IntroductionDelivery Resources, Experiences, and Advocacy for Moms (DREAM) is an interprofessional service-learning program that empowers preclinical medical students by training them to provide labor support. Boston Medical Center is a safety-net hospital featuring an in-house doula service with limited coverage capacity. Consequently, many patients do not receive continuous labor support, although evidence shows that continuous labor support improves outcomes and may help reduce birth-outcome health disparities. We present a pragmatic approach to integrating preclinical students as labor-support staff and outline the methods and content of the training process as well as the evaluations used to assess program effectiveness.MethodsStudents were trained by doulas (Birth Sisters) and midwives to provide prenatal, labor, and postpartum support. Students completed an orientation and training workshop and then partnered with a Birth Sister for one prenatal visit, labor, and postpartum visit prior to working independently. Student leaders provided structure, mentoring, and support for preclinical students. Pre- and postsurveys assessed student confidence and obstetric knowledge acquisition. Budget, logistics, and program evaluation process are reviewed.ResultsStudents demonstrated increased knowledge, as well as confidence in communication, advocacy, and support. Although balancing DREAM with academics was stressful, students continued to meet academic standards and felt their participation was gratifying and worthwhile. Student reflections and patient statements on their experience show the program was mutually beneficial.DiscussionPreclinical students need gratifying clinical opportunities to develop confidence in communication and advocacy skills. Partnering them with underserved women to provide labor support is a pragmatic and clinically valuable intervention.

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Both patients and physicians agreed that social media can be a patient education tool and that the role of a physician should extend beyond the physical practice. However, patient and physician responses on using social media accounts as a tool for emotional support did not align. This may be due to the prevalence of social support groups on social media that offer extensive emotional support. Additionally, while physicians reported higher satisfaction in patients that follow them on social media, patients who did so did not report higher satisfaction. Although both patients and physicians agreed that social media is a tool for patients to see a side to their doctors beyond medicine, there was a significant difference between their responses-physicians agreed with this statement more strongly than patients. Trust is a critical component of the physician-patient relationship, and appropriate physician social media use allows to optimize this relationship in the digital age, especially when working with a younger patient population.

was 121.7 mIU/mL (IQR 86.0, 115.5), in those 35 -40 the median hCG level was 110.2 mIU/mL (IQR 75.8, 155.8), and in those > 40 the median hCG level was 119.8 mIU/mL (IQR 78.2, 173.8) at mean of 13.4 days AOR.CONCLUSIONS: Specific rises in early hCG levels after SET were associated with LB when hCG levels were checked 15 days AOR. In cycles where hCG levels both doubled and reached 100 mIU/mL by 15 days AOR, the LB rate was 84% and this was a stronger predictor of LB than either parameter alone. LB was only achieved in 9% of cycles where hCG levels neither ''doubled'' nor ''reached 100''. Age was not associated with early hCG levels in cycles that ended in LB.IMPACT STATEMENT: Defining explicit parameters related to early hCG levels that can reliably predict LB can improve counseling. Using ''doubling'' and ''reaching 100'' 15 days AOR as parameters may help guide patient's expectations regarding pregnancy outcomes as early as possible after SET.

OBJECTIVE: Advanced paternal age and maternal age as a main factor influencing pregnancy results in cases where testicular sperm is used are not well known. To evaluate the influence of maternal age combined with paternal age on fertilization, embryo development, and pregnancy by intracytoplasmic sperm injection (ICSI) using testicular sperm. DESIGN: A retrospective study was performed to analyze the effects of maternal age combined with paternal age on pregnancy outcomes in azoospermic patients. MATERIALS AND METHODS: A total of 452 ICSI cycles using testicular sperm were analyzed. Testicular biopsy specimens were evaluated and categorized based on the most advanced pattern of spermatogenesis observed. For analysis of age factor, female and male patients were divided into the following age categories: %30 years, 31-35 years, 36-40 years, 41-45 years, and R46 years. The effects of maternal age and paternal age on the rates of fertilization, good embryos, clinical pregnancy, and delivery were compared. RESULTS: Regarding maternal and paternal age, the rates of fertilization and embryo quality did not differ among the age groups. However, clinical pregnancy and delivery rates were significantly decreased in over 40 years of maternal age and paternal age, respectively, compared with younger age group (p<0.05). Compared obstructive azoospermia (OA) and non-obstructive azoospermia (NOA), fertilization rate was higher in OA group than NOA group, however, embryo quality, clinical pregnancy and delivery rates were not different. In OA, the rates of fertilization and embryo quality were similar among age groups, however, clinical pregnancy and delivery rates were significantly lower in over 40 years of maternal age and paternal age, respectively (p<0.05). In NOA, the rates of fertilization, good embryos, clinical pregnancy, and delivery did not differ among age groups. Using testicular sperm, pregnancy outcomes were not different between maternal and paternal age. Women older than 40 years should be advised the increased pregnancy failure. CONCLUSIONS: Using testicular sperm, pregnancy outcomes were not different between maternal and paternal age. However, in couples using testicular sperm in patients with azoospermia, either advanced paternal or maternal age over 40 years showed a negative effect on the pregnancy and delivery rate. Therefore, women older than 40 years and/or women with advanced male partner age using testicular sperm in patients with azoospermia should be advised of the increased incidence of pregnancy failure.