorrhea (2008). Practice Committee of the American Society for Reproductive Medicine, Washington, DC.  Fertility and Sterility:  Volume 90, Supplement 3, S219-s225, DOI:  https://doi.org/doi:10.1016/j.fertnstert.2008.08.038  

ACOG Committee Opinions & Practice Bulletins

1. Committee Opinion No.702: Female Athlete Triad. Obstet Gynecol. 2017 Jun;129(6):e160-e167. DOI:  https://doi.org/10.1097/AOG.0000000000002113
2. Committee Opinion No.698: Hormone Therapy in Primary Ovarian Insufficiency. (Re-affirmed 2021) Obstet Gynecol. 2017 May;129;e134-41. DOI:  https://doi.org/10.1097/AOG.0000000000002044
3. Committee opinion no. 605: primary ovarian insufficiency in adolescents and young women. (Re-affirmed 2021) Obstet Gynecol. 2014 Jul;124(1):193-197. DOI:  https://doi.org/10.1097/01.AOG.0000451757.51964.98
4. American Academy of Pediatrics Committee on Adolescence; American College of Obstetricians and Gynecologists Committee on Adolescent Health Care; Diaz A, Laufer MR, Breech LL. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Pediatrics. 2006 Nov;118(5):2245-50. DOI:  https://doi.org/10.1542/peds.2006-2481
5. Management of Acute Obstructive Uterovaginal Anomalies: ACOG Committee Opinion Summary, Number 779. Obstet Gynecol. 2019 Jun;133(6):1290-1291. DOI: https://doi.org/10.1097/AOG.0000000000003282

Textbooks

1. Speroff, 9^th ed: Amenorrhea (Chapter 10)

Other Resources

1. Catherine M. Gordon, Kathryn E. Ackerman, Sarah L. Berga, Jay R. Kaplan, George Mastorakos, Madhusmita Misra, M. Hassan Murad, Nanette F. Santoro, Michelle P. Warren, Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 5, 1 May 2017, Pages 1413–1439, https://doi.org/10.1210/jc.2017-00131

Outcomes

• Define primary and secondary amenorrhea
• Describe the clinical manifestations, causes, and pathophysiology of diseases associated with amenorrhea
• Outline the evaluation and management of patients with amenorrhea
• CREOG Objectives:
  • Unit 3: Gynecology: Benign Disorders of the Urogenital Tract
    • Reproductive endocrinology and infertility
      • Describe the diagnostic testing, indications for management, and treatments for the following conditions:
        • a) Amenorrhea
  • Unit 4: Office Practice:  Focused Areas in Gynecologic Care
    • Pediatric/Adolescent Gynecology
      • Address the unique needs of pediatric and adolescent gynecology patients (including indications for referral) for conditions and topics including the following:
        • f)Primary amenorrhea
• ACGME Competencies/Milestones:
  • Patient Care (PC) 13: Ambulatory gynecology

Recommended Activities & Assessments

• ASRM Academy Online Resident CREOG modules “Amenorrhea” (RES007) with assessments http://www.asrm.org/asrm-academy/
• “Amenorrhea” Lesson(s) PowerPoint and case scenarios by Dr. Winifred Mak, REI Fellowship Program Director, UT Health San Antonio. R1amenorrhea2020.pptx
• ACGME:
  • Direct observation (live or video)
  • Rating scales/evaluation forms
  • Audit of clinical practice (e.g., quality performance measures)
  • Simulation (including standardized patients)
  • Case logs/registries

BASIC GYNECOLOGICAL ULTRASOUND 

ASRM Practice & Ethics Documents

1. American Society for Reproductive Medicine position statement on qualifications for providing ultrasound procedures in reproductive medicine (2022). Practice Committee of the American Society for Reproductive Medicine, Washington, DC.  Fertility and Sterility: Volume 118, No. 4, DOI:  https://doi.org/10.1016/j.fertnstert.2022.07.014

ACOG Committee Opinions & Practice Bulletins

1. Guidelines for diagnostic imaging during pregnancy and lactation. Committee Opinion No. 723. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;130:e210–6. DOI: https://doi.org/10.1097/AOG.0000000000002355
2. AIUM-ACR-ACOG-SMFM-SRU Practice Parameter for the Performance of Standard Diagnostic Obstetric Ultrasound Examinations. J Ultrasound Med. 2018 Nov;37(11):E13-E24. DOI:  https://doi.org/10.1002/jum.14831
3. Antepartum Fetal Surveillance: ACOG Practice Bulletin, Number 229. Obstet Gynecol. 2021 Jun 1;137(6):e116-e127. DOI:  https://doi.org/10.1097/AOG.0000000000004410

Textbooks

1. Ultrasound in Obgyn2 chap 11, 12 and 14
   • Chapter 11  Ultrasound of Non-Pregnant Uterus
   • Chapter 12 Ultrasound Evaluation of the Adnexae
   • Chapter 14 Stepwise Standardized Approach to the Basic Ultrasound Exam of the Female Pelvis

Other Resources

1. Guidelines to Perinatal Care, eighth ed., Ch. 6 Fetal Ultrasound Imaging. American College of Obstetricians and Gynecologists and American Academy of Pediatrics (September 2017) Guidelines for Perinatal Care, 8th edition [eBook] | shopAAP

Outcomes

• Identify the principles of sonography
• CREOG Objectives:
  • Unit 2 – II Antepartum Care
    • Perform Ultrasonography
      • Assess fetal number, lie, presentation, viability, and placental location.
      • Assess fetal biometry.
      • Assess cervical length.
      • Perform and interpret a biophysical profile (BPP).
      • Describe indications for assessment with Doppler ultrasonography (eg, umbilical artery [UA] and middle cerebral artery [MCA]).
• ACGME Competencies/Milestones:
  • Patient Care (PC) 1: Antepartum Care

Recommended Activities & Assessments

• ACGME Recommendations:
  • Direct observation (live or video)
  • Rating scales/evaluation forms
  • Audit of clinical practice (e.g., quality performance measures)
  • Simulation (including standardized patients)
  • Case logs/registries

INTRODUCTION TO INFERTILITY     

ASRM Practice & Ethics Documents

1. Definition of infertility: a committee opinion (2023). Practice Committee of the American Society for Reproductive Medicine, Washington, DC. Fertility and Sterility: Volume 120, Issue 6, p1170, DOI: https://doi.org/10.1016/S0015-0282(23)01971-4

ACOG Committee Opinions & Practice Bulletins 15

1. Infertility workup for the women's health specialist: ACOG committee opinion, Number 781. Obstet Gynecol. 2019 Jun;133(6):e377-e384. DOI: https://doi.org/10.1097/AOG.0000000000003271 

Textbooks

1. Speroff, 9^th ed: Female Infertility (Chapter 25)
2. Speroff, 9^th ed: Male Infertility (Chapter 26)

Outcomes

• Define infertility
• Identify causes of male and female infertility
• CREOG Objectives:
  • Unit 1: General Considerations - II. Basic Science 
    • Describe the physiology of the normal menstrual cycle, including the following:
      • 2. Changes during perimenopause
• ACGME Competencies/Milestones:
  • Medical Knowledge (MK) 1: Anatomy and pathophysiology of female reproduction

Recommended Activities & Assessments

• ASRM Academy Online Courses and Modules with Assessments: Basic Infertility Short Course (in development); Basic Infertility Course (MD072); Causes of Female Infertility Module (1A 2); Male Reproductive Anatomy and Physiology Module (1B 1); Causes of Male Infertility Module (1B 2) http://www.asrm.org/asrm-academy/
• ACGME Recommendations:
  • In-training examinations
  • Oral questioning methods (e.g., SNAPPS)
  • Direct observation (live or video)
  • Assessment of Reasoning Tool
    

REPRODUCTIVE ETHICS

Classic / Original Research Articles

1. Edgoose JYC, Quiogue M, Sidhar K. How to identify, understand, and unlearn implicit bias in patient care. Fam Pract Manag. 2019;26(4):29-33. How to Identify, Understand, and Unlearn Implicit Bias in Patient Care | AAFP

