Fibroid care: how it was, how it’s changing, and where it’s headed next. In this episode of BackTable OBGYN, hosts Dr. Mark Hoffman and Dr. Amy Park welcome minimally invasive GYN surgeon Dr. Arleen Song to discuss the evolving landscape of fibroid care.

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SYNPOSIS

Dr. Song, a veteran in the field with nearly 20 years of experience, shares her journey from Michigan to Duke, current treatments in fibroid management, and the importance of personalized care. The team explores new surgical techniques, the role of medical therapies such as Ella GnRH antagonists, and the importance of patient education. They also address challenges such as access to care, the significance of research funding, and the evolving understanding of fibroid genetics and long-term management. This episode provides a comprehensive overview of the state of fibroid care and the strides being made in this vital aspect of women's health.

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TIMESTAMPS

00:00 - Introduction
02:21 - Evolution of Fibroid Treatment
05:50 - Advancements in Minimally Invasive Surgery
08:47 - Longitudinal Care and Personalized Treatment
13:00 - Modern Approaches to Fibroid Treatment
21:15 - New Technologies and Procedures
27:01 - Preoperative Assessment and Imaging
31:15 - Preoperative Counseling and Risk Assessment
33:14 - Medications for Fibroid and Endometriosis
37:59 - Challenges in Access to Care
38:43 - Racial Disparities in Fibroid Research
42:35 - The Importance of Specialized Care
49:22 - Future Directions in Fibroid Treatment

Vaginal rejuvenation is often misunderstood, misrepresented, and overdue for honest conversations in medicine. In this crossover episode between BackTable Urology and BackTable OBGYN, Dr. Nirit Rosenblum, a urology and OBGYN professor at NYU Langone Medical Center, is joined by Dr. Karyn Eilber, Chair of the Cedars-Sinai Medical Group Department of Surgery, and Dr. Ariana Smith, Chief of Urology at Pennsylvania Hospital. Together, they bring a multidisciplinary lens to one of the most misunderstood areas of women’s health.

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SYNPOSIS

The discussion revolves around the broad definition of vaginal rejuvenation, distinguishing between medical and cosmetic interventions. They address common misconceptions, the roles of different health professionals, and emphasize the importance of pelvic floor physical therapy and the appropriate use of systemic and vaginal estrogen therapy. The conversation also highlights critical gaps in research surrounding laser and radiofrequency interventions, underscoring the need for stronger evidence, clearer patient education, and continued advocacy around menopause care and sexual function.

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TIMESTAMPS

00:00 - Introduction
02:11 - Defining Vaginal Rejuvenation
04:35 - Common Procedures and Misconceptions
10:04 - Insurance and Coverage of Procedures
12:04 - Laser and Radiofrequency Therapies
18:10 - Vaginal Estrogen and Lift of Black Box Warning
19:59 - The Role of Systemic Hormone Therapy
26:56 - Vaginal Rejuvenation Misconceptions
32:21 - Pelvic Floor Physical Therapy and Timing of Procedures
34:24 - Regional Variations in Therapeutic Availability
38:40 - Gender Inequity in Healthcare
40:16 - Final Thoughts

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RESOURCES

Joint Report on Terminology for Cosmetic Gynecology

https://journals.lww.com/fpmrs/abstract/2022/06000/joint_report_on_terminology_for_cosmetic.2.aspx

Who should consider fertility preservation, when is the right time, and what are the risks? In this episode of BackTable OBGYN, Dr. Amy Park interviews Dr. Mindy Christianson, the section head of Reproductive Endocrinology and Infertility at the Cleveland Clinic, who shares how fertility preservation is evolving for patients planning families and those facing fertility-impacting treatments.

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SYNPOSIS

Dr. Christianson discusses her journey into the field of fertility preservation, inspired by an early encounter with a breast cancer patient. The conversation covers various aspects of fertility preservation, including the preservation of eggs, embryos, ovarian and testicular tissue, and planned fertility preservation. Dr. Christianson elaborates on the protocols, patient demographics, and the evolving collaboration between oncology and reproductive endocrinology. The discussion also highlights technologies like ovarian tissue transplantation and in vitro maturation, as well as practical tips for healthcare providers on improving patient access to fertility preservation services.

