Departments

Although perimenopause and menopause represent natural stages in a woman’s life, some women may find the common symptoms of this stage burdensome to the point of affecting their quality of life. On average, women experience menopause at age 51. Approximately 1% of women experience “premature” menopause, which occurs before age 40. (Menopause is considered “early”—but not premature—when it happens after age 40 but before 45.) Some medical conditions, such as autoimmune disorders, and some treatments, such as chemotherapy, radiation therapy, and ovarian surgeries, may increase the risk of early or premature menopause. Both premature and early menopause can be particularly burdensome—not only are the physical symptoms (hot flashes, night sweats, and vaginal dryness) more severe, but the psychological distress that accompanies an early onset of menopause can be particularly stressful, especially for women who may not have met their fertility goals. Our team of clinicians is equipped to help optimize the quality of life and health of the reproductively aging population of women by addressing their symptom burden, as well as identifying and minimizing their long-term health risks (such as osteoporosis or fractures). Our team is equally responsive to the reproductive needs and goals of our patients. Our Fertility Preservation Program addresses the needs of those who require treatments that may result in ovarian compromise or early ovarian failure. Our Third-Party Reproduction Program is committed to helping women with premature and early menopause meet their fertility goals through the use of donor eggs or gestational surrogacy . Our clinicians strive to serve our perimenopausal and menopausal patients’ immediate medical needs while also anticipating and reducing the risk of health problems that may arise in the future.

The Sexuality, Intimacy, and Menopause Program is one of the only clinics of its kind in the country. By combining both medical and psychological interventions, it is designed to help women who experience sexual dysfunction after cancer. Sexual dysfunction after cancer is common; however, sexual side effects often go untreated after having successfully treated a patient’s cancer. Our doctors look to manage not only the physical issues, but also any psychological concerns that may arise. Founded by Elena Ratner, MD, MBA, associate professor of Obstetrics, Gynecology & Reproductive Sciences and co-chief for the Section of Gynecologic Oncology, and Mary Jane Minkin, MD, clinical professor of Obstetrics, Gynecology & Reproductive Sciences, the clinic began nearly a decade ago. Psychologist Dwain Fehon, PsyD, associate professor of Psychiatry and chief psychologist of Psychiatric Services at Yale New Haven Hospital, is a vital member of the team. He and his staff provide essential emotional care that helps improve our patients’ relationships and personal health. Many women have concerns related to intimacy and menopause because of cancer surgery or treatment. Our specialists consult with patients to address the difficult physical and emotional aspects of cancer care and treatment, and create a personalized care plan for each patient. We have developed a unique focus on menopause management for cancer survivors and “previvors”—healthy women who have their breasts or ovaries removed because of a genetic risk of developing cancer. What types of patients do we see? Women who experience: Changes in sexual function as a result of chemotherapy, radiation, or surgery for cancer Menopause symptoms as a side effect of cancer treatment Early menopause or sexual changes after surgery for cancer risk reduction What we provide: Menopause symptom management Resources for cancer survivors on maintaining sexual health Access to complementary and supportive services Access to individual and couples counseling What to expect from an appointment: Our team will first discuss each patient’s medical and cancer history, as well as what type of treatment they have had. They will be asked about symptoms of menopause and sexual problems, such as hot flashes, night sweats, changes in sexual desire, painful intercourse, vaginal dryness, or changes in mood or sleep patterns. Depending on their symptoms, patients may have a gynecologic exam. The team will then discuss options for symptom management and improving their sexual health. They will also have the opportunity to talk about emotional and relationship issues affecting their life. Women are welcome to bring their partners to the appointment.

