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Grimes CL, Clare CA, Meriwether KV, Geynisman-Tan J, Lozo S, Antosh DD, Brown HW, LeBrun EEW, Raman SV, Iglesia CB, Keltz J, Kim-Fine S, Brennand EA, Rogers R. Reporting Race and Ethnicity In Research Presented at the Society of Gynecologic Surgeons' Annual Meeting. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cara L. Grimes
- Departments of Obstetrics and Gynecology and Urology, New York Medical College, Valhalla, New York, USA
| | - Camille A. Clare
- Department of Obstetrics and Gynecology, State University of New York-Downstate Health Sciences University, Brooklyn, New York, USA
| | - Kate V. Meriwether
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Julia Geynisman-Tan
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
| | - Svjetlana Lozo
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York, USA
| | - Danielle D. Antosh
- Department of Obstetrics and Gynecology, Houston Methodist Medical Center, Houston, Texas, USA
| | - Heidi W. Brown
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Emily E. Weber LeBrun
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Sonali V. Raman
- Department of Women's Health, Female Pelvic Medicine and Reconstructive Surgery, St. Elizabeth Healthcare, Fort Thomas, Kentucky, USA
| | - Cheryl B. Iglesia
- Department of Obstetrics and Gynecology, MedStar Health and Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Julia Keltz
- Departments of Obstetrics and Gynecology and Urology, New York Medical College, Valhalla, New York, USA
| | - Shunaha Kim-Fine
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Erin A. Brennand
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rebecca Rogers
- Department of Obstetrics and Gynecology, Albany Medical College, Albany, New York, USA
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Arabkhazaeli M, Keltz J, Eisenberg R, Levie M, Yettaw Luts H. A Retrospective Study of Risk Factors for Small Bowel Obstruction After Hysterectomy. JSLS 2021; 24:JSLS.2020.00070. [PMID: 33447005 PMCID: PMC7791091 DOI: 10.4293/jsls.2020.00070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives: The purpose of this study was to evaluate the incidence of small bowel obstruction (SBO) following hysterectomy and to identify factors that may increase the risk of SBO by route of hysterectomy. Methods: A retrospective review of the electronic medical records of all hysterectomies completed between January 2011 through July 2013 at our institution was performed. Information on patient demographics, comorbid conditions, and surgical characteristics were collected. All cases were reviewed for documentation of SBO in the immediate or remote postoperative period, up to 5 years post-hysterectomy. Results: Between January 2011 and July 2013, 1630 hysterectomies were performed at Montefiore Medical Center. A minimally invasive technique was employed for 49.8%, including 15.7% vaginal and 33.9% laparoscopic hysterectomies. Of these 1630 cases, 40 SBO’s were documented; 30 after an abdominal approach and 10 after a minimally invasive approach. The overall incidence of SBO was 2.4%. A multivariable analysis adjusting for potential confounders demonstrated lower odds of SBO for the minimally invasive approaches combined, compared to abdominal hysterectomy (0.44, 95% confidence interval, 0.20, 0.98, p = .0444). Additional variables independently associated with development of SBO included intra-operative bowel injury and malignancy, whereas intra-operative blood loss and lysis of adhesions were not independently associated with SBO. Conclusions: After adjusting for confounders including malignancy, abdominal hysterectomy was associated with a significantly higher risk for SBO when compared to minimally invasive hysterectomy. Our study adds to the body of literature supporting a minimally invasive approach to hysterectomy when feasible.