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TIMESTAMPS

00:00 - Introduction
03:34 - Understanding Fertility Preservation
07:56 - Consultation Process for Fertility Preservation
17:36 - Advancements in Egg Freezing Technology
25:55 - Egg Freezing Recommendations
26:34 - Collaboration Between Oncology and REI
26:52 - Pediatric Oncology and Fertility Preservation
28:58 - Ovarian Tissue Transplantation
33:17 - Uterine Transposition Surgery
40:05 - Gene Editing and Fertility Preservation
43:01 - Financial and Emotional Aspects of Fertility Preservation
48:02 - Practical Advice for OBGYNs
51:12 - Resources and Final Thoughts

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RESOURCES

Livestrong Fertility
https://livestrong.org/how-we-help/livestrong-fertility/

Resolve: The National Infertility Association
https://resolve.org/

Society for Assisted Reproductive Technology
https://www.sart.org/

American Society for Reproductive Medicine
https://www.asrm.org/

A physician’s expertise can extend beyond the exam room and into the courtroom. In this episode of BackTable OBGYN, Dr. Elizabeth Moore, a general OBGYN and founder of MooreExperts, joins host Dr. Mark Hoffman to share her expertise on the intricacies of medical-legal work.

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SYNPOSIS

They cover Dr. Moore's journey into expert witness work, including how the pandemic shifted her career focus and ultimately led to the creation of a platform to assist OBGYNs in navigating legal cases. They discuss the challenges of managing extensive medical records, the importance of adhering to the standard of care, and the unique nature of obstetrics cases. They also emphasize the need for precise, evidence-based report writing to avoid unnecessary trials and address the emotional and financial toll legal processes can take on physicians. Finally, the episode explores the need for better systems to protect both patients and healthcare providers while offering insight into future challenges, including AI and private equity involvement in legal cases.

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TIMESTAMPS

00:00 - Introduction
05:08 - First Experiences in Medical-Legal Work
08:57 - The Role of Education in Legal Cases
11:37 - Challenges and Rewards of Medical-Legal Work
13:58 - Understanding Standard of Care and Malpractice
15:59 - The Importance of Detailed Reports and Depositions
20:02 - The Jury System and Its Challenges
25:45 - Balancing Professional and Personal Life
29:43 - Getting Started in Medical-Legal Work
32:07 - Recognizing Patterns in Medical Litigation
33:51 - Educating Attorneys for Fair Trials
36:33 - Concerns and Improvement of Medical Expert Testimonies
45:54 - The Role of Systems in Reducing Medical Errors
51:52 - Future Challenges and Opportunities in Medical Legal Work
56:07 - Final Thoughts

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RESOURCES

ACOG Technical Bulletin 365: Seeking and Giving Consultation
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2007/05/seeking-and-giving-consultation

MooreExperts OBGYN Consulting Medical Legal Expert Witness Masterclass
https://www.mooreexperts.com/

Bless This Mess: A Picture Story of Healthcare by Dr. Stephen Klasko
https://www.amazon.ae/Bless-This-Mess-Picture-Healthcare/dp/1483479625

What if the key to improving obstetrical surgery outcomes isn’t a new technology, but rethinking who’s in the operating room? In this episode of BackTable OBGYN, host Dr. Mark Hoffman and co-host Dr. Amy Park welcome Dr. Sony Singh, a prominent figure in the field of minimally invasive gynecologic surgery (MIGS) and obstetrics, to share perspectives on the emerging role of MIG surgeons in obstetrical surgery.

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SYNPOSIS

Dr. Singh shares his extensive career journey, from his education in Canada and Australia to his current role as department chair of OBGYN at the Ottawa Hospital. The conversation delves into the integration of MIGS into obstetric surgery, including procedures like laparoscopic cerclages, placenta accreta management, and cesarean scar pregnancies. The hosts and guest discuss the challenges and importance of building a robust team, regionalization of care, maintaining work-life balance, and the eventual transition of leadership roles to sustain the high standards of care. This episode highlights the crucial role of minimally invasive specialists in advancing OBGYN practices while promoting a sustainable work culture.

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TIMESTAMPS

00:00 - Introduction
02:08 - Dr. Singh’s Journey
07:37 - The Role of MIG Surgeons in Obstetrical Surgery
16:06 - Building a Collaborative Team
18:38 - Challenges and Best Practices
25:26 - Expanding the Scope of MIG Surgeons
30:19 - The Evolution of Urogynecology and MIGS
31:31 - Leadership and Building Programs
37:54 - Scaling Up and Regionalization of Care
42:53 - Balancing Work and Personal Life
54:37 - Concluding Thoughts

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RESOURCES

Canadian Society for Advancement of Gynecologic Excellence
https://cansage.org/about/

From Strength to Strength, by Arthur Brooks
https://www.arthurbrooks.com/books

How economically viable is gynecologic surgery today, and what happens if the system keeps pushing the limits? In this episode of BackTable OBGYN, Dr. Marisa Dahlman from Virginia Mason in Seattle sits down with hosts Mark Hoffman and Dr. Amy Park to discuss the evolving landscape of this field and the pressures surrounding reimbursement.

