ABSTRACT
Background: Women are increasingly electing to cryopreserve oocytes in order to delay childbearing. Planned oocyte cryopreservation often requires significant investment, yet there is a paucity of data to guide patients on their likelihood of obtaining significant returns. In addition, the prediction of live birth rates after using cryopreserved oocytes remains an area of active investigation. Objective(s): We aimed to characterize patterns in planned oocyte cryopreservation over the last decade, determine the percentage of patients who returned to utilize cryopreserved oocytes, and develop a counseling tool for patients on the anticipated number of cryopreserved oocytes based on age and AMH. Material(s) and Method(s): We performed a retrospective review of women undergoing planned oocyte cryopreservation at a single, large, university-affiliated REI practice from January 2010 to December 2020. Oocyte cryopreservation for cancer diagnosis, TESE failure, or inability to produce a semen sample on the day of oocyte retrieval were excluded. The primary outcome was the percentage of patients who returned to utilize cryopreserved oocytes for fertilization and subsequent embryo transfer or PGT-A. Secondary outcomes were the number of planned oocyte cryopreservation cycles per year, the number of oocyte thaw/warm cycles per year, and the mean number of cryopreserved oocytes based on age (<25, 25-30, 30-35, 35-42, >42) and AMH (<0.5 ng/mL, 0.5-1 ng/mL, 1-3.5 ng/mL, >3.5 ng/mL). Result(s): 2,845 planned oocyte cryopreservation cycles were performed between January 2010 and December 2020. The mean patient age at cycle start was 36.6 +/- 3.6 years. The number of oocyte cryopreservation cycles increased from 2010 (n=9) to 2019 (n=499). The number of oocyte thaw/warm cycles similarly increased between 2010 (n=1) and 2019 (n=100), and the majority of thaw/warm cycles (77.3%) took place within the last three years (2018-2020). Notably, 2020 witnessed a decrease in both planned oocyte cryopreservation (n=215) and oocyte thaw/warm (n=84) cycles due to the COVID-19 pandemic. AMH was the strongest predictor of the mean number of cryopreserved oocytes, and the highest yield (mean 18.6) occurred in patients 30-35 years old with an AMH >3.5 ng/mL. During the study period, 12.4% (267/2,159) of patients returned to utilize cryopreserved oocytes. Conclusion(s): The number of planned oocyte cryopreservation cycles increased each year between 2010 and 2019;however, a minority of women (12.4%) ultimately returned to utilize cryopreserved oocytes. Financial Support: None REFERENCES: 1. Leung, A.Q., Baker, K., Vaughan, D., Shah, J.S., Korkidakis, A., Ryley, D.A., Sakkas, D., Toth, T.L., 2021. Clinical outcomes and utilization from over a decade of planned oocyte cryopreservation. Reprod Biomed Online 43, 671-679. 2. Practice Committee of the American Society for Reproductive Medicine. Electronic address:, 2021. Evidence-based outcomes after oocyte cryopreservation for donor oocyte in vitro fertilization and planned oocyte cryopreservation: a guideline. Fertil Steril 116, 36-47. Copyright © 2022
ABSTRACT
Objective: We sought to evaluate the impact of non-cavity-distorting intramural myomas on pregnancy outcomes in an ideal study group: patients undergoing frozen embryo transfer (FET) of a single euploid blastocyst. Material(s) and Method(s): This is an interval analysis of a prospective cohort study at a single large university-affiliated institution from January 2018 to April 2022. There was a hiatus in recruitment from March 2020 to February 2022 due to the COVID-19 pandemic. All patients underwent an autologous natural or programmed FET with endometrial preparation and luteal support per a standardized protocol. Prior to transfer, patients were divided based on the presence (Group A) or absence (Group B) of non-cavity-distorting myomas. All ultrasounds (US) were performed by physicians. If myomas were detected, their number, size, location (FIGO classification system), and distance from the uterine cavity were recorded. The primary outcome was clinical intrauterine pregnancy (IUP). The secondary outcomes were positive human chorionic gonadotropin (hCG) test, biochemical pregnancy, missed abortion, and ongoing pregnancy and live birth rates. A Fisher's exact test was done to compare proportions. A p-value of <0.05 was deemed statistically significant. Result(s): Of the 122 enrolled patients, 19 (15.6%) had a non-cavity-distorting intramural myoma (Group A), while 103 (84.4%) did not have a myoma (Group B). No patients had a cavity-distorting myoma. The patients who had myomas tended to be older with a higher BMI, but otherwise had