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Affiliation(s)
- Moona Arabkhazaeli
- Department of Obstetrics and Gynecology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Julia Keltz
- Department of Obstetrics and Gynecology, Westchester Medical Health Center, Valhalla, NY
| | - Ruth Eisenberg
- Department of Epidemiology and Population Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Mark Levie
- Department of Obstetrics and Gynecology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Holly Yettaw Luts
- Department of Obstetrics and Gynecology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
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Rovner P, Keltz J, Allshouse A, Isaac B, Hickmon C, Lesh J, Chosich J, Santoro N. Induction of the LH Surge in Premenarchal Girls Confirms Early Maturation of the Hypothalamic-Pituitary-Ovarian Axis. Reprod Sci 2017; 25:33-38. [PMID: 29153058 DOI: 10.1177/1933719117741377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine whether premenarchal girls exhibit positive estradiol feedback similar to regularly cycling adult women when given exogenous estradiol. METHODS This was a prospective clinical cohort study at 2 institutions. Nine girls and 6 women received a 7-day course of transdermal estradiol designed to produce physiologic, mid-cycle circulating estradiol levels. Participants collected daily morning urine for luteinizing hormone (LH), estradiol metabolites (E1c), and progesterone metabolites (Pdg), corrected for creatinine. Main outcomes were percentage increase in LH from nadir to peak and the absolute value of peak LH between the 2 groups, using t testing and linear mixed-effects modeling. RESULTS All participants exhibited a positive feedback response to estradiol. Adult women had a 532.8% (95% confidence interval [CI]: 253.7-1119) increase in LH after estradiol exposure; premenarchal girls had a 497.9% increase (95% CI: 274.5-903.2; P = .86). The absolute value of the LH surge in women was 9.50 mLU/mgCr (95% CI: 2.59- 43 34.90) and in premenarchal girls was 2.57 mLU/mgCr (95% CI: 0.53-12.49; P = .15). CONCLUSIONS Premenarchal girls can mount an LH surge proportionally similar to regularly cycling adults. This occurs earlier in puberty than previously believed, in contrast to current dogma that maturation of the hypothalamic-pituitary-ovarian axis occurs after menarche and is the rate-limiting step for the establishment of regular, ovulatory cycles. Failure to achieve regular cycles may instead be due to nutritional or ovarian factors. Young girls who fail to ovulate shortly after menarche may warrant further evaluation for endocrinopathies.
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Affiliation(s)
- Polina Rovner
- 1 Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Julia Keltz
- 2 Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Amanda Allshouse
- 3 Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Barbara Isaac
- 2 Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Cheryl Hickmon
- 2 Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jennifer Lesh
- 1 Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Justin Chosich
- 1 Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nanette Santoro
- 1 Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA.,2 Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
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Arabkhazaeli M, Keltz J, Tam J, Yettaw Luts H. A Five-Year Retrospective Study of Risk Factors for Small Bowel Obstruction in Benign Hysterectomies. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Schortz J, Lopez J, Keltz J, Chudnoff S, Levie M. Techniques for Laparoscopic Removal of Essure Coils. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mehta S, Escobar P, Keltz J, Schortz J, Levie M, Chudnoff S, Yettaw LH. Trends in Hysterectomies and Tissue Extraction from 2010-2015 at a Single Institution. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Grant A, Keltz J, Huang K. Is Decreased Insufflation Pressure During Major Robotic-Assisted Gynecologic Surgery Associated With Decreased Recovery Time and Patient Reported Pain Score. J Minim Invasive Gynecol 2016; 22:S26. [PMID: 27679192 DOI: 10.1016/j.jmig.2015.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- A Grant
- NYU Langone Medical Center, New York, New York
| | - J Keltz
- NYU Langone Medical Center, New York, New York
| | - K Huang
- NYU Langone Medical Center, New York, New York
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Goldman KN, Keltz J, Berg RE, Noyes NL. Heterotopic Gestation with Twin Intrauterine Implantation Following Transfer of Three Developmentally-delayed Embryos from Cryopreserved Oocytes: A Case Report. J Reprod Med 2015; 60:436-440. [PMID: 26592072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND In vitro fertilization (IVF) data suggest improved live birth rates for embryos transferred at the blastocyst versus the cleavage stage. Embryos that have not reached the blastocyst stage by day 5 postthaw have diminished potential for implantation and live birth. Few data exist regarding embryogenesis and optimal timing of transfer for embryos derived from previously cryopreserved oocytes, but we report the case of 100% implantation following transfer of 3 developmentally-delayed embryos derived from cryopreserved oocytes. CASE A 38-year-old woman cryopreserved 20 oocytes for the purpose of future childbearing. At age 42 she returned to thaw and fertilize 8 oocytes using donor sperm. Embryos were cultured to day 5 postthaw, at which time 1 morula and 2 cleavage-stage embryos were available for transfer. Three-embryo transfer resulted in a heterotopic tubal pregnancy and twin intrauterine gestation. Laparoscopic salpingectomy was performed for the ectopic gestation. The twin intrauterine pregnancy spontaneously reduced to singleton, and the patient delivered a live-born infant. CONCLUSION While heterotopic and multifetal pregnancy are known risks of multiembryo transfer, 3 lesser-quality embryos derived from cryopreserved oocytes would be unlikely to have high implantation potential. Future studies are needed to delineate timing of embryogenesis events in previously cryopreserved oocytes.