Our Reproductive Endocrinology & Infertility Division specializes in aiding patients facing challenges with their reproductive abilities . We are committed to diagnosing conditions and guiding each patient through the available treatment options to help them realize their dreams of starting or expanding their family. We focus on diagnosing and managing endocrine disorders and other chronic conditions that hinder conception or the maintenance of pregnancy. Additionally, we assist patients in preserving their fertility before undergoing cancer treatments. Our expertise extends to supporting individuals without partners, same-sex couples, and transgender individuals in overcoming barriers to parenthood. With its globally recognized reputation, our academic health center is known for cutting-edge therapies and exceptional success rates. Our state-of-the-art facility is staffed by approachable clinicians, many of whom are esteemed experts in fertility treatment. Our clinicians deliver compassionate and personalized care tailored to our patients’ individual needs throughout their journey. Several of our clinicians have held or currently hold leadership positions in prestigious professional organizations, such as the American Society for Reproductive Medicine (ASRM) and the Society for Reproductive Investigation (SRI), underscoring our commitment to excellence in the field of reproductive medicine. Our clinicians have contributed to over 1,000 scientific publications, significantly advancing the field. They have also authored the seminal reference book Speroff's Clinical Gynecologic Endocrinology and Infertility , which guides clinicians in providing comprehensive care to patients with infertility and reproductive disorders. With decades of experience treating patients and helping them achieve pregnancy, our clinicians are also dedicated to advancing research in their specialized areas. Their findings have led to the development of new diagnostic tests, surgical procedures, and innovative technologies, shaping and advancing the field of assisted reproductive technology. As research is integral to our practice, patients can access clinical trials conducted at our facility. Recognizing the emotional complexities associated with infertility, our clinicians offer empathy, support, and a celebration of successes, guiding patients through their challenges. Financial coordinators are available to clarify health insurance eligibility and costs, ensuring transparency and minimizing unexpected fees. The Yale Medicine Reproductive Endocrinology & Infertility Division offers specialized programs including: Endometriosis Program: We diagnose and treat endometriosis , addressing pelvic pain and infertility to improve pregnancy outcomes. Fertility Center: We offer an array of individualized treatment options for both women and men looking to start a family. Our physicians, staff, and scientists share our patients’

Fertility preservation has emerged as a crucial aspect of health care. It affords individuals facing medical treatments (such as chemotherapy or radiation therapy) that may compromise their fertility an opportunity to safeguard their ability to have biological children in the future. Fortunately, people who face a cancer diagnosis now have options to preserve their chances of one day having a baby with their own sperm or eggs. There are other circumstances in which people may pursue fertility preservation. These include conditions that may cause infertility, like endometriosis or diminished ovarian reserve , and those affected may also seek fertility preservation . People approaching their mid or late 30s may consider freezing their eggs to extend the window of time when they can conceive. Transgender individuals interested in becoming parents in the future may elect to freeze their sperm or eggs before they transition. Our Fertility Preservation Program encompasses a range of services tailored to meet one’s individual needs. At the heart of this program lies a commitment to empowering individuals with knowledge and understanding. It is designed to help people freeze their eggs, embryos, sperm, testicular tissue, or ovarian tissue for future use. This offers the chance to build a family when the time is right. The process starts with a consultation with a reproductive specialist, who will review a patient’s medical and reproductive history and provide direction, as far as testing and preservation options are concerned. Depending on the underlying motivation and the nature of the situation, options are reviewed. Options may include: Egg Freezing: This approach involves the use of hormones to stimulate the maturation of multiple eggs, which are then retrieved and frozen. This option can take a few weeks to complete. Embryo Freezing: Similar to egg freezing, hormones are used to mature multiple eggs, which are then retrieved and combined with sperm to generate embryos, which are then frozen. This can also take a few weeks to complete. Sperm Freezing: In most situations, sperm can be obtained through natural means, frozen, and stored for later use. In some situations, sperm is obtained by surgical means and then frozen. Testicular Tissue Freezing: Testicular tissue can be surgically obtained and then frozen. Sperm can be extracted from the tissue after thawing and used to fertilize eggs. Ovarian Tissue Freezing: When a medical condition leaves no time to freeze eggs, ovarian tissue can be surgically obtained. After treatment is completed and it is deemed safe to get pregnant, the tissue can be re-placed into one’s body. The reproductive specialist will work with patients and their other providers to afford them the opportunity for the most appropriate preservation option. This process can be stressful, and part of that stress may be financial. Our program is equipped to provide resources and guidance along these lines. Our coordinators rev