ASRM Practice & Ethics Documents

1. Informed Consent In Assisted Reproduction: An Ethics Committee Opinion (2023) Fertility and Sterility  119:6, June 2023.  American Society for Reproductive Medicine.  DOI:   https://doi.org/10.1016/j.fertnstert.2023.03.009
2. Disparities In Access To Effective Treatment For Infertility In The United States: An Ethics Committee Opinion (2021). Fertility and Sterility 116:1, July 2021.  American Society for Reproductive Medicine, DOI:   https://doi.org/10.1016/j.fertnstert.2021.02.019
3. Access To Fertility Treatment Irrespective Of Marital Status, Sexual Orientation, Or Gender Identity: An Ethics Committee Opinion (2021). Fertility and Sterility 116:2, August 2021. American Society for Reproductive Medicine, DOI: https://doi.org/10.1016/j.fertnstert.2021.03.034

ACOG Committee Opinions & Practice Bulletins & Practice Bulletins

1. American College of Obstetrics and Gynecology. ACOG Committee Opinion No. 390 (2007). Ethical decision making in obstetrics and gynecology. Obstet Gynecol. 2007 Dec;110(6):1479-87. DOI: https://doi.org/10.1097/01.AOG.0000291573.09193.36
2. Professional responsibilities in obstetric–gynecologic medical education and training. (Re-affirmed 2020) Committee Opinion No. 500. American College of Obstetricians and Gynecologists. Obstet Gynecol 2011;118:400–4. DOI:  https://doi.org/10.1097/AOG.0b013e31822c999a

Textbooks

1. “Reproductive Ethics in Clinical Practice” by Chor&Watson, Oxford University Press, 2021 ISBN: 9780190873028
2. “Case Studies in the Ethics of Assisted Reproduction” by King&Band, Springer, 2023 ISBN: 9783031412141

Outcomes

• Develop a thorough understanding of fundamental ethical principles such as autonomy, beneficence, nonmaleficence, and justice, and learn to apply these principles effectively in diverse clinical scenarios in reproductive medicine.
• Gain proficiency in navigating complex ethical dilemmas, particularly those arising from emerging technologies and treatments in reproductive medicine, including genetic testing and gene editing.
• Cultivate skills in cultural competency and patient-centered communication, ensuring sensitive and respectful handling of patients' diverse cultural backgrounds and beliefs in reproductive health decisions.
• CREOG Objectives:
  • Unit 1: General Considerations:  Physician Competencies
    • Professionalism
      • Demonstrate respect, compassion, integrity, and responsiveness to the needs of patients and society that supersede self-interest.
      • Describe and apply the basic principles of medical ethics, including autonomy, beneficence, justice, and nonmaleficence, taking into account the following considerations:
        • a) Balancing accountability to patients, society, and the profession
        • b) Uncompromised honesty
        • c) Making decisions about the provision or withholding of clinical care
        • d) Fair allocation of limited medical resources
        • e) The role of a patient’s age and mental capacity in ethical decision making
        • f) Ethical implications of commonly used obstetric and gynecologic technologies
        • g) Managing conflicting ethical obligations in complex patient care situations
      • Maintain a work ethic that enhances clinical care and the work environment (eg, positive attitude and high level of initiative).
        • a) Develop and maintain habits of punctuality and efficiency.
        • b) Demonstrate receptiveness to instruction and feedback.
        • c) Develop skills for providing constructive feedback.
• ACGME Competencies/Milestones:
  • Interpersonal and Communication Skills (I&CS) 3: Interprofessional and Team Communication Professionalism (P) 1. Professional behavior
  • Professionalism (P) 2: Ethical Principles
  • Professionalism (P) 3: Accountability/Conscientiousness
  • Professionalism (P) 4: Compassion and Respect for Others

Recommended Activities & Assessments

• ASRM Academy Online Recorded Webinars “Navigating Religious Considerations of Patients Undergoing IVF”; “Dobbs: The decision, potential impact, and your role in the fight to protect reproductive rights” http://www.asrm.org/asrm-academy/
• Case studies discussing real-world ethical dilemmas encountered in reproductive medicine.
• Role-playing exercises where residents can practice navigating ethical discussions with simulated patients.
• ACGME Recommendations:
  • Professionalism
    • Multi-source feedback
    • Patient surveys (can be part of multi-source feedback)
    • Direct observation
  • Interpersonal and Communication Skills
    • Multi-source feedback
    • Patient surveys (can be part of multisource feedback)
    • Direct observation (live or video)
    • Simulation (including standardized patients)

ACCESS TO CARE

Classic / Original Research Articles

1. Vyas N, Douglas CR, Mann C, Weimer AK, Quinn MM. Access, barriers, and decisional regret in pursuit of fertility preservation among transgender and gender-diverse individuals. Fertil Steril. 2021 Apr;115(4):1029-1034. DOI:  https://doi.org/10.1016/j.fertnstert.2020.09.007

ASRM Practice & Ethics Documents

1. Cross-border reproductive care:  an Ethics Committee opinion (2022). Ethics Committee of the American Society for Reproductive Medicine, Washington, DC. Fertility and Sterility: Volume 117, No. 5, https://doi.org/10.1016/j.fertnstert.2022.01.012
2. Reproductive and infertility care in times of public health crises:  an Ethics Committee opinion (2022).  Ethics Committee of the American Society for Reproductive Medicine, Washington, DC.  Fertility and Sterility:  In Press, https://doi.org/10.1016/j.fertnstert.2022.02.011
3. Disparities in access to effective treatment for infertility in the United States:  an Ethics Committee opinion (2021).  Ethics Committee of the American Society for Reproductive Medicine, Washington, DC.  Fertility and Sterility:  Volume 116, No. 1, https://doi.org/10.1016/j.fertnstert.2021.02.019
4. Access to fertility treatment irrespective of marital status, sexual orientation, or gender identity (2021). Ethics Committee of the American Society for Reproductive Medicine, Washington, DC. Fertility and Sterility:  Volume 116, No. 2, https://doi.org/10.1016/j.fertnstert.2021.03.034

ACOG Committee Opinions & Practice Bulletins

1. ACOG Committee Opinion No. 823, Health Care for Transgender and Gender Diverse Individuals: Correction. Obstetrics & Gynecology 139(2):p 345, February 2022. DOI: https://www.doi.org/10.1097/AOG.0000000000004684
2. Committee on Health Care for Underserved Women. ACOG Committee Opinion No. 729: Importance of Social Determinants of Health and Cultural Awareness in the Delivery of Reproductive Health Care. Obstet Gynecol. 2018 Jan;131(1):e43-e48 (Re-affirmed 2021) DOI:  https://doi.org/10.1097/AOG.0000000000002459

Outcomes

• CREOG Objectives:
  • Unit 1: General Considerations:  Physician Competencies
    • Interpersonal and Communication Skills
      • Enable a diverse and inclusive environment through interpersonal communication skills with patients, other providers, students, and professionals demonstrating:
        • a) An awareness/assessment and impact of implicit bias
        • b) An ability to create an environment of inclusivity including gender-affirming care, support of those with different abilities, support for all language preferences and medical diagnosis
        • c) Language and inclusive communication (eg, use of an interpreter for preferred language)
• ACGME Competencies/Milestones:
  • Interpersonal and Communication Skills (I&CS) 1: Patient- and family-centered communication

Recommended Activities & Assessments

• ASRM Academy Online Courses and Modules with Assessments: Leadership in Access to Care online course (LATC100); Leadership in Access to Care online module (LATCM001):  The Impact of Infertility; Leadership in Access to Care online module (LATCM002):  Sociodemographic Barriers & Strategies for Improving Access; Leadership in Access to Care online module (LATCM003):  Socioeconomic Barriers & Strategies for Improving Access; Leadership in Access to Care online module (LATCM004):  Advocacy & Patient Support for Healthcare Professionals
• ASRM Academy Online Recorded Webinars “The Demise of Roe v Wade: Potential Impact on Fertility Care”; “Dobbs: The decision, potential impact, and your role in the fight to protect reproductive rights”; “Racial disparities in endometriosis treatment: How do we close the gap?” http://www.asrm.org/asrm-academy/
• CREOG Health Equity Curriculum (Updated September, 2022) Health Equity | ACOG
• ACGME Recommendations:
  • Multi-source feedback
  • Patient surveys (can be part of multisource feedback)
  • Direct observation (live or video)
  • Simulation (including standardized patients)

HYPERPROLACTINEMIA & GALACTORRHEA

ASRM Practice & Ethics Documents

1. Fertility evaluation of infertile women: a committee opinion

ACOG Committee Opinions & Practice Bulletins

1. Practice Bulletin No. 164: Diagnosis and Management of Benign Breast Disorders. Obstet Gynecol. 2016 Jun;127(6):e141-e156. DOI:  https://doi.org/10.1097/AOG.0000000000001482 Erratum in: Obstet Gynecol. 2021 Feb 1;137(2):382.