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Keltz J, Grant A, Huang J. Factors Contributing to Longer Recovery Times after Major Robotic-Assisted Gynecologic Surgery. J Minim Invasive Gynecol 2014. [DOI: 10.1016/j.jmig.2014.08.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Keltz J, Hodes-Wertz B, Goldman K, McCaffrey C, Ampeloquio E, Grifo J. Artificially collapsed (AC) blastocysts have improved post-thaw survival whether the embryo is euploid or aneuploid. Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.1432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Merhi ZO, Keltz J, Zapantis A, Younger J, Berger D, Lieman HJ, Jindal SK, Polotsky AJ. Male adiposity impairs clinical pregnancy rate by in vitro fertilization without affecting day 3 embryo quality. Obesity (Silver Spring) 2013; 21:1608-12. [PMID: 23754329 DOI: 10.1002/oby.20164] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 10/29/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Male adiposity is detrimental for achieving clinical pregnancy rate (CPR) following assisted reproductive technologies (ART). The hypothesis that the association of male adiposity with decreased success following ART is mediated by worse embryo quality was tested. DESIGN AND METHODS Retrospective study including 344 infertile couples undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles was performed. Cycle determinants included number of oocytes retrieved, zygote PN-score, total number of embryos available on day 3, number of embryos transferred, composite day 3 grade for transferred embryos, composite day 3 grade per cycle, and CPR. RESULTS Couples with male body mass index (BMI) over 25 kg m(-2) (overweight and obese) exhibited significantly lower CPR compared to their normal weight counterparts (46.7% vs. 32.0% respectively, P = 0.02). No significant difference was observed for any embryo quality metrics when analyzed by male BMI: mean zygote PN-scores, mean composite day 3 grades for transferred embryos or composite day 3 grades per cycle. In a multivariable logistic regression analysis adjusting for female age, female BMI, number of embryos transferred and sperm concentration, male BMI over 25 kg m(-2) was associated with a lower chance for CPR after IVF (OR = 0.17 [95% CI: 0.04-0.65]; P = 0.01) but not after ICSI cycles (OR = 0.88 [95% CI: 0.41-1.88]; P = 0.75). In this cohort, male adiposity was associated with decreased CPR following IVF but embryo quality was not affected. CONCLUSIONS Embryo grading based on conventional morphologic criteria does not explain the poorer clinical pregnancy outcomes seen in couples with overweight or obese male partner.
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Affiliation(s)
- Zaher O Merhi
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Vermont College of Medicine, Burlington, VT, USA
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Merhi Z, Keltz J, Zapantis A, Jindal S, Lieman H, Polotsky A. Clinical pregnancy rate but not embryo quality is reduced following IVF-ET in couples with overweight male partner. Fertil Steril 2010. [DOI: 10.1016/j.fertnstert.2010.07.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Keltz J, Zapantis A, Jindal SK, Lieman HJ, Santoro N, Polotsky AJ. Overweight men: clinical pregnancy after ART is decreased in IVF but not in ICSI cycles. J Assist Reprod Genet 2010; 27:539-44. [PMID: 20635132 DOI: 10.1007/s10815-010-9439-y] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 05/11/2010] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate if elevated male body mass influences success after assisted reproductive technologies METHODS Retrospective study of 290 cycles. RESULTS Male body mass index greater than 25.0 kg/m² was associated with significantly lower clinical pregnancy (53.2% vs. 33.6%). Multivariable logistic regression indicated that the likelihood of clinical pregnancy was decreased if the male partner was overweight after in vitro fertilization but not after intracytoplasmic sperm injection (odds ratios: 0.21 [0.07-0.69] vs. 0.75 [0.38-1.49], respectively) after adjustment for number of embryos transferred, sperm concentration, female age and body mass. CONCLUSION In this cohort, overweight status of the male partner was independently associated with decreased likelihood of clinical pregnancy after in vitro fertilization but not after intracytoplasmic sperm injection. A detrimental impact of higher male body mass was observed after adjusting for sperm concentration, suggesting that intracytoplasmic sperm injection may overcome some obesity related impairment of sperm-egg interaction.
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Affiliation(s)
- Julia Keltz
- Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA.
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