Brent Monseur, MD, ScM

All Publications

• Shared IVF among female couples: clinical outcomes of the Reception of Oocytes from the Partner (ROPA) method. Reproductive biomedicine online Brandao, P., Monseur, B., Melo, P., Goncalves-Henriques, M., Ceschin, N., Reis-Soares, S., Sousa-Santos, R., Bellver, J. 2023; 47 (4): 103284

  Abstract

  RESEARCH QUESTION: What is the population undergoing the ROPA (Reception of Oocytes from Partner) method and what are the outcomes of the technique?DESIGN: Case series of all ROPA treatments carried out between 2011 and 2020 in 18 fertility clinics in Spain. Demographic characteristics, cycle features, laboratory and clinical outcomes, and the intentions regarding the disposition of surplus embryos were analysed.RESULTS: Donor patients were on average 3.5 years younger than recipients (P = 0.001). No significant differences were found in body mass index or anti-Mullerian hormone. In 13% of cases, fertility issues were found: poor ovarian reserve (6.8%); endometriosis (2.9%); and polycystic ovary syndrome (2.2%). Including cases of advanced age (38 years old or older), more than one-half of couples (53.6%) had some condition that could affect fertility. Mean number of mature oocytes per cycle was 10 (+/- 5.7), and fertilization rate was 74.5% (+/- 18.8). Mean number of viable embryos was 3.2 (+/- 1.5). Surplus embryos were cryopreserved in 50.4% of cycles. Outcomes after embryo transfers from ROPA, and subsequent frozen cycles were as follows: positive pregnancy test (61.0%), clinical pregnancy (54.1%) and miscarriage rate (16.1%). Other outcomes were live birth rate per embryo transfer (44.7%); multiple pregnancy rate (5.4%); per cumulative ROPA cycle (48.6%); and per couple (61.6%).CONCLUSION: The outcomes of the ROPA method are reassuring. About one-half of the ROPA cycles resulted in a live birth and one-quarter of the cycles had surplus embryos after achievinga live birth. Main neonatal outcomes were also reassuring.

  View details for DOI 10.1016/j.rbmo.2023.103284

  View details for PubMedID 37542844

• Oocyte and embryo cryopreservation in ART: past achievements and current challenges. Fertility and sterility Casciani, V., Monseur, B., Cimadomo, D., Alvero, R., Rienzi, L. 2023

  Abstract

  Cryopreservation has revolutionized the treatment of infertility and fertility preservation. This review summarizes the milestones that paved the way to the current routinary clinical implementation of this game-changing practice in ART. Still, evidence to support "the best practice" in cryopreservation is controversial and several protocol adaptations exist that were described and compared herein, such as cumulus-intact versus cumulus-free oocyte cryopreservation, artificial collapse, assisted hatching, closed versus open carriers, and others. A last matter of concern is whether cryo-storage duration may impact oocyte/embryo competence, but the current body of evidence in this regard is reassuring. From social and clinical perspectives, oocyte and embryo cryopreservation has evolved from an afterthought when assisted reproduction was intended for immediate pregnancy with supernumerary embryos of secondary interest to its current purpose which is primarily to preserve fertility long-term and more comprehensively allow for family planning. However, the initial consenting process which still is geared to short-term fertility care may no longer be relevant when the individuals that initially preserved the tissues have completed their reproductive journey. A more encompassing counseling model is required to address changing patient values over time.

  View details for DOI 10.1016/j.fertnstert.2023.06.005

  View details for PubMedID 37290552

• Reproductive endocrinologist and infertility specialists' knowledge, skills, behaviors, and attitudes regarding the care for transgender and gender-diverse individuals. F&S reports Lipkin, P., Monseur, B., Mayo, J., Moravek, M., Nahata, L., Amato, P., Alvero, R., Obedin-Maliver, J. 2023; 4 (2): 213-223

  Abstract

  Objective: To investigate associations between reproductive endocrinology and infertility (REI) providers' prior training and current knowledge, skills, attitudes, and behaviors regarding fertility preservation and family building for transgender and gender-diverse (T/GD) patients.Design: The survey was distributed to members of the Society for Reproductive Endocrinology and Infertility, the REI-physician-focused professional body within the American Society for Reproductive Medicine, with additional participants recruited through snowball sampling.Results: Participants (n = 206) reported on training in T/GD care; 51% endorsed prior training. Most participants (93%) believed T/GD individuals were as fit for parenthood as cisgender individuals. Prior training was associated with an increased likelihood of offering T/GD health resources and more frequent consultations with specialist colleagues.Common barriers to providing care indicated by respondents included cost, delays in gender-affirming care, and lack of knowledge of the potential impact of hormonal interventions. Common facilitators included education and training, prior experience, and affordability of services.Conclusions: Most REI providers believed T/GD individuals are fit for parenthood and agreed that prior training facilitates care for T/GD patients. The lack of provider knowledge emerged as a barrier to care. Although training helped facilitate some components of care, systemic barriers such as the cost and variability of patient population characteristics/experiences are important considerations when serving T/GD individuals.