Textbooks

1. Yen & Jaffee, Chapter 3, “Prolactin and its role in human reproduction”

Other Resources

1. Endocrine Society Clinical Practice Guideline: Diagnosis and Treatment of Hyperprolactinemia

Outcomes

• Identify the physiology and pathophysiology of prolactin secretion
• Explain the diagnosis and management of patients with hyperprolactinemia
• Identify the physiology and pathophysiology of prolactin secretion
• Explain the diagnosis and management of patients with hyperprolactinemia
• Describe the causes of galactorrhea/hyperprolactinemia (MK)
• Elicit a pertinent history to evaluate galactorrhea/hyperprolactinemia (PC)
• Order and interpret selected diagnostic studies, including: (PC)
  • Serum prolactin
  • Serum TSH
  • CT or MRI of pituitary
• Treat galactorrhea/hyperprolactinemia (PC)
• Describe the indications for referral to a neurosurgeon for surgical treatment of a pituitary adenoma (SBP)
• Describe long-term follow-up for the patient with galactorrhea/hyperprolactinemia/ pituitary adenoma focusing particularly on the risk of complications, such as:  (PC)
  • Headaches
  • Visual field defects
  • Infertility
  • Hypoestrogenism
• Describe the management of patients with a pituitary adenoma in pregnancy (PC)
• ACGME Competencies/Milestones:
  • Medical Knowledge (MK) 2: Differential diagnosis

Recommended Activities & Assessments

• ASRM Academy Online Resident CREOG Module “Galactorrhea/Hyperprolactinemia” (RES008) with assessments http://www.asrm.org/asrm-academy/
• SREI Review Lessons, “High Yield REI CREOG Review” PowerPoint SREI High Yield CREOG Review
• ACGME Recommendations:
  • Medical Knowledge (MK):
  • In-training examinations
  • Oral questioning methods (e.g., SNAPPS)
  • Direct observation (live or video)
  • Assessment of Reasoning Tool

PREMENSTRUAL SYNDROME (PMS)/PREMENSTRUAL DYSPHORIC DISORDER (PMDD)

ACOG Committee Opinions & Practice Bulletins

1. Management of Premenstrual Disorders: ACOG Clinical Practice Guideline No. 7. Obstet Gynecol. 2023 Dec 1;142(6):1516-1533. DOI: https://doi.org/10.1097/aog.0000000000005426 PMID: 37973069.

Outcomes

• PMS:
  • Describe the diagnostic criteria for premenstrual syndrome (PMS) (MK)
  • List the possible causes of PMS (MK)
  • Elicit a pertinent history to evaluate PMS (ICS)
  • Describe the differential diagnosis of PMS (MK)
  • Treat PMS with interventions, such as: (PC)
    • Psychosocial support or referral
    • Counseling about lifestyle changes
    • Medication
• ACGME Competencies/Milestones:
  • Medical Knowledge (MK) 2: Differential diagnosis
  • Systems-based Practice (SBP) 3: System navigation for patient-centered care

Recommended Activities & Assessments

• ASRM Academy Online CREOG module Premenstrual Syndrome & Premenstrual Dysphoric Disorder (PMS & PMDD) (RES009) with assessments http://www.asrm.org/asrm-academy/
• ACGME Recommendations:
  • Medical Knowledge (MK):
    • In-training examinations
    • Oral questioning methods (e.g., SNAPPS)
    • Direct observation (live or video)
    • Assessment of Reasoning Tool
  • Systems-based Practice (SBP)
    • Quality improvement knowledge assessment test
    • Audit of clinical practice (e.g., quality performance measures)
    • Multi-source feedback
    • Rating scales/evaluation forms

CLINICAL REPRODUCTIVE GENETICS

Classic / Original Research Articles

1. Capalbo A, Poli M, Rienzi L, Girardi L, Patassini C, Fabiani M, Cimadomo D, Benini F, Farcomeni A, Cuzzi J, Rubio C, Albani E, Sacchi L, Vaiarelli A, Figliuzzi M, Findikli N, Coban O, Boynukalin FK, Vogel I, Hoffmann E, Livi C, Levi-Setti PE, Ubaldi FM, Simón C. Mosaic human preimplantation embryos and their developmental potential in a prospective, non-selection clinical trial. Am J Hum Genet. 2021 Dec 2;108(12):2238-2247. DOI:  https://doi.org/10.1016/j.ajhg.2021.11.002
2. Cornelisse S, Zagers M, Kostova E, Fleischer K, van Wely M, Mastenbroek S. Preimplantation genetic testing for aneuploidies (abnormal number of chromosomes) in in vitro fertilisation. Cochrane Database Syst Rev. 2020 Sep 8;9(9):CD005291. DOI:  https://doi.org/10.1002/14651858.CD005291.pub3
3. Dresser R. Preimplantation genetic diagnosis as medical innovation: reflections from The President's Council on Bioethics. Fertil Steril. 2006 Jun;85(6):1633-7. DOI:  https://doi.org/10.1016/j.fertnstert.2006.01.013
4. Gleicher N, Albertini DF, Barad DH, Homer H, Modi D, Murtinger M, Patrizio P, Orvieto R, Takahashi S, Weghofer A, Ziebe S, Noyes N; International Do No Harm Group in IVF (IDNHG-IVF). The 2019 PGDIS position statement on transfer of mosaic embryos within a context of new information on PGT-A. Reprod Biol Endocrinol. 2020 May 29;18(1):57. DOI:  https://doi.org/10.1186/s12958-020-00616-w
5. Handyside AH, Lesko JG, Tarín JJ, Winston RM, Hughes MR. Birth of a normal girl after in vitro fertilization and preimplantation diagnostic testing for cystic fibrosis. N Engl J Med. 1992 Sep 24;327(13):905-9. DOI:  https://doi.org/10.1056/NEJM199209243271301
6. Munné S, Chen S, Fischer J, Colls P, Zheng X, Stevens J, Escudero T, Oter M, Schoolcraft B, Simpson JL, Cohen J. Preimplantation genetic diagnosis reduces pregnancy loss in women aged 35 years and older with a history of recurrent miscarriages. Fertil Steril. 2005 Aug;84(2):331-5. DOI:  https://doi.org/10.1016/j.fertnstert.2005.02.027
7. Sher G, Keskintepe L, Keskintepe M, Maassarani G, Tortoriello D, Brody S. Genetic analysis of human embryos by metaphase comparative genomic hybridization (mCGH) improves efficiency of IVF by increasing embryo implantation rate and reducing multiple pregnancies and spontaneous miscarriages. Fertil Steril. 2009 Dec;92(6):1886-94. DOI:  https://doi.org/10.1016/j.fertnstert.2008.11.029

ASRM Practice & Ethics Documents

1. American Society for Reproductive Medicine; American College of Obstetricians and Gynecologists' Committee on Gynecologic Practice. Prepregnancy counseling: Committee Opinion No. 762. Fertil Steril. 2019 Jan;111(1):32-42. DOI:  https://doi.org/10.1016/j.fertnstert.2018.12.003 

ACOG Committee Opinions & Practice Bulletins

1. Committee Opinion No. 693 Summary: Counseling About Genetic Testing and Communication of Genetic Test Results. Obstet Gynecol. 2017 Apr;129(4):771-772. DOI: https://doi.org/10.1097/AOG.0000000000002011
2. ACOG Committee Opinion No. 587: Effective patient-physician communication. Obstet Gynecol. 2014 Feb;123(2 Pt 1):389-393. DOI: https://doi.org/10.1097/01.AOG.0000443279.14017.12
3. Modern genetics in obstetrics and gynecology. ACOG Technology Assessment in Obstetrics and Gynecology No. 14. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018 (Re-affirmed 2023);132:e143–68.
4. Committee Opinion No. 691: Carrier Screening for Genetic Conditions. Obstet Gynecol. 2017 Mar;129(3):e41-e55. DOI: https://doi.org/10.1097/AOG.0000000000001952
5. Committee Opinion No. 690 Summary: Carrier Screening in the Age of Genomic Medicine. Obstet Gynecol. 2017 Mar;129(3):595-596. DOI: https://doi.org/10.1097/AOG.0000000000001947
6. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics; Committee on Genetics; Society for Maternal-Fetal Medicine. Screening for Fetal Chromosomal Abnormalities: ACOG Practice Bulletin, Number 226. Obstet Gynecol. 2020 Oct;136(4):e48-e69. DOI: https://doi.org/10.1097/AOG.0000000000004084
7. Practice Bulletin No. 162: Prenatal Diagnostic Testing for Genetic Disorders. Obstet Gynecol. 2016 May;127(5):e108-e122. DOI: https://doi.org/10.1097/AOG.0000000000001405