Endometriosis, a common gynecological disease, affects one in 10 women in the U.S., and is diagnosed in up to half of women who experience infertility . Due to its nonspecific symptoms, endometriosis often goes undetected for years. Many individuals attribute their chronic pelvic pain to menstrual cramps rather than recognizing it as a symptom of endometriosis. Additionally, some may remain unaware of their condition due to silent symptoms. It can take up to a decade for some patients to receive a proper diagnosis. Normally, the uterine lining (endometrium) grows along the interior walls of the uterus, providing a cushioned and receptive environment for embryo implantation during pregnancy. However, in endometriosis, the endometrium grows outside the uterus, commonly on the exterior of the uterus, ovaries, fallopian tubes, bladder, intestines, or other pelvic structures. This displacement frequently leads to chronic pelvic pain and may cause secondary symptoms, such as irritability, difficulty sleeping , anxiety , depression , or low self-esteem. Over time, endometriosis induces inflammation, bleeding, and scar tissue formation within the pelvic cavity, regardless of whether the patient experiences pelvic pain. The presence of scar tissue can hinder fertility. Early diagnosis of endometriosis, before the formation of scar tissue, can help preserve fertility. A delayed diagnosis may pose challenges for conception, even with assisted reproductive procedures like in vitro fertilization (IVF) . To confirm endometriosis, clinicians biopsy a small sample of uterine tissue and examine it under a microscope for signs of the condition. For patients diagnosed with endometriosis, the news may bring emotional relief after years of pelvic pain without a clear cause. Our providers offer treatments to alleviate chronic pain and related physical and emotional symptoms, and assess whether endometriosis has contributed to infertility. Treatment options for endometriosis include medications and/or surgical procedures, such as excision surgery, to relieve pain, remove scar tissue, and improve organ function. These treatments may also prevent a recurrence. In cases of endometriosis-related infertility, clinicians may recommend IVF or other assisted reproductive therapies to enhance pregnancy chances. Many patients with endometriosis benefit from therapy alongside medical treatments. Additionally, we conduct various research projects, offering patients access to medication and testing at no cost. Throughout the infertility journey, our counselors support patients with endometriosis, explaining different assisted reproductive technologies and helping patients understand their options fully.

Polycystic ovary syndrome (PCOS) is one of the most commonly misdiagnosed conditions associated with female infertility . It is a prevalent yet intricate endocrine disorder marked by an imbalance of female reproductive hormones. Common symptoms include irregular menstrual periods, acne , and excessive facial or body hair growth. PCOS is often linked with obesity. In addition to fertility issues, women with PCOS face an increased lifetime risk of conditions such as diabetes , uterine lining pre-cancer, cholesterol abnormalities, high blood pressure , sleep apnea , and depression . Effective PCOS management typically requires a multidisciplinary approach involving primary care physicians (for general health, weight loss, diabetes risk, high blood pressure, and depression), gynecologists (for gynecological health and uterine lining protection), endocrinologists (for hormonal issues, including hair excess and acne, obesity, diabetes, and elevated cholesterol ), and reproductive endocrinology and infertility specialists (for pregnancy goals). Maternal-fetal medicine specialists may also be involved for fertility-seeking women at risk of gestational diabetes or pregnancy-related blood pressure problems. Mental health providers and nutritionists can also provide valuable support for improving overall well-being. Our aim is to optimize the family-building goals of women with PCOS while prioritizing the overall well-being of both mothers and babies. For overweight or obese women with PCOS, lifestyle modifications focusing on diet and exercise can lead to significant improvements in menstrual cycles, acne, and mood. Metformin, commonly prescribed for diabetes, may also benefit overweight or obese women with PCOS, as well as some undergoing fertility treatment. Treatment options for PCOS should be tailored to reduce symptoms (such as abnormal menstruation, acne, and excessive hair growth), address individual goals (such as fertility), and mitigate lifetime risks (such as diabetes, depression, heart disease, and uterine cancer ). Treatment may include birth control pills with or without anti-androgens for acne and hair growth, as well as medications like metformin. Our team is dedicated to helping patients with PCOS achieve their fertility goals through personalized treatment plans. Our approach begins with a comprehensive evaluation, including hormonal and metabolic profiling and an assessment of uterine and fallopian tube health. For couples in heterosexual relationships, semen analysis is a critical step. Endometrial biopsy may be recommended for women with irregular menstruation. Preconception consultations with high-risk obstetricians may also be advisable for those at higher risk of pregnancy complications. For women with PCOS-related infertility, various treatment options are available, such as ovulation induction with medications like letrozole. Metformin may be added if the ovaries are unresponsive to these medications. Injectable hormo