  View details for DOI 10.1016/j.xfre.2023.03.009

  View details for PubMedID 37398621

• Pathways to fatherhood: clinical experiences with assisted reproductive technology in single and coupled intended fathers. F&S reports Monseur, B., Lee, J. A., Qiu, M., Liang, A., Copperman, A. B., Leondires, M. 2022; 3 (4): 317-323

  Abstract

  Objective: To explore the cycle characteristics and outcomes of single and coupled intended fathers (SCIFs) using assisted reproductive technology.Design: Cross-sectional study.Setting: Multicenter, fertility practices from 2016 to2020.Patients: In this study, cycles among SCIFs with access to fertility coverage from 2016 to 2020 were included.Interventions: None.Main Outcome Measures: Our primary outcome was live birth rate. The secondary outcomes included the number of embryos transferred, miscarriage rate, and incidence of multifetal birth.Results: Five single and 39 coupled intended fathers completed an invitro fertilization cycle with a majority using egg donation and an agency-based gestational carrier (69.7%, 83/119). In most couples, both partners wanted to serve as the sperm source (64.4%, 29/45). The vast majority (97.7%, 43/44) also used preimplantation genetic testing for aneuploidy. Among the embryo transfer (ET) cycles (n = 27), most consisted of a single euploid ET (74.07%, 20/27), whereas the remaining consisted of a double euploid ET (25.92%, 7/27). The SCIFs had high rates of success, with a live birth rate of 85.19% (23/27). A mean of 1.26 ± 0.44 embryos were transferred, with a majority resulting in singleton birth (70.37%, 19/27).Conclusions: Our study of SCIFs using assisted reproductive technology in the United States demonstrates that this population shares similar preferences for sperm source and the use of preimplantation genetic testing. Clinical outcomes suggest that this population is successful at achieving a live birth when using egg donation and a gestational carrier.

  View details for DOI 10.1016/j.xfre.2022.07.009

  View details for PubMedID 36568926

• MUUTICENTER CASE SERIES OF TRANSGENDER MEN WITH FERTILITY BENEFITS: ACCESS TO CARE AND NAVIGATING OBSTACLES Rubin, E. S., Yang, Y., Qiu, M., Lee, J. A., Copperman, A. B., Liang, A., Leondires, M. P., Monseur, B. C. ELSEVIER SCIENCE INC. 2022: E22

  View details for Web of Science ID 000891804600055

• EXPLORING THE REPRODUCTIVE BLACK MARKET: FERTILITY MEDICATIONS ON THE DARK WEB Li, Z., Le, K., Liao, X., Monseur, B. C. ELSEVIER SCIENCE INC. 2022: E16

  View details for Web of Science ID 000891804600040

• Sexual and/or gender minority disparities in obstetric and birth outcomes. American journal of obstetrics and gynecology Leonard, S. A., Berrahou, I., Zhang, A., Monseur, B., Main, E. K., Obedin-Maliver, J. 2022