Textbooks

• Speroff, 9^th ed: Genetics (Chapter 31)

Outcomes

• CREOG Objectives:
  • Unit 1: Physician Competencies
    • Medical knowledge
      • Describe the difference between screening and diagnostic tests
  • Unit 1: Basic Science—Overlapping Content
    • Describe patterns of inheritance.
      • Mendelian modes (eg, autosomal dominant, autosomal recessive, X-linked)
      • Non-Mendelian modes (eg, mitochondrial, imprinting, polygenic)
  • Unit 2: Obstetrics: II. Antepartum Care
    • Assess and counsel patients about genetics.
      • Understand patterns of inheritance.
      • Solicit a family pedigree.
      • Describe and perform prepregnancy counseling and testing.
      • Describe and perform antepartum genetic testing and counseling.
      • Perform prenatal genetic screening.
      • Refer for diagnostic testing.
  • Unit 3: Gynecology: II. Neoplasia and Malignancies of the Reproductive Tract and Breast
    • Risk identification and reduction
      • Assess patients’ risk for cancer of the breast, ovary, endometrium, and other sites.
        • a) Review family and personal history to identify patterns suggestive of hereditary cancer syndromes to provide appropriate referrals to a genetic counselor.
        • b) List genetic markers most frequently associated with hereditary cancer risk (eg, BRCA1/2, MSH6, MSH2, MLH1, PMS2).
        • c) Understand implications of positive and negative genetic test results for surveillance planning and risk-reducing strategies.
        • d) Understand and counsel patients regarding indications, available options, interpretations, and limitations of genetic testing.
        • e) Counsel patients at increased risk of cancer regarding risk-reducing strategies including lifestyle modifications, medical interventions, and surgical interventions.
  • Unit 4: Periodic Health Assessment
    • Understand the effect of personal genetics on periodic assessment of a patient and initiate appropriate referral for further evaluation.
• ACGME Competencies/Milestones:
  • Practice-based Learning and Improvement (PBL&I) 1: Evidence-based and informed practice
  • Medical Knowledge (MK) 1: Anatomy and pathophysiology of female reproduction
  • Medical Knowledge (MK) 2: Differential diagnosis
  • Patient Care (PC) 1: Antepartum care
  • Patient Care (PC) 13: Ambulatory gynecological and office-based procedures

Recommended Activities & Assessments

• ACGME Recommendations:
  • Practice-based Learning & Improvement (PBL&I):
    • Audit of clinical practice (e.g., quality performance measures)
    • Evidence-based medicine logs
    • Case logs
    • Rating scales/evaluation forms
    • Reflective practice rubrics
  • Medical Knowledge (MK):
    • In-training examinations
    • Oral questioning methods (e.g., SNAPPS)
    • Direct observation (live or video)
    • Assessment of Reasoning Tool
  • Patient Care (PC):
    • Direct observation (live or video)
    • Rating scales/evaluation forms
    • Audit of clinical practice (e.g., quality performance measures)
    • Simulation (including standardized patients)
    • Case logs/registries

MENSTRUAL CYCLE & PHYSIOLOGY OF THE HYPOTHALAMIC-PITUITARY AXIS DEEP DIVE

Recommended Activities & Assessments

1. SREI Review Lessons, “High Yield REI CREOG Review” PowerPoint SREI High Yield CREOG Review

INFERTILITY

Classic / Original Research Articles

1. Bhattacharya S, Harrild K, Mollison J, Wordsworth S, Tay C, Harrold A, McQueen D, Lyall H, Johnston L, Burrage J, Grossett S, Walton H, Lynch J, Johnstone A, Kini S, Raja A, Templeton A. Clomifene citrate or unstimulated intrauterine insemination compared with expectant management for unexplained infertility: pragmatic randomised controlled trial. BMJ. 2008 Aug 7;337:a716. DOI:  https://doi.org/10.1136/bmj.a716
2. Custers IM, van Rumste MM, van der Steeg JW, van Wely M, Hompes PG, Bossuyt P, Broekmans FJ, Renckens CN, Eijkemans MJ, van Dessel TJ, van der Veen F, Mol BW, Steures P; CECERM. Long-term outcome in couples with unexplained subfertility and an intermediate prognosis initially randomized between expectant management and immediate treatment. Hum Reprod. 2012 Feb;27(2):444-50. DOI:  https://doi.org/10.1093/humrep/der389
3. Diamond, MP, Legro, RS, Coutifaris, C., Alvero, R., Robinson, RD, Casson, P., Christman, G.M., Ager, J., Huang, H., Hansen, K., Baker, V.,Usadi, R., et al., for the NICHD Reproductive Medicine Network.  Letrozole, Gonadotropin, or Clomiphene for Unexplained Infertility.  New England Journal of Medicine, 2015, Sept.  373:1230 – 1240.  DOI:  Letrozole, Gonadotropin, or Clomiphene for Unexplained Infertility - PubMed
4. Farquhar CM, Liu E, Armstrong S, Arroll N, Lensen S, Brown J. Intrauterine insemination with ovarian stimulation versus expectant management for unexplained infertility (TUI): a pragmatic, open-label, randomised, controlled, two-centre trial. Lancet. 2018 Feb 3;391(10119):441-450. DOI:  https://doi.org/10.1016/S0140-6736(17)32406-6
5. Guzick DS, Carson SA, Coutifaris C, Overstreet JW, Factor-Litvak P, Steinkampf MP, Hill JA, Mastroianni L, Buster JE, Nakajima ST, Vogel DL, Canfield RE. Efficacy of superovulation and intrauterine insemination in the treatment of infertility. National Cooperative Reproductive Medicine Network. N Engl J Med. 1999 Jan 21;340(3):177-83. DOI:  https://doi.org/10.1056/NEJM199901213400302
6. Reindollar RH, Regan MM, Neumann PJ, Levine BS, Thornton KL, Alper MM, Goldman MB. A randomized clinical trial to evaluate optimal treatment for unexplained infertility: the fast track and standard treatment (FASTT) trial. Fertil Steril. 2010 Aug;94(3):888-99. DOI:  https://doi.org/10.1016/j.fertnstert.2009.04.022
7. Steures P, van der Steeg JW, Hompes PG, Habbema JD, Eijkemans MJ, Broekmans FJ, Verhoeve HR, Bossuyt PM, van der Veen F, Mol BW; Collaborative Effort on the Clinical Evaluation in Reproductive Medicine. Intrauterine insemination with controlled ovarian hyperstimulation versus expectant management for couples with unexplained subfertility and an intermediate prognosis: a randomised clinical trial. Lancet. 2006 Jul 15;368(9531):216-21. DOI:  https://doi.org/10.1016/S0140-6736(06)69042-9

ASRM Practice & Ethics Documents

1. Definition of infertility: a committee opinion (2023). Practice Committee of the American Society for Reproductive Medicine, Washington, DC. Fertility and Sterility: Volume 120, Issue 6, p1170, DOI: https://doi.org/10.1016/S0015-0282(23)01971-4

Recommended Activities & Assessments

• “Pre-Rotation Test #1” by Dr. Winifred Mak, REI Fellowship Program Director, UT Health San Antonio. Pre Test #1
• “Pre-Rotation Test #2” by Dr. Winifred Mak, REI Fellowship Program Director, UT Health San Antonio. Pre Test #2
• “Infertility” Lesson(s) and Case Scenarios PowerPoint by Dr. Winifred Mak, REI Fellowship Program Director, UT Health San Antonio ppt
• SREI Review Lessons, “High Yield REI CREOG Review” PowerPoint SREI High Yield CREOG Review