similar baseline characteristics including gravidity, parity, endometrial thickness, peak estradiol level, and AMH. There was no significant difference in the proportion of patients who achieved a clinical IUP in Group A (52.6%) and Group B (63.1%, p=0.45). There was also no difference in the secondary outcomes (Table 1). Conclusion(s): This prospective observational study has not demonstrated a significant impact of non-cavity-distorting intramural myomas on FET outcomes, although this study is ongoing and will continue to recruit patients. Impact Statement: Non-cavity-distorting myomas do not appear to affect positive hCG, biochemical, clinical IUP rate, miscarriage, or ongoing pregnancy or live birth rates in an ideal study population of single euploid FET transfer cycles. Copyright © 2022
ABSTRACT
Objective: We aimed (1) to quantify the impact of COVID-19 on the number of oocyte cryopreservation cycles performed, and (2) to characterize the demographics of fertility preservation patients both before and during the pandemic. Material(s) and Method(s): We performed a retrospective analysis of patients who underwent social oocyte cryopreservation at a large university-affiliated REI practice. Cycles were divided into two 22-month study periods: pre-pandemic (May 2018-February 2020) and post-pandemic (March 2020-December 2021). Oocyte cryopreservation cycles for medical indications (e.g., cancer diagnosis) were excluded. A Student's t-test was used to compare parametric variables between the two groups, while a Wilcoxon Rank-Sum was used for non-parametric variables. A Chi-squared test was used to compare the proportion of oocyte cryopreservation cycles to total ovarian stimulation cycles during each study period. A p-value of <0.05 was considered statistically significant. Result(s): During the pandemic, there was a decrease in total ovarian stimulation cycles (n=6,343) compared to the pre-pandemic period (n=6,653). In contrast, there was an 18.9% increase in the number of oocyte cryopreservation cycles seen in the post-pandemic group versus the pre-pandemic group (n=1,165 and n=980, respectively). Overall, there was a difference in the proportion of oocyte cryopreservation cycles performed at our institution pre-pandemic and post-pandemic (14.7 vs. 18.3%, p < 0.001). In addition, the age of post-pandemic oocyte cryopreservation patients decreased (36.2 vs. 35.7 yr, p = 0.004). There was no significant difference found in the BMI, AMH, and number of cryopreserved oocytes per cycle between the two patient groups. Conclusion(s): Although total ovarian stimulation cases declined following the pandemic, the number of social oocyte cryopreservation cycles increased proportionally. This suggests a shift in patients who present to REI clinics for proactive reproductive planning versus infertility care. More studies are needed to elucidate if this is due to a trend toward delayed childbearing, increase in ART, and/or the pandemic. Impact Statement: Following the COVID-19 pandemic, there was a proportional increase in social oocyte cryopreservation cycles. [Formula presented] Copyright © 2022
ABSTRACT
In clinical practice, infertility treatment delays can occur due to medical, logistical, or financial reasons. Concerns over treatment delays were brought to the forefront in March 2020 when the SARS-CoV-2 pandemic prompted both the ESHRE and ASRM to recommend the suspension of new infertility treatment cycles. At the time, little was known about the risk of viral transmission on reproductive health and necessary medical resources urgently needed to be reallocated to the front lines of the pandemic. These society recommendations were met with resistance from some clinicians and patients that raised valid concerns about whether delaying IVF treatment for a few months could negatively affect pregnancy outcomes.To help answer this question, we designed a retrospective cohort study to assess whether a delay up to 180 days in initiating IVF treatment affects pregnancy outcomes in infertile women with diminished ovarian reserve. This population was selected because their treatment outcomes were the most likely to affected by treatment delays due to the continuous decline in ovarian reserve over time. Infertile women treated at our IVF center were included if they had diminished ovarian reserve and started an ovarian stimulation cycle within 180 days of their initial consultation that resulted in an oocyte retrieval with planned fresh embryo transfer between 1 January 2012 and 31 December 2018. Diminished ovarian reserve was defined as an anti-Mŭllerian hormone (AMH) <1.1 ng/mL.In total, 1,790 patients met inclusion criteria (1