  Abstract

  Many sexual and/or gender minority individuals build families through pregnancy and childbirth, but it is unknown whether they experience different clinical outcomes than non-sexual and/or gender minority individuals.To evaluate obstetric and birth outcomes among likely sexual and/or gender minority patients in comparison with likely non-sexual and/or gender minority patients.We performed a population-based cohort study of live birth hospitalizations during 2016-2019 linked to birth certificates in California. California changed its birth certificate in 2016 to include gender-neutral fields "parent giving birth" and "parent not giving birth," with options for each role to specify "mother," "father," or "parent." We classified birthing patients in mother-mother partnerships and those who identified as a father in any partnership as likely sexual and/or gender minority, and classified birthing patients in mother-father partnerships as likely not sexual and/or gender minority. We used multivariable modified Poisson regression models to estimate risk ratios for associations between likely sexual and/or gender minority parental structures and outcomes. Models were adjusted for sociodemographic factors, comorbidities, and multifetal gestation selected by causal diagrams. We replicated analyses after excluding multifetal gestations.In the final birthing patient sample, 1,483,119 were mothers with father partners, 2,572 were mothers with mother partners, and 498 were fathers with any partner. Compared with birthing patients in mother-father partnerships, birthing patients in mother-mother partnerships experienced significantly higher rates of multifetal gestation (aRR 3.9, 95% CI 3.4-4.4), labor induction (aRR 1.2, 95% CI 1.1-1.3), postpartum hemorrhage (aRR 1.4, 95% CI 1.3-1.6), severe morbidity (aRR 1.4, 95% CI 1.2-1.8), and non-transfusion severe morbidity (aRR 1.4, 95% CI 1.1-1.9). Severe morbidity was identified following the Centers for Disease Control and Prevention "severe maternal morbidity" index. Gestational diabetes mellitus, hypertensive disorders of pregnancy, cesarean birth, preterm birth (<37 weeks' gestation), low birthweight (<2,500 g), and low Apgar score (<7 at 5 minutes) did not significantly differ in multivariable analyses. No outcomes significantly differed between father birthing patients in any partnership and birthing patients in mother-father partnerships in either crude or multivariable analyses, although the risk of multifetal gestation was non-significantly higher (aRR 1.5, 95% CI 0.9-2.7). Adjusted risk ratios for outcomes were similar after restriction to singleton gestations.Birthing mothers with mother partners experienced disparities in several obstetric and birth outcomes, independent of sociodemographic factors, comorbidities, and multifetal gestation. Birthing fathers in any partnership were not at significantly elevated risk of any adverse obstetric or birth outcome considered in this study.

  View details for DOI 10.1016/j.ajog.2022.02.041

  View details for PubMedID 35358492

• Effectiveness of Non-Surgical Management of Non-Tubal Ectopic Pregnancies in a Fertility Practice. Strug, M., Deng, J., Monseur, B., Alvero, R., Aghajanova, L. SPRINGER HEIDELBERG. 2022: 262-263

  View details for Web of Science ID 000762765300556

• An assessment of oncofertility content on reproductive endocrinology and infertility clinic websites. Journal of assisted reproduction and genetics Mujumdar, V., Shivashankar, K., Madding, R., Levy, A. T., Gordhandas, S., Rosenblum, N. G., Richard, S., Monseur, B. 2022

  Abstract

  PURPOSE: To assess oncofertility content on fertility clinic websites as indicated by eight relevant keywords. Additionally, we sought to describe the relationship between oncofertility content and five predetermined clinic characteristics.METHODS: We examined 381 fertility clinic websites that are members of the Society for Associated Reproductive Technology (SART). Extracted data included clinic location, practice type (private vs academic), size (cycles/year), type of NCI designated center (cancer center vs comprehensive cancer center), and distance from the nearest NCI center. Additionally, we documented whether the clinic was located in a state mandating reproductive and infertility services and/or included fertility preservation for "iatrogenic infertility" as reported by the American Society for Reproductive Medicine (ASRM). Data were summarized using descriptive statistics and compared using chi-squared or t-test as appropriate.RESULTS: Of the 381 fertility clinic websites analyzed, 322 (85%) contained at least one oncofertility-related keyword. Most frequently used terms included cancer (79%) and fertility preservation (78%), while less frequently used terms included suppression (9.4%) and shielding (5.0%). Practices that initiated≥501 cycles per year were more likely to mention one of the oncofertility keywords (OR 1.2; 95% CI 1.1-1.3). The associations of oncofertility website content with practice type, state-mandated fertility insurance coverage, and distance from an NCI-designated cancer center were not statistically significant. Large clinic size was the only predictive factor for inclusion of oncofertility website content. Further studies are required to evaluate whether inclusion of oncofertility content on clinic websites impacts the use of these services by patients with cancer.CONCLUSION: This is the first study correlating availability of oncofertility content on SART fertility clinic websites with consideration of geographic proximity to NCI designated cancer centers. Large clinic size was the only predictive factor for inclusion of oncofertility website content.