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SYNPOSIS

Dr. Dahlman begins by sharing her career path and fellowship experience before the conversation expands to explore the shift from MIGS (Minimally Invasive Gynecologic Surgery) to CBG (Complex Benign Gynecology), current reimbursement challenges, the difficulty of balancing obstetric and gynecological practice, and how these forces influence training and clinical life. They also discuss the stressors new graduates face while building viable practices, broader healthcare system challenges, resource allocation, and potential solutions to improve practice sustainability and patient care.

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TIMESTAMPS

00:00 - Introduction
03:06 - Fellowship Training and Career Pathways
11:43 - Impact of Reimbursement on Fellowship Applications
15:20 - Workforce Issues and Future of GYN Surgery
28:02 - Advocacy and Leadership in Healthcare
29:27 - Understanding Hospital Revenue and Efficiency
31:54 - The Role of Physician Leadership in Healthcare
35:35 - Navigating Healthcare System Mergers
36:47 - The Future of Healthcare Amidst Financial Cuts
41:40 - Addressing Healthcare Costs and Reimbursement
45:11 - The Importance of Women's Health Services
47:37 - Strategies for Improving Healthcare Systems
53:48 - Concluding Thoughts

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RESOURCES

Trends in gynecologic surgery reimbursement and physician pay
https://pubmed.ncbi.nlm.nih.gov/40305043/

Everything you need to know about tubo-ovarian abscesses (TOAs): breaking the stigma, safer treatment, fertility preservation, and better outcomes. This episode of BackTable OBGYN features Dr. Katherine Smith, an assistant professor and MIGS Fellowship Program director at UT Southwestern. With hosts Dr. Amy Park and Dr. Mark Hoffman, Dr. Smith provides an extensive overview of contemporary TOA management, emphasizing the significance of early intervention and the evolving understanding of TOAs beyond traditional STI etiologies.

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SYNPOSIS

The conversation delves into the management of TOAs, both non-ruptured and ruptured, and the underexplored connection to the female reproductive tract microbiome. They also touch on the integration of AI in clinical practice, particularly in streamlining administrative tasks. The episode underscores the need for updated guidelines and more research into the microbiological aspects of TOAs to improve patient outcomes.

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TIMESTAMPS

00:00 - Introduction
02:20 - Understanding TOAs: Early Interventions and Challenges
04:43 - Clinical Management of TOAs
08:06 - Surgical Approaches and Considerations
22:25 - Microbiome and Infection Insights
32:10 - Discussing Patient Reactions and Education
32:47 - Teaching Practices and Medical Education
34:18 - Clinical Observations and Data
36:55 - Surgical Management of Ruptured TOAs
40:50 - Challenges in Treating Infected Endometriomas
50:13 - Exploring the Role of AI in Medical Practice
54:23 - Concluding Remarks

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RESOURCES

ACOG Recommends Concurrent Sexual Partner Treatment for Recurrent Bacterial Vaginosis for the First Time
https://www.acog.org/news/news-releases/2025/10/acog-recommends-concurrent-sexual-partner-treatment-recurrent-bacterial-vaginosis-first-time

Strange Bedfellows, Ina Park MD, MS
https://www.inapark.net/the-book

Endometriosis and fibroids don't have to block your patient’s path to pregnancy. In this episode of BackTable OBGYN, host Dr. Mark Hoffman welcomes Dr. Jim Robinson, Director of Reproductive Surgery at Shady Grove Fertility in Maryland, to share his guidance on reproductive surgery applications and reproductive health.

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SYNPOSIS

The conversation explores the management of endometriosis and fibroids, the use of office hysteroscopy, and the intricacies of hysteroscopic and laparoscopic procedures. Dr. Robinson covers the importance of individualized patient care, the latest advancements in reproductive technology, and insights from his unique career blending academic medicine with a focus on enhancing fertility outcomes. Listeners will gain a comprehensive understanding of the critical role surgical interventions play in reproductive endocrinology and the nuanced approach required to optimize patient outcomes.