INFERTILITY EVALUATION

Classic / Original Research Articles

1. Steiner AZ, Herring AH, Kesner JS, Meadows JW, Stanczyk FZ, Hoberman S, Baird DD. Antimüllerian hormone as a predictor of natural fecundability in women aged 30-42 years. Obstet Gynecol. 2011 Apr;117(4):798-804. DOI:  https://doi.org/10.1097/AOG.0b013e3182116bc8
2. Ulrich ND, Marsh EE. Ovarian Reserve Testing: A Review of the Options, Their Applications, and Their Limitations. Clin Obstet Gynecol. 2019 Jun;62(2):228-237. DOI:  https://doi.org/10.1097/GRF.0000000000000445

ASRM Practice & Ethics Documents

1. ASRM Committee Guideline: Fertility Evaluation of Infertile Women: A Committee Opinion (2021) Fertility and Sterility 116:5, November 2021 American Society for Reproductive Medicine.  DOI:   https://doi.org/10.1016/j.fertnstert.2021.08.038
2. ASRM Committee Guideline: The clinical relevance of luteal phase deficiency Fertility and Sterility 115:6, June 2021 American Society for Reproductive Medicine.  DOI:   https://doi.org/10.1016/j.fertnstert.2021.02.010
3. Practice Committee of the American Society for Reproductive Medicine in collaboration with the Society for Male Reproduction and Urology. Evaluation of the azoospermic male: a committee opinion. Fertil Steril. 2018 May;109(5):777-782.  DOI:  https://doi.org/10.1016/j.fertnstert.2018.01.043
4. AUA/ASRM Joint Committee Guideline: Diagnosis and treatment of infertility in men (Parts I and II) (2021) Fertility and Sterility.  American Urological Association Education and Research, Inc. and American Society for Reproductive Medicine. DOI:  https://doi.org/10.1016/j.fertnstert.2020.11.015
5. American Society for Reproductive Medicine; American College of Obstetricians and Gynecologists' Committee on Gynecologic Practice. Prepregnancy counseling: Committee Opinion No. 762. Fertil Steril. 2019 Jan;111(1):32-42. DOI:  https://doi.org/10.1016/j.fertnstert.2018.12.003
6. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and Practice Committee. Female age-related fertility decline. Committee Opinion No. 589. Fertil Steril. 2014 Mar;101(3):633-4. DOI:  https://doi.org/10.1016/j.fertnstert.2013.12.032
7. Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org; Practice Committee of the American Society for Reproductive Medicine. Testing and interpreting measures of ovarian reserve: a committee opinion. Fertil Steril. 2020 Dec;114(6):1151-1157. DOI:  https://doi.org/10.1016/j.fertnstert.2020.09.134
8. Practice Committees of the American Society for Reproductive Medicine and the Society for Reproductive Endocrinology and Infertility. Diagnosis and treatment of luteal phase deficiency: a committee opinion. Fertil Steril. 2021 Jun;115(6):1416-1423. DOI:  https://doi.org/10.1016/j.fertnstert.2021.02.010

ACOG Committee Opinions & Practice Bulletins & Practice Bulletins

1. Infertility Workup for the Women's Health Specialist: ACOG Committee Opinion, Number 781. Obstet Gynecol. 2019 Jun;133(6):e377-e384. DOI:  https://doi.org/10.1097/AOG.0000000000003271
2. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and Practice Committee. Female age-related fertility decline. Committee Opinion No. 589. Fertil Steril. 2014 Mar;101(3):633-4. DOI:  https://doi.org/10.1016/j.fertnstert.2013.12.032

Textbooks

1. Speroff, 9^th ed: Female Infertility (Chapter 25)
2. Speroff, 9^th ed: Male Infertility (Chapter 26)

Outcomes

• Describe a complete work-up for infertility
• Interpret testing results from a fertility work-up, including the limitations of testing
• Describe the relationship between female age, aneuploidy, and fecundability
• Interpret a semen analysis
• Understand aspects of fertility care that are popular in the lay public, but not usually helpful to patients (example: progesterone for luteal phase deficiency)
• Describe appropriate preconception counseling and screening and explain further diagnostic and therapeutic approaches for couples carrying dominant, X-linked, or recessive disorders

Recommended Activities & Assessments

• ASRM Academy Online Resident CREOG Modules “Infertility Evaluation” (RES013); Recorded Webinar:  The evolving infertility evaluation: what is the role for diagnostic hysteroscopy and laparoscopy? http://www.asrm.org/asrm-academy/

INFERTILITY DIAGNOSIS

Classic / Original Research Articles

1. Barratt CLR, Björndahl L, De Jonge CJ, Lamb DJ, Osorio Martini F, McLachlan R, Oates RD, van der Poel S, St John B, Sigman M, Sokol R, Tournaye H. The diagnosis of male infertility: an analysis of the evidence to support the development of global WHO guidance-challenges and future research opportunities. Hum Reprod Update. 2017 Nov 1;23(6):660-680. DOI:  https://doi.org/10.1093/humupd/dmx021

INFERTILITY MANAGEMENT

Classic / Original Research Articles

1. Achache H, Revel A. Endometrial receptivity markers, the journey to successful embryo implantation. Hum Reprod Update. 2006 Nov-Dec;12(6):731-46.  DOI: https://doi.org/10.1093/humupd/dml004
2. Attia AM, Abou-Setta AM, Al-Inany HG. Gonadotrophins for idiopathic male factor subfertility. Cochrane Database Syst Rev. 2013 Aug 23;(8):CD005071.  DOI: https://doi.org/10.1002/14651858.CD005071.pub4
3. Bergin K, Eliner Y, Duvall DW Jr, Roger S, Elguero S, Penzias AS, Sakkas D, Vaughan DA. The use of propensity score matching to assess the benefit of the endometrial receptivity analysis in frozen embryo transfers. Fertil Steril. 2021 Aug;116(2):396-403. DOI: https://doi.org/10.1016/j.fertnstert.2021.03.031
4. Geng T, Cheng L, Ge C, Zhang Y. The effect of ICSI in infertility couples with non-male factor: a systematic review and meta-analysis. J Assist Reprod Genet. 2020 Dec;37(12):2929-2945. DOI:  https://doi.org/10.1007/s10815-020-01970-9
5. Isikoglu M, Avci A, Kendirci Ceviren A, Aydınuraz B, Ata B. Conventional IVF revisited: Is ICSI better for non-male factor infertility? Randomized controlled double blind study. J Gynecol Obstet Hum Reprod. 2021 Sep;50(7):101990.  DOI:  https://doi.org/10.1016/j.jogoh.2020.101990
6. Lensen S, Osavlyuk D, Armstrong S, Stadelmann C, Hennes A, Napier E, Wilkinson J, Sadler L, Gupta D, Strandell A, Bergh C, Vigneswaran K, Teh WT, Hamoda H, Webber L, Wakeman SA, Searle L, Bhide P, McDowell S, Peeraer K, Khalaf Y, Farquhar C. A Randomized Trial of Endometrial Scratching before In Vitro Fertilization. N Engl J Med. 2019 Jan 24;380(4):325-334. DOI:  https://doi.org/10.1056/NEJMoa1808737
7. Likes CE, Cooper LJ, Efird J, Forstein DA, Miller PB, Savaris R, Lessey BA. Medical or surgical treatment before embryo transfer improves outcomes in women with abnormal endometrial BCL6 expression. J Assist Reprod Genet. 2019 Mar;36(3):483-490. DOI:  https://doi.org/10.1007/s10815-018-1388-x
8. Schisterman EF, Sjaarda LA, Clemons T, Carrell DT, Perkins NJ, Johnstone E, Lamb D, Chaney K, Van Voorhis BJ, Ryan G, Summers K, Hotaling J, Robins J, Mills JL, Mendola P, Chen Z, DeVilbiss EA, Peterson CM, Mumford SL. Effect of Folic Acid and Zinc Supplementation in Men on Semen Quality and Live Birth Among Couples Undergoing Infertility Treatment: A Randomized Clinical Trial. JAMA. 2020 Jan 7;323(1):35-48. DOI:  https://doi.org/10.1001/jama.2019.18714  Erratum in: JAMA. 2020 Mar 24;323(12):1194. PMID: 31910279; PMCID: PMC6990807.
9. Simón C, Gómez C, Cabanillas S, Vladimirov I, Castillón G, Giles J, Boynukalin K, Findikli N, Bahçeci M, Ortega I, Vidal C, Funabiki M, Izquierdo A, López L, Portela S, Frantz N, Kulmann M, Taguchi S, Labarta E, Colucci F, Mackens S, Santamaría X, Muñoz E, Barrera S, García-Velasco JA, Fernández M, Ferrando M, Ruiz M, Mol BW, Valbuena D; ERA-RCT Study Consortium Group. A 5-year multicentre randomized controlled trial comparing personalized, frozen and fresh blastocyst transfer in IVF. Reprod Biomed Online. 2020 Sep;41(3):402-415. DOI:  https://doi.org/10.1016/j.rbmo.2020.06.002
10. Steiner AZ, Hansen KR, Barnhart KT, Cedars MI, Legro RS, Diamond MP, Krawetz SA, Usadi R, Baker VL, Coward RM, Huang H, Wild R, Masson P, Smith JF, Santoro N, Eisenberg E, Zhang H; Reproductive Medicine Network. The effect of antioxidants on male factor infertility: the Males, Antioxidants, and Infertility (MOXI) randomized clinical trial. Fertil Steril. 2020 Mar;113(3):552-560.e3. DOI:  https://doi.org/10.1016/j.fertnstert.2019.11.008
11. Vitagliano A, Andrisani A, Alviggi C, Vitale SG, Valenti G, Sapia F, Favilli A, Martins WP, Raine-Ferring N, Polanski L, Ambrosini G. Endometrial scratching for infertile women undergoing a first embryo transfer: a systematic review and meta-analysis of published and unpublished data from randomized controlled trials. Fertil Steril. 2019 Apr;111(4):734-746.e2.  DOI:  https://doi.org/10.1016/j.fertnstert.2018.12.008
12. Vitagliano A, Di Spiezio Sardo A, Saccone G, Valenti G, Sapia F, Kamath MS, Blaganje M, Andrisani A, Ambrosini G. Endometrial scratch injury for women with one or more previous failed embryo transfers: a systematic review and meta-analysis of randomized controlled trials. Fertil Steril. 2018 Sep;110(4):687-702.e2. DOI:  https://doi.org/10.1016/j.fertnstert.2018.04.040