  View details for DOI 10.1007/s10815-022-02442-y

  View details for PubMedID 35217946

• INSURANCE COVERAGE DOES NOT MITIGATE RACIAL AND ETHNIC DISPARITIES SEEN IN FERTILITY TREATMENT UTILIZATION: A SURVEY OF US POSTPARTUM WOMEN. Morris, J. R., Monseur, B. C., Jackson-Bey, T., Hipp, H. S. ELSEVIER SCIENCE INC. 2021: E14

  View details for Web of Science ID 000699951500033

• HIGH GROUNDWATER ARSENIC CONTAMINATION IS ASSOCIATED WITH STILLBIRTH, RECURRENT PREGNANCY LOSS, AND INFERTILITY: A POPULATION-BASED STUDY IN INDIA OF 643,944 REPRODUCTIVE AGED WOMEN. Monseur, B. C., Pinchoff, J., Koons, K., Desai, S., Alvero, R. J., Hindin, M. J. ELSEVIER SCIENCE INC. 2021: E91

  View details for Web of Science ID 000699951500208

• Assessment of oncofertility content on reproductive endocrinology and infertility clinic websites Mujumdar, V., Shivashankar, K., Madding, R., Levy, A., Richard, S., Gordhandas, S., Rosenblum, N., Monseur, B. ACADEMIC PRESS INC ELSEVIER SCIENCE. 2021: S93-S94

  View details for Web of Science ID 000687070800165

• ASSESSMENT OF ONCOFERTILITY CONTENT ON REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY CLINIC WEBSITES Mujumdar, Madding, R., Shivashankar, K., Levy, A., Gordhandas, S., Richard, S., Rosenblum, N., Monseur, B. ELSEVIER SCIENCE INC. 2021: E35-E36

  View details for Web of Science ID 000680508800051

• IVF OUTCOMES IN A MULTI-CENTER ANALYSIS OF SINGLE OR COUPLED INTENDED FATHERS: BIOLOGY AND FATHERHOOD Leondires, M. P., Lee, J. A., Monseur, B., Qiu, M., Copperman, A. B. ELSEVIER SCIENCE INC. 2021: E22

  View details for Web of Science ID 000680508800030

• INFLAMMATORY PROTEINS AS PREDICTORS OF DIMINISHED OVARIAN RESERVE Murugappan, G., Huang, H., Grawe, A., Monseur, B., Westphal, L., Teng, N. ELSEVIER SCIENCE INC. 2021: E4

  View details for Web of Science ID 000680508800003

• The Influence of PrEP-Related Stigma and Social Support on PrEP-Use Disclosure among Women Who Inject Drugs and Social Network Members. AIDS and behavior Felsher, M., Dutra, K., Monseur, B., Roth, A. M., Latkin, C., Falade-Nwulia, O. 2021

  Abstract

  Pre-exposure prophylaxis (PrEP) is a promising but underutilized HIV prevention strategy for Women who Inject Drugs (WWID). Stigma and disclosure concerns have been key barriers to PrEP use among women in PrEP efficacy trials. Social support has been found to buffer against some PrEP stigma, though these factors have been largely unexplored among WWID. Investigating how WWID disclose PrEP use is important given evidence that disclosure is associated with higher adherence. We aimed to identify the impact of stigma and support on PrEP disclosure within social networks of WWID participating in a PrEP demonstration project in Philadelphia, PA, USA. PrEP-using WWID≥18years completed social network surveys. Generalized estimating equations were used to account for the correlation of network structure. Thirty-nine WWID (i.e. egos) named an average of 9.5±3.3 network members (i.e. alters), for a total sample of 371 unique relationships. Egos disclosed their PrEP use to an average of 4.0 alters (SD=2.8). Related to PrEP stigma, participants had 0.4 times decreased odds of PrEP disclosure with alters who would disapprove of them taking PrEP (95% CI: 0.1-0.9). Related to support, participants had 2.5 times higher odds of disclosure among peers who could provide PrEP advice (95% CI: 1.0-6.0). Interventions that increase social support and decrease stigma are pivotal for increasing PrEP use disclosure among WWID.

  View details for DOI 10.1007/s10461-021-03312-x

  View details for PubMedID 34014430

• Is living in a region with high groundwater arsenic contamination associated with adverse reproductive health outcomes? An analysis using nationally representative data from India. International journal of hygiene and environmental health Pinchoff, J., Monseur, B., Desai, S., Koons, K., Alvero, R., Hindin, M. J. 2021; 239: 113883

