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Purpose: To evaluate the assisted reproductive technology (ART) outcomes after abdominal trachelectomy (AT). Methods: This was a retrospective study. We compared the ART outcome of 13 patients who underwent AT at another hospital prior to undergoing ART at our clinic after surgery (T group) and 52 control patients selected based on age, the time of treatment onset, and anti-Müllerian hormone levels (non-T group). Results: In all oocyte retrieval cycles, there were no significant differences in the number of oocyte retrieval, rate of fertilization, and good blastocysts. The pregnancy and live birth rates per embryo transfer (ET) were lower in the T group than in the non-T group (pregnancy rate, 20% versus [vs.] 39%, p=0.0166; live birth rate, 15% vs. 30%, p=0.0281). Endometrial thickness before ET was lesser in the T group than in the non-T group (7.4 [minimum–maximum, 3.5–14.3] mm vs. 9.0 [5.5–14.9] mm, p<0.0001). Multivariate logistic regression models showed that the age at oocyte retrieval (adjusted odds ratio [OR], 0.78; 95% confidence interval [CI], 0.69–0.89), the presence of good embryos (adjusted OR, 3.17; 95% CI, 1.29–7.82), and a history of AT (adjusted OR, 0.35; 95% CI, 0.15–0.83) were factors related to pregnancy per ET. Conclusion: The pregnancy rate per ET was lower and the endometrium was thinner before ET in patients with than in those without a history of AT. It is important for clinicians to be aware of the longer time to pregnancy in patients on ART after AT.

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CommentaryOpen AccessConsidering the low recognition toward recreational therapy (or therapeutic recreation) in healthcare and rehabilitation, this paper discusses the long-time controversy over TR/RT professional philosophy and an international perspective regarding its professionalization including future direction of Japanese recreation services.A few years ago, a colleague shared with me an article from The Economist, entitled "The future of jobs: the onrushing wave, " showing that the occupation of recreational therapist has the lowest probability of replacement by automation [1]. The article further emphasized the critical need for specialists engaged in emotional and relational work and that working in these fields is inherently noble [1]. As a certified therapeutic recreation specialist (CTRS), this article helped me appreciate anew the occupational worth of my fellow CTRSs and recreational professionals. At the same time, however, I wonder how many people recognize my profession's very existence.Recreation therapy (RT; also known as therapeutic recreation [TR]) is "a systematic process that utilizes recreation and other activitybased intervention to address the assessed needs of individuals with illness and/or disabling conditions, as a means to psychological and physical health, recovery and well-being [2]". These professionals provide a variety of activities, including arts and crafts, sports and physical activity, games, dance and movement, drama, music, and activities in community settings [3]. According to the National Council for Therapeutic Recreation Certification (NCTRC), 11,554 CTRSs are primarily serving in hospitals, skilled nursing facilities, and other facilities [4]. Historically, RT/TR was developed and organized in the United States, and is mostly known in North America. Despite its development as a profession in both community and healthcare settings for over a half-century, it seems that the field has not received proper recognition. Data from the U.S. Bureau of Labor Statistics [5] revealed 18,600 RT jobs compared to 114,600 jobs in occupational therapy (OT) and 214,900 in physical therapy (PT). Statistics also indicate that median pay in RT is $44,000 per year compared to $78,810 in OT and $82,390 in PT. In addition, in their review of a previous study, Harkins and Bedini [6] indicated the less frequent inclusion of RT in healthcare textbooks compared to PT and OT, and the presence of occupational prejudice of PTs and OTs toward RTs. Furthermore, based on a web-based survey of administrative positions in healthcare facilities, they learned that RT was not sufficiently recognized by healthcare administrators, and explained that administrators do not have accurate knowledge of RT, including its level of education and training, and that RT was the least utilized treatment. Finally, Harkins and Bedini found that administrators were more likely to believe that RT services can be handled by other healthcare professions.What would account for this situation? One answer might emerge from ...

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