Yale’s Department of Obstetrics, Gynecology and Reproductive Sciences is dedicated to helping women at all stages of life. A global leader in women’s health, Yale is known for its innovative contributions to diagnosis and treatment, including: Developing the first fetal echocardiography Pioneering the first obstetrical ultrasound Developing the first fetal blood sampling and first fetal transfusion Offering the first chorionic villus sampling in New England Co-authoring the first U.S. study for first-trimester risk assessment Developing the first comprehensive first-trimester risk assessment program in New England Inventing fetal monitoring and many prenatal diagnostic and treatment techniques Our physicians tap into the broad expertise of our entire institution to provide compassionate, customized care for all of our patients, from adolescence through adulthood. Through eight subspecialty areas, we offer the most advanced diagnostics and therapies that harness the latest advances in technology. Recent clinical research includes a new emphasis on therapeutic vaccines in gynecologic oncology, novel treatments for endometriosis and menopause, a comprehensive patient safety program in maternal-fetal medicine, and an advanced fetal therapy program. Specialized care is offered in the following areas: Family planning Gynecologic oncology Gynecologic specialties Maternal-fetal medicine Obstetric specialties & midwifery Pediatric & adolescent gynecology Reproductive endocrinology & infertility Urogynecology & reconstructive pelvic surgery Maternal-fetal medicine service offers 24-hour on-site dedicated space for complex pregnancies and fetal care First in Connecticut to perform in-utero laser therapy in pregnancies complicated by twin-to-twin transfusion syndrome Outstanding survival outcomes for all types of gynecologic surgery, from open to robotic Pioneer in caring for patients with sexual intimacy issues after cancer surgery Fetal therapy program Midwifery and birthing center

The Cardiovascular Disease and Pregnancy Program at Yale offers comprehensive and individualized support before, during, and after pregnancy for people with heart conditions. Our mission is to improve outcomes in pregnancy for patients with either pre-existing or newly diagnosed heart disease and ensure that pregnant patients receive appropriate and specialized risk assessment, treatment, and support. Cardiovascular disease is the number one cause of maternal mortality in the United States. While most people with pre-existing cardiovascular conditions can safely and successfully become pregnant, carry a baby to term, and breastfeed, patients with cardiovascular conditions are at higher risk of complications during pregnancy and after delivery. Pregnancy can also reveal or cause previously undiagnosed heart problems, and certain pregnancy complications can put patients at a higher risk for future cardiovascular disease. Yale’s Cardiovascular Disease and Pregnancy Program brings together cardiologists, maternal-fetal medicine specialists , nutritionists, pharmacists, lactation consultants , social workers, and family planning specialists who utilize their unique expertise to provide comprehensive patient care. Our multidisciplinary team meets regularly to create individualized care plans for each pregnant patient with heart disease. We provide care to: People with known heart disease, including congenital heart disease and acquired heart diseases, such as abnormal heart rhythms (arrhythmias), heart failure, and ischemic heart disease (coronary artery disease) People who develop cardiovascular disease or are newly diagnosed with heart disease during pregnancy (for example, peripartum cardiomyopathy) People who develop pregnancy-specific complications (including preeclampsia and related hypertensive disorders or gestational diabetes) that put them at higher risk for future cardiovascular disease Before pregnancy Contraception counseling: We provide individualized contraception counseling to patients with cardiovascular conditions to help determine the best and most reliable form of contraception for them based on a variety of factors, including specific heart conditions, interaction with other medications, and personal preferences. Comprehensive risk assessment: We provide a comprehensive risk assessment for patients with heart conditions who wish to become pregnant. We coordinate care to ensure they receive updated imaging and diagnostic studies and are on pregnancy-safe medications before they conceive. We also work closely with patients to provide nutrition and exercise guidance. Preconception counseling: We provide consultations to explore and discuss a potential pregnancy and family building. During this visit, we will answer all patient questions and develop care recommendations to support patients prior to, during, and after pregnancy. We also introduce members of the care team. During pregnancy Prenatal care management: We work wi