ASRM Practice & Ethics Documents

1. Doyle N, Combs JC, Jahandideh S, Wilkinson V, Devine K, O'Brien JE. Live birth after transfer of a single euploid vitrified-warmed blastocyst according to standard timing vs. timing as recommended by endometrial receptivity analysis. Fertil Steril. 2022 Aug;118(2):314-321. DOI:  https://doi.org/10.1016/j.fertnstert.2022.05.013

Recommended Activities & Assessments

• SREI Review Lessons, “High Yield REI CREOG Review” PowerPoint SREI High Yield CREOG Review

SURGICAL TREATMENT FOR INFERTILITY

Classic / Original Research Articles

1. Chervenak FA, Neuwirth RS. Hysteroscopic resection of the uterine septum. Am J Obstet Gynecol. 1981 Oct 1;141(3):351-3. DOI:  https://doi.org/10.1016/s0002-9378(16)32647-3
2. Gomel V. Tubal reanastomosis by microsurgery. Fertil Steril. 1977 Jan;28(1):59-65. DOI: https://doi.org/10.1016/S0015-0282(16)42318-6
3. Johnson NP, Mak W, Sowter MC. Laparoscopic salpingectomy for women with hydrosalpinges enhances the success of IVF: a Cochrane review. Hum Reprod. 2002 Mar;17(3):543-8. DOI:  https://doi.org/10.1093/humrep/17.3.543
4. Rikken JFW, Kowalik CR, Emanuel MH, Bongers MY, Spinder T, Jansen FW, Mulders AGMGJ, Padmehr R, Clark TJ, van Vliet HA, Stephenson MD, van der Veen F, Mol BWJ, van Wely M, Goddijn M. Septum resection versus expectant management in women with a septate uterus: an international multicentre open-label randomized controlled trial. Hum Reprod. 2021 Apr 20;36(5):1260-1267.  DOI:  https://doi.org/10.1093/humrep/deab037
5. Rouzi AA, Mackinnon M, McComb PF. Predictors of success of reversal of sterilization. Fertil Steril. 1995 Jul;64(1):29-36. DOI:  https://doi.org/10.1016/S0015-0282(16)57651-1
6. Stone R, Carey E, Fader AN, Fitzgerald J, Hammons L, Nensi A, Park AJ, Ricci S, Rosenfield R, Scheib S, Weston E. Enhanced Recovery and Surgical Optimization Protocol for Minimally Invasive Gynecologic Surgery: An AAGL White Paper. J Minim Invasive Gynecol. 2021 Feb;28(2):179-203. DOI:  https://doi.org/10.1016/j.jmig.2020.08.006

ASRM Practice & Ethics Documents

1. Pfeifer SM, Attaran M, Goldstein J, Lindheim SR, Petrozza JC, Rackow BW, Siegelman E, Troiano R, Winter T, Zuckerman A, Ramaiah SD. ASRM müllerian anomalies classification 2021. Fertil Steril. 2021 Nov;116(5):1238-1252. DOI:  https://doi.org/10.1016/j.fertnstert.2021.09.025 Erratum in: Fertil Steril. 2023 Jun;119(6):1088. PMID: 34756327.

ACOG Committee Opinions & Practice Bulletins

1. Informed Consent and Shared Decision Making in Obstetrics and Gynecology: ACOG Committee Opinion, Number 819. Obstet Gynecol. 2021 Feb 1;137(2):e34-e41.  DOI:  https://doi.org/10.1097/AOG.0000000000004247
2. Committee opinion no. 464: patient safety in the surgical environment. Obstet Gynecol. 2010 Sep;116(3):786-790. DOI:  https://doi.org/10.1097/AOG.0b013e3181f69b22
3. Shafer A, Gehrig P. Clinical Updates in Women's Health Care Summary: Surgical Considerations: Primary and Preventive Care Review. Obstet Gynecol. 2019 Jan;133(1):233. DOI:  https://doi.org/10.1097/AOG.0000000000003009

Outcomes

• CREOG Objectives:
  • Unit 1: General Considerations
    • Describe the differences between wound healing by primary versus secondary intention for both obstetric and gynecologic surgeries.
  • Unit 5: Perioperative OB-GYN Care:
    • II. Perioperative considerations
      • Obtaining surgical informed consent.
    • III. Intraoperative Care
      • Describe key considerations and elements of the following aspects of intraoperative care:
        • Team communication and patient safety measures
        • Suture selection and use
        • Instrumentation selection and use
        • Patient positioning
        • Incision planning
        • Surgical field exposure and use of assistants
        • Safe use of technology (e.g., management of power sources, instruments, devices, and fluid management systems)
    • Postoperative Care
      • Describe your considerations for and approach to the optimization of the following components of postoperative care:
        • Assessment of postoperative milestones
        • Management of lines, tubes, and drains
        • Wound care
        • Discharge planning and coordination
    • Management of Complications
      • Understand risk factors, etiologies, signs and symptoms, evaluation, initial management, and indications for referral for the following complications:
        • Differential diagnosis of vital sign abnormalities in the post-op period (eg, fever, tachycardia, hypotension, tachypnea)
        • Ileus/obstruction
        • Wound complications (e.g., infection, dehiscence) 
        • Fluid or electrolyte imbalance, including abnormal urinary output
        • Injury to pelvic structures (e.g., urinary tract, gastrointestinal tract, blood vessels, nerves)
        • Cardiovascular and pulmonary events (e.g., deep vein thrombosis/pulmonary embolism, myocardial infarction, stroke, aspiration pneumonia) 
        • Acute and chronic blood loss
• ACGME Outcomes/Milestones:
  • System Based Practice 1: Patient Safety
  • Patient Care 7: Peri-Procedural Care
  • Patient Care 9, 11 GYN Technical Skis: Laparotomy and LSC

Recommended Activities & Assessments

• ASRM Academy Online MAC Tool ASRM MAC Tool 2021 | American Society for Reproductive Medicine | ASRM
• ACOG Surgical Curriculum: https://www.acog.org/education-and-events/creog/curriculum-resources/surgical-curriculum
• ACOG Simulations: Abdominal Incisions:  Module | ACOG