  Abstract

  Exposure to groundwater arsenic via drinking water is common in certain geographies, such as parts of India, and causes a range of negative health effects, potentially including adverse reproductive health outcomes.We conducted an ecological analysis of self-reported rates of stillbirth, recurrent pregnancy loss, and infertility in relation to groundwater arsenic levels in India. We used a gridded, modeled dataset of the probability of groundwater arsenic exceeding 10 μg/L (World Health Organization drinking water limit) to calculate mean probabilities at the district level (n = 599 districts). A spatial integration approach was used to merge these estimates with the third India District-Level Health Survey (DLHS-3) conducted in 2007-08 (n = 643,944 women of reproductive age). Maps of district level arsenic levels and rates of each of the three outcomes were created to visualize the patterns across India. To adjust for significant spatial autocorrelation, spatial error models were fit.District-level analysis showed that the average level of stillbirth was 4.3%, recurrent pregnancy loss was 3.3%, and infertility was 8.1%. The average district-level probability of groundwater arsenic levels exceeding 10 μg/L was 42%. After adjustment for sociodemographic factors, and accounting for spatial dependence, at the district level, for each percentage point increase in predicted arsenic levels exceeding 10 μg/L increased, the rates of stillbirths was 4.5% higher (95% confidence interval (CI) 2.4-6.6, p < 0.0001), the rates of RPL are 4.2% higher (95% CI 2.5-5.9, p < 0.0001), and the rates of infertility are 4.4% higher (95% CI 1.2-7.7, p=<0.0001).).While arsenic exposure has been implicated with a range of adverse health outcomes, this is one of the first population-level studies to document an association between arsenic and three adverse reproductive pregnancy outcomes. The high levels of spatial correlation suggest that further and targeted efforts to mitigate arsenic in groundwater are needed.

  View details for DOI 10.1016/j.ijheh.2021.113883

  View details for PubMedID 34837822

• EFFECT OF HORMONAL CONTRACEPTION ON ILLNESS SEVERITY IN WOMEN WITH POSITIVE SARS-COV2 TESTS. Mujumdar, V., Levy, A. T., Madding, R., Berghella, V., Quist-Nelson, J., Schlaff, W. D., Monseur, B. C. ELSEVIER SCIENCE INC. 2020: E535–E536

  View details for Web of Science ID 000579355301491

• Compassionate embryo transfer: part of a bigger question. Fertility and sterility Monseur, B., Alvero, R. J., Schlaff, W. D. 2020

  View details for DOI 10.1016/j.fertnstert.2020.05.037

  View details for PubMedID 32654819

• Epigenetic clock measuring age acceleration via DNA methylation levels in blood is associated with decreased oocyte yield. Journal of assisted reproduction and genetics Monseur, B., Murugappan, G., Bentley, J., Teng, N., Westphal, L. 2020

  Abstract

  PURPOSE: To investigate how biologic age (phenotypic age at which your body functions) greater than chronologic age, (age acceleration (AgeAccel)), correlates with oocyte yield.METHODS: Thirty-nine women undergoing ovarian stimulation, inclusive of all infertility diagnoses, were included in this pilot study. Methylome analysis of peripheral blood was utilized to determine biologic age. AgeAccel was defined as biologic age >2years older than chronologic age. A negative binomial model was used to obtain the crude association of AgeAccel with number of oocytes. A parsimonious adjusted model for the number of oocytes was obtained using backwards selection (p<0.05).RESULTS: Measures of age were negatively correlated with number of oocytes (chronological age Pearson rho=-0.45, biologic age Pearson rho=-0.46) and AMH was positively correlated with number of oocytes (Pearson rho=0.91). Patients with AgeAccel were noted to have lower AMH values (1.29ng/mL vs. 2.29, respectively (p=0.049)) and lower oocyte yield (5.50 oocytes vs. 14.50 oocytes, respectively (p=0.0030)). A crude association of a 7-oocyte reduction in the age-accelerated group was found (-6.9 oocytes (CI -11.6, -2.4)). In a model with AMH and antral follicle count, AgeAccel was associated with a statistically significant 3.3 reduction in the number of oocytes (-3.1; 95% CI -6.5, -0.1; p=0.036).CONCLUSIONS: In this small pilot study, AgeAccel is associated with a lower AMH and lower oocyte yield providing preliminary evidence that biologic age, specifically AgeAccel, may serve as an epigenetic biomarker to improve the ability of predictive models to assess ovarian reserve.

  View details for DOI 10.1007/s10815-020-01763-0

  View details for PubMedID 32285295

• EPIGENETIC CLOCK MEASURING AGE ACCELERATION VIA DNA METHYLATION LEVELS IN BLOOD IS ASSOCIATED WITH DECREASED OOCYTE YIELD. Monseur, B., Murugappan, G., Bentley, J., Teng, N., Westphal, L. ELSEVIER SCIENCE INC. 2019: E4–E5

  View details for DOI 10.1016/j.fertnstert.2019.02.039

  View details for Web of Science ID 000463487700003