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TIMESTAMPS

00:00 - Introduction
05:17 - Understanding Reproductive Surgery
08:51 - Hysteroscopy in Reproductive Surgery
16:28 - Endometriosis and Infertility
23:50 - Diagnosing and Treating Adenomyosis
28:10 - Surgical Interventions for Reproductive Health
33:52 - Balancing Endometrioma Removal and Fertility
35:49 - Surgical Approaches and Patient Goals
36:46 - Complexities of Fertility Consultations
42:48 - Impact of Fibroids on Reproductive Health
45:33 - Adhesion Prevention in Myomectomy
48:33 - Innovations in Fibroid Ablation
52:10 - Understanding Isthmoceles and Their Impact
58:11 - Concluding Thoughts

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RESOURCES

ReceptivaDx: What does it mean to test positive for high levels of bcl6
https://receptivadx.com/what-does-it-mean-to-test-positive-for-high-levels-of-bcl6/

Impact of hysteroscopic surgery for isthmocele associated with cesarean scar syndrome: https://pubmed.ncbi.nlm.nih.gov/28892298/

Ever wondered what it’s like to train and practice obstetrics and gynecology across New Zealand and Australia? In this episode of BackTable OBGYN, Dr. Amy Park sits down with Dr. Michael Wynn-Williams, a renowned gynecologist and endometriosis specialist. Dr. Wynn-Williams discusses his extensive training across New Zealand, Australia, the UK, and Scotland, emphasizing his role in minimally invasive gynecology.
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SYNPOSIS
The conversation covers the nuances of gynecology and obstetrics training in Australia and New Zealand, the balance between public and private healthcare systems, and the cultural differences in medical practice. Dr. Wynn-Williams also sheds light on issues like medical-legal environments, insurance, the impact of geography on healthcare delivery, and the integration of advanced ultrasound practices in endometriosis care. The episode provides valuable insights for those considering a career in gynecology in these regions.
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TIMESTAMPS
00:00 - Introduction
07:35 - Training in Australia and New Zealand
15:05 - Public and Private Healthcare Systems
20:25 - Challenges and Equity in Healthcare
24:39 - Balancing Public and Private Practice
28:48 - Inpatient Services and Day Case Hysterectomy
29:46 - City vs. Rural Practices and Equity Issues
31:55 - Staffing Challenges in New Zealand
33:57 - Living and Working in New Zealand and Australia
35:25 - Navigating Medical Practice Transfers
40:10 - Medical-Legal Environment in Australia and New Zealand
43:31 - Gender-Based Reimbursement and Training Challenges
51:41 - Endometriosis Ultrasound Scanning and Collaboration
52:27 - Final Thoughts
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RESOURCES
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), the professional body responsible for training, accreditation, and standards in obstetrics and gynecology in both countries
https://ranzcog.edu.au/

Not all pain is visible and not all solutions are obvious, especially in chronic pelvic pain. In this episode of BackTable OBGYN, host Dr. Mark Hoffman welcomes Dr. Aakriti Carrubba, an expert in minimally invasive gynecological surgery and pelvic pain from the Mayo Clinic, to talk through the evaluation and treatment of chronic pelvic pain.
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SYNPOSIS
Dr. Carrubba shares her journey from Kentucky to Florida, detailing her extensive training and interest in managing pelvic pain. The discussion covers the evaluation of pelvic pain, the significance of a thorough patient history and systematic pelvic exams, and the role of interdisciplinary approaches, including physical therapy and pain management. Dr. Carrubba emphasizes the importance of addressing central sensitization and chronic pain syndromes, explaining that not all pain can be attributed solely to structural abnormalities. The episode also touches on the integration of advanced AI tools in medical practice to enhance patient documentation and overall care.
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TIMESTAMPS
00:00 - Introduction
01:09 - Dr. Carrubba’s Background and Journey
03:54 - Fellowship Experience and Pelvic Pain Focus
06:44 - Approach to Chronic Pelvic Pain
14:04 - Detailed Pelvic Pain Exam Techniques
17:14 - Trigger Point Injections and Their Role
21:33 - Challenges in Pain Management and Education
26:34 - Role of Central Sensitization in Chronic Pelvic Pain
29:35 - Approach to Central Sensitization and Screening
33:13 - Approaches to Excision Surgery
36:04 - Post-Surgery Management and Hormonal Suppression
38:19 - Teaching and Training in Pelvic Pain Management
41:35 - Pain Rehabilitation Clinic for Central Sensitization
44:59 - Teaching Pelvic Pain Anatomy to Trainees
48:24 - Advancements in AI for Medical Documentation
52:26 - Reflections on Pelvic Pain Training and Education
56:00 - Final Thoughts