ANDROGEN DISORDERS / POLYCYSTIC OVARY SYNDROME

Classic / Original Research Articles

1. Barry JA, Azizia MM, Hardiman PJ. Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2014 Sep-Oct;20(5):748-58. DOI:  https://doi.org/10.1093/humupd/dmu012
2. Fraison E, Kostova E, Moran LJ, Bilal S, Ee CC, Venetis C, Costello MF. Metformin versus the combined oral contraceptive pill for hirsutism, acne, and menstrual pattern in polycystic ovary syndrome. Cochrane Database Syst Rev. 2020 Aug 13;8(8):CD005552. DOI:  https://doi.org/10.1002/14651858.CD005552.pub3
3. Franik S, Eltrop SM, Kremer JA, Kiesel L, Farquhar C. Aromatase inhibitors (letrozole) for subfertile women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2018 May 24;5(5):CD010287. DOI:  https://doi.org/10.1002/14651858.CD010287.pub3 Update in: Cochrane Database Syst Rev. 2022 Sep 27;9:CD010287.
4. Fruzzetti F, Perini D, Russo M, Bucci F, Gadducci A. Comparison of two insulin sensitizers, metformin and myo-inositol, in women with polycystic ovary syndrome (PCOS). Gynecol Endocrinol. 2017 Jan;33(1):39-42. DOI:  https://doi.org/10.1080/09513590.2016.1236078
5. Hirschberg AL, Gidlöf S, Falhammar H, Frisén L, Almqvist C, Nordenskjöld A, Nordenström A. Reproductive and Perinatal Outcomes in Women with Congenital Adrenal Hyperplasia: A Population-based Cohort Study. J Clin Endocrinol Metab. 2021 Jan 23;106(2):e957-e965. DOI:  https://doi.org/10.1210/clinem/dgaa801
6. Legro RS, Barnhart HX, Schlaff WD, Carr BR, Diamond MP, Carson SA, Steinkampf MP, Coutifaris C, McGovern PG, Cataldo NA, Gosman GG, Nestler JE, Giudice LC, Leppert PC, Myers ER; Cooperative Multicenter Reproductive Medicine Network. Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. N Engl J Med. 2007 Feb 8;356(6):551-66. https://doi.org/10.1056/NEJMoa063971
7. Legro RS, Brzyski RG, Diamond MP, et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome [published correction appears in N Engl J Med. 2014 Oct 9;317(15):1465]. N Engl J Med. 2014;371(2):119-129. DOI:  https://doi.org/10.1056/NEJMoa1313517 
8. Legro RS, Dodson WC, Kris-Etherton PM, Kunselman AR, Stetter CM, Williams NI, Gnatuk CL, Estes SJ, Fleming J, Allison KC, Sarwer DB, Coutifaris C, Dokras A. Randomized Controlled Trial of Preconception Interventions in Infertile Women With Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2015 Nov;100(11):4048-58. DOI:  https://doi.org/10.1210/jc.2015-2778
9. Legro RS, Schlaff WD, Diamond MP, Coutifaris C, Casson PR, Brzyski RG, Christman GM, Trussell JC, Krawetz SA, Snyder PJ, Ohl D, Carson SA, Steinkampf MP, Carr BR, McGovern PG, Cataldo NA, Gosman GG, Nestler JE, Myers ER, Santoro N, Eisenberg E, Zhang M, Zhang H; Reproductive Medicine Network. Total testosterone assays in women with polycystic ovary syndrome: precision and correlation with hirsutism. J Clin Endocrinol Metab. 2010 Dec;95(12):5305-13. DOI:  https://doi.org/10.1210/jc.2010-1123
10. Lim SS, Hutchison SK, Van Ryswyk E, Norman RJ, Teede HJ, Moran LJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2019 Mar 28;3(3):CD007506.  DOI:  https://doi.org/10.1002/14651858.CD007506.pub4 
11. Ng SM, Stepien KM, Krishan A. Glucocorticoid replacement regimens for treating congenital adrenal hyperplasia. Cochrane Database Syst Rev. 2020 Mar 19;3(3):CD012517.  DOI:  https://doi.org/10.1002/14651858.CD012517.pub2
12. Speiser PW, Arlt W, Auchus RJ, Baskin LS, Conway GS, Merke DP, Meyer-Bahlburg HFL, Miller WL, Murad MH, Oberfield SE, White PC. Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018 Nov 1;103(11):4043-4088. DOI:  https://doi.org/10.1210/jc.2018-01865 Erratum in: J Clin Endocrinol Metab. 2019 Jan 1;104(1):39-40.
13. Stein, IF, Leventhal, ML.  Amenorrhea associated with bilateral polycystic ovaries, American Journal of Obstetrics and Gynecology, Volume 29, Issue 2, 1935, Pages 181-191, ISSN 0002-9378, https://doi.org/10.1016/S0002-9378(15)30642-6
14. Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, Piltonen T, Norman RJ; International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod. 2018 Sep 1;33(9):1602-1618. DOI:  https://doi.org/10.1093/humrep/dey256 Erratum in: Hum Reprod. 2019 Feb 1;34(2):388.
15. Zimmerman LD, Setton R, Pereira N, Rosenwaks Z. Contemporary Management of Polycystic Ovarian Syndrome. Clin Obstet Gynecol. 2019;62(2):271-281. DOI:  https://doi.org/10.1097/GRF.0000000000000449

ACOG Committee Opinions & Practice Bulletins

1. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin No. 194: Polycystic Ovary Syndrome. Obstet Gynecol. 2018 Jun;131(6):e157-e171. DOI:  https://doi.org/10.1097/AOG.0000000000002656 Erratum in: Obstet Gynecol. 2020 Sep;136(3):638. PMID: 29794677.
2. Practice bulletin no. 136: management of abnormal uterine bleeding associated with ovulatory dysfunction. Obstet Gynecol. 2013 Jul;122(1):176-185. DOI:  https://doi.org/10.1097/01.AOG.0000431815.52679.bb
3. Screening and Management of the Hyperandrogenic Adolescent: ACOG Committee Opinion, Number 789. Obstet Gynecol. 2019 Oct;134(4):e106-e114. DOI:  https://doi.org/10.1097/AOG.0000000000003475
4. Fauser BC, Tarlatzis BC, Rebar RW, Legro RS, Balen AH, Lobo R, Carmina E, Chang J, Yildiz BO, Laven JS, Boivin J, Petraglia F, Wijeyeratne CN, Norman RJ, Dunaif A, Franks S, Wild RA, Dumesic D, Barnhart K. Consensus on women's health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril. 2012 Jan;97(1):28-38.e25. doi: 10.1016/j.fertnstert.2011.09.024. Epub 2011 Dec 6. PMID: 22153789. Consensus on women's health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group - PubMed

Textbooks

1. Speroff, 9^th ed: Chronic Anovulation and the Polycystic Ovary Syndrome (Chapter 11)

Other Resources

1. PCOS 4 Quadrant Handout (Dr. Shapiro)
2. Polycystic Ovary Syndrome and Associated Hyperandrogenism. ACOG eModule.

Outcomes

• Describe the diagnosis, counseling, and treatment for PCOS
• Describe fertility treatment options for PCOS
• Describe the differential diagnosis of hirsutism and evaluation
• Describe the differential diagnosis of irregular menses and treatment options for abnormal uterine bleeding
• CREOG Objectives:
  • Unit 3: Gynecology
    • Reproductive endocrinology and infertility
      • Describe the diagnostic testing, indications for management, and treatments for the following conditions:
        • b)Androgen excess

Recommended Activities & Assessments

• ASRM Online Resident CREOG Modules “Polycystic Ovary Syndrome” (RES011); Recorded Webinar: Transgenerational Transmission of Polycystic Ovary Syndrome and Its Impact on Offspring http://www.asrm.org/asrm-academy/