Providing patient-centered, compassionate gynecologic care is our priority. Our diverse team of gynecologists offers consultative and treatment services for a comprehensive range of gynecologic conditions. Our clinical expertise in prevention, screening, and diagnosis of gynecologic cancers, prevention and treatment of gynecologic infections, fibroid management, management of endometriosis and pelvic pain, contraceptive services, and gynecologic care for patients with HIV are just a few examples of areas in which we are proud to be making a difference in our community. We offer state-of-the-art approaches to individualize the care of women with complex gynecologic conditions, including those that are precancerous, require minimally invasive surgery, or other advanced medical or surgical treatments. We care for patients of all ages across the entire community, including those who are underserved. We offer expertise in treating a variety of conditions including: Abnormal pap smears Abnormal uterine bleeding Chronic pelvic pain Complex surgical histories Endometriosis Fibroids Menopausal symptoms Ovarian cysts Pelvic infections Precancerous changes in the vulva, vagina, cervix (dysplasia), or uterus (hyperplasia) Sexual dysfunction Additionally, we provide the following specialty services: Minimally Invasive Gynecologic Surgery (MIGS) . We offer an array of advanced laparoscopic, robotic, vaginal, and hysteroscopic surgical techniques to manage benign and precancerous gynecologic conditions. Office-based procedures. We offer several in-office procedures including colposcopy and LEEP, contraceptive implant and IUD insertion and removal, diagnostic hysteroscopy, endometrial and vulval biopsies, and trigger point injections in a safe, comfortable, and convenient setting. Transgender care. We offer surgical consultation for women transitioning to men. Pre-invasive gynecology care. We provide multidisciplinary evaluation and management of abnormal pap tests and precancerous conditions of the uterus, cervix, vagina, and vulva using the most up-to-date practice guidelines, in collaboration with gynecologic pathologists. Chronic Pelvic Pain. We provide a comprehensive, patient-centered approach to pelvic pain. We work with a multidisciplinary team (colorectal, urology, interventional radiology, social work, physical therapy, and vascular surgery) to address pelvic pain, which often has multiple causes. We are committed to working closely with local practices, community-based health centers, and colleagues in other medical specialties to ensure coordination of timely and appropriate gynecologic care for our patients. Our multidisciplinary approach includes partnership with primary care, other surgical specialties, pathology, radiology, social work and care coordination. We are committed to serving the community and providing access to care. Our collaborative care model includes working with the Connecticut Veterans Administration Health Care System, Corn

For individuals or couples diagnosed with infertility after a thorough evaluation, our clinicians may recommend in vitro fertilization (IVF) to help them start a family. During the IVF process, eggs and sperm are combined in a laboratory setting to form embryos. An embryo is then implanted into the patient’s uterus when circumstances are optimal. IVF stands as one of the most effective fertility treatments available, significantly enhancing the chances of pregnancy for patients. It may be advised for female infertility conditions, such as damaged fallopian tubes or severe endometriosis , or for male infertility -related issues, such as low sperm count or abnormal sperm. Additionally, IVF might be suggested in cases where the cause of infertility remains unknown. Our IVF program operates within a state-of-the-art laboratory featuring LifeAire technology, an innovative air purification system known for its advanced filtration techniques. This system ensures optimal air quality by eliminating up to 99.99% of biological and chemical contaminants, safeguarding eggs, sperm, and embryos from harmful airborne substances. The laboratory is staffed by experienced embryologists with doctorate degrees, contributing to our high success rates in IVF. Throughout the IVF journey, patients receive support from caring clinicians who address their questions and concerns. Recognizing the emotional weight of the process for individuals hoping to start or expand their family, our providers strive to minimize stress and foster meaningful patient-provider relationships. When IVF is recommended, patients meet with a financial counselor to confirm health insurance coverage before starting treatment. (Prior authorization from health insurers is typically required.) An IVF cycle typically aligns with the onset of the patient’s menstrual cycle, when multiple eggs are available for maturation in the ovaries. Unlike natural ovulation, where only one egg matures each month, IVF protocols involve administering medications to stimulate the maturation of multiple eggs. Patients undergo periodic evaluations by clinicians to monitor hormone levels and progress through ultrasound studies and blood tests, enabling adjustments to the treatment protocol as needed. During the cycle, patients receive injectable hormones to promote the growth of eggs and prevent their premature release. A final hormone injection triggers egg release approximately 36 hours before a scheduled egg retrieval procedure at the hospital. The egg retrieval procedure, performed under anesthesia, involves the clinician using ultrasound guidance to collect mature eggs from the ovaries through a thin needle inserted via the vaginal wall. Subsequently, the retrieved eggs are fertilized in the IVF laboratory. Depending on sperm health, fertilization occurs either by surrounding each egg with a large number of sperm or by injecting individual sperm into each egg. Fertilized eggs are then incubated, and embryo devel

When a young person has questions or concerns related to gender, the entire family is affected. We are a safe, supportive resource and interdisciplinary program for children, adolescents, and young adults who are exploring their gender identity, as well as for their families. We provide comprehensive care for young people who are questioning their assigned gender and/or are seeking consultation and care. Our team includes pediatric-trained endocrinologists, psychologists, and psychiatrists, as well as a medical ethicist, a chaplain, and a lawyer. We work closely together as a team and also consult with a wide array of other specialists. Together, we are committed to providing care in compassionate and respectful ways. Our clinicians follow current medical protocols, and the care offered by our program is supported by professional guidelines endorsed by the American Academy of Pediatrics, the American Medical Association, the American Psychiatric Association, and the American Psychological Association. When it comes to gender identity and related concerns, our first step is to listen. Some youth are exploring their identity. Others know that how they feel inside does not match up with the gender they were assigned at birth. We help sort through these questions. After an initial consultation, we offer a thorough biopsychosocial readiness assessment, which includes obtaining information from patients and their families. This comprehensive assessment takes six to eight hours to complete and can be done in one day or divided over several sessions. If we determine that any mental health or other support is needed, we can connect patients with resources at Yale or in the community. After the evaluation and when all parties agree that it is safe, healthy, and appropriate, we offer a variety of care options related to gender affirmation. At the first visit to our program, gender affirmation visit, patients and their families will meet with both one of our a pediatric endocrinologists and a mental health provider experienced in caring for dealing with patients who report gender variance. First and foremost, we make sure we understand our patients’ needs and desires. We will discuss the risks and side effects of any proposed care options, work together to learn what support systems are already in place, and determine what additional treatments and resources our patients may need. If you are in crisis, call the confidential toll-free National Suicide Hotline at 1-800-273-TALK (8255), 24 hours a day, seven days a week. If texting is easier, you can also text the National Crisis Text Line by texting HOME to 741741.

Patients often hesitate to discuss miscarriages, or spontaneous pregnancy losses. While one miscarriage might prompt a doctor's visit, experiencing two or more losses warrants a thorough examination for underlying reproductive issues. Yale Medicine’s Recurrent Pregnancy Loss Program assembles experts from various fields to provide comprehensive and compassionate care to patients facing this condition. We utilize cutting-edge technologies for diagnosis and tailor individualized treatments to address the root cause. Recurrent pregnancy loss is defined as two or more failed pregnancies, including those confirmed via pregnancy blood test or ultrasound. Miscarriage is relatively common, affecting 15% to 20% of known pregnancies within the first 20 weeks. However, experiencing two or more consecutive losses, which affects 1%-3% of pregnancies, may indicate underlying genetic, physiological, or anatomical issues. Anatomic abnormalities in the uterus, such as fibroids , polyps, adhesions, or the presence of a septum dividing the uterine cavity, can lead to pregnancy complications. Hormonal disorders, like uncontrolled diabetes or thyroid issues , can also contribute to recurrent pregnancy loss. Additionally, chromosomal abnormalities in embryos, autoimmune conditions, infections, and lifestyle factors, such as smoking, drug use, caffeine and alcohol consumption, toxin exposure, and obesity, may play a role. Our multidisciplinary team works closely with patients to identify potential contributing factors while offering emotional support during this challenging time. Initial assessments include a thorough review of medical history, physical examinations, specialized ultrasounds, and consultations with specialists, such as reproductive endocrinologists, maternal-fetal medicine specialists, reproductive immunologists, geneticists, and pathologists. We employ advanced diagnostic techniques, including genetic testing and analysis of fetal tissue, to pinpoint underlying causes. Our team includes psychological counselors, dietitians, and experienced nurses who provide comprehensive support throughout diagnosis and treatment. At Yale Medicine, our Recurrent Pregnancy Loss Program combines compassionate care with state-of-the-art genetic analysis. Following a definitive diagnosis, we offer customized treatment options, which may include surgical interventions to address anatomical abnormalities, in vitro fertilization (IVF) , or a genetic screening of embryos. Even in cases where a specific cause cannot be identified, the outlook remains positive, with the majority of subsequent pregnancies proceeding normally. Throughout the process, we remain dedicated to understanding the root cause of difficulties and providing empathy and reassurance to patients facing recurrent pregnancy loss.