RECURRENT PREGNANCY LOSS

Classic / Original Research Articles

1. Barnhart KT, Gosman G, Ashby R, Sammel M. The medical management of ectopic pregnancy: a meta-analysis comparing "single dose" and "multidose" regimens. Obstet Gynecol. 2003 Apr;101(4):778-84. DOI:  https://doi.org/10.1016/s0029-7844(02)03158-7
2. Barnhart KT, Sammel MD, Rinaudo PF, Zhou L, Hummel AC, Guo W. Symptomatic patients with an early viable intrauterine pregnancy: HCG curves redefined. Obstet Gynecol. 2004 Jul;104(1):50-5. DOI:  https://doi.org/10.1097/01.AOG.0000128174.48843.12
3. Barnhart KT, Hansen KR, Stephenson MD, et al. Effect of an Active vs Expectant Management Strategy on Successful Resolution of Pregnancy Among Patients With a Persisting Pregnancy of Unknown Location: The ACT or NOT Randomized Clinical Trial. JAMA. 2021;326(5):390–400. DOI:  https://doi.org/10.1001/jama.2021.10767
4. Cicinelli E, Matteo M, Tinelli R, Pinto V, Marinaccio M, Indraccolo U, De Ziegler D, Resta L. Chronic endometritis due to common bacteria is prevalent in women with recurrent miscarriage as confirmed by improved pregnancy outcome after antibiotic treatment. Reprod Sci. 2014 May;21(5):640-7.  DOI:  https://doi.org/10.1177/1933719113508817
5. Coomarasamy A, Williams H, Truchanowicz E, Seed PT, Small R, Quenby S, Gupta P, Dawood F, Koot YE, Bender Atik R, Bloemenkamp KW, Brady R, Briley AL, Cavallaro R, Cheong YC, Chu JJ, Eapen A, Ewies A, Hoek A, Kaaijk EM, Koks CA, Li TC, MacLean M, Mol BW, Moore J, Ross JA, Sharpe L, Stewart J, Vaithilingam N, Farquharson RG, Kilby MD, Khalaf Y, Goddijn M, Regan L, Rai R. A Randomized Trial of Progesterone in Women with Recurrent Miscarriages. N Engl J Med. 2015 Nov 26;373(22):2141-8. DOI:  https://doi.org/10.1056/NEJMoa1504927
6. de Jong PG, Kaandorp S, Di Nisio M, Goddijn M, Middeldorp S. Aspirin and/or heparin for women with unexplained recurrent miscarriage with or without inherited thrombophilia. Cochrane Database Syst Rev. 2014 Jul 4;2014(7):CD004734.  DOI:  https://doi.org/10.1002/14651858.CD004734.pub4
7. Doubilet, PM, Benson, CB, Bourne, T, et. al.  Diagnostic criteria for nonviable pregnancy early in the first trimester. The New England Journal of Medicine. Massachusetts Medical Society, Oct 10, 2013. DOI:  https://doi.org/10.1056/NEJMra1302417
8. Haas DM, Hathaway TJ, Ramsey PS. Progestogen for preventing miscarriage in women with recurrent miscarriage of unclear etiology. Cochrane Database Syst Rev. 2018 Oct 8;10(10):CD003511. DOI:  https://doi.org/10.1002/14651858.CD003511.pub4 Update in: Cochrane Database Syst Rev. 2019 Nov 20;2019(11): PMID: 30298541; PMCID: PMC6516817.
9. Long Y, Zhu H, Hu Y, Shen L, Fu J, Huang W. Interventions for non-tubal ectopic pregnancy. Cochrane Database of Systematic Reviews 2020, Issue 7. Art. No.: CD011174. DOI: https://doi.org/10.1002/14651858.CD011174.pub2
10. McQueen DB, Zhang J, Robins JC. Sperm DNA fragmentation and recurrent pregnancy loss: a systematic review and meta-analysis. Fertil Steril. 2019 Jul;112(1):54-60.e3. DOI:  https://doi.org/10.1016/j.fertnstert.2019.03.003
11. Mol F, van Mello NM, Strandell A, Strandell K, Jurkovic D, Ross J, Barnhart KT, Yalcinkaya TM, Verhoeve HR, Graziosi GCM, Koks CAM, Klinte I, Hogström L, Janssen ICAH, Kragt H, Hoek A, Trimbos-Kemper TCM, Broekmans FJM, Willemsen WNP, Ankum WM, Mol BW, van Wely M, van der Veen F, Hajenius PJ; European Surgery in Ectopic Pregnancy (ESEP) study group. Salpingotomy versus salpingectomy in women with tubal pregnancy (ESEP study): an open-label, multicentre, randomised controlled trial. Lancet. 2014 Apr 26;383(9927):1483-1489. DOI:  https://doi.org/10.1016/S0140-6736(14)60123-9
12. Naimi AI, Perkins NJ, Sjaarda LA, Mumford SL, Platt RW, Silver RM, Schisterman EF. The Effect of Preconception-Initiated Low-Dose Aspirin on Human Chorionic Gonadotropin-Detected Pregnancy, Pregnancy Loss, and Live Birth : Per Protocol Analysis of a Randomized Trial. Ann Intern Med. 2021 May;174(5):595-601. DOI:  https://doi.org/10.7326/M20-0469
13. Noble LS, Kutteh WH, Lashey N, Franklin RD, Herrada J. Antiphospholipid antibodies associated with recurrent pregnancy loss: prospective, multicenter, controlled pilot study comparing treatment with low-molecular-weight heparin versus unfractionated heparin. Fertil Steril. 2005 Mar;83(3):684-90. DOI:  https://doi.org/10.1016/j.fertnstert.2004.11.002
14. Pasquier E, de Saint Martin L, Bohec C, Chauleur C, Bretelle F, Marhic G, Le Gal G, Debarge V, Lecomte F, Denoual-Ziad C, Lejeune-Saada V, Douvier S, Heisert M, Mottier D. Enoxaparin for prevention of unexplained recurrent miscarriage: a multicenter randomized double-blind placebo-controlled trial. Blood. 2015 Apr 2;125(14):2200-5. DOI:  https://doi.org/10.1182/blood-2014-11-610857
15. Sato T, Sugiura-Ogasawara M, Ozawa F, Yamamoto T, Kato T, Kurahashi H, Kuroda T, Aoyama N, Kato K, Kobayashi R, Fukuda A, Utsunomiya T, Kuwahara A, Saito H, Takeshita T, Irahara M. Preimplantation genetic testing for aneuploidy: a comparison of live birth rates in patients with recurrent pregnancy loss due to embryonic aneuploidy or recurrent implantation failure. Hum Reprod. 2019 Dec 1;34(12):2340-2348. DOI:  https://doi.org/10.1093/humrep/dez229 Erratum in: Hum Reprod. 2020 Jan 1;35(1):255. PMID: 31811307.

ASRM Practice & Ethics Documents

1. Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org. Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertil Steril. 2020 Mar;113(3):533-535. DOI:  https://doi.org/10.1016/j.fertnstert.2019.11.025
2. Practice Committee of the American Society for Reproductive Medicine. Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fertil Steril. 2012 Nov;98(5):1103-11. DOI:  https://doi.org/10.1016/j.fertnstert.2012.06.048

ACOG Committee Opinions & Practice Bulletins & Practice Bulletins

1. Committee on Practice Bulletins—Obstetrics, American College of Obstetricians and Gynecologists. Practice Bulletin No. 132: Antiphospholipid syndrome. Obstet Gynecol. 2012 Dec;120(6):1514-21. DOI:  https://doi.org/10.1097/01.AOG.0000423816.39542.0f
2. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin No. 200: Early Pregnancy Loss. Obstet Gynecol. 2018 Nov;132(5):e197-e207. DOI:  https://doi.org/10.1097/AOG.0000000000002899

Textbooks

1. Speroff, 9^th: Recurrent Pregnancy Loss(Chapter 28)

Outcomes

• Define recurrent pregnancy loss
• Describe risk factors, signs and symptoms, evaluation of recurrent pregnancy loss
• Describe expected pathophysiology, history, physical exam findings, diagnostic testing, and imaging for recurrent pregnancy loss
• Interpret basic diagnostic testing such as hormonal profile, gynecologic ultrasound, sonohystogram, and genetic testing as appropriate
• Describe the diagnosis and treatment of antiphospholipid syndrome
• Understand the role of aneuploidy and chromosomal translocation in recurrent pregnancy loss
• CREOG Objectives:
  • Unit 3: Gynecology B.  Reproductive endocrinology and infertility;
    • Describe the diagnostic testing, indications for management, and treatments for the following conditions:
      • c. Recurrent pregnancy loss
• ACGME Milestones:
  • PC2-First Trimester Bleeding; MK1-Anatomy and Pathophysiology of Female Reproduction; ICS1-Patient and Family-centered communication

Recommended Activities & Assessments

• RES012 – Recurrent Pregnancy Loss
• R1 RPL cases 2020.pptx
• SREI High Yield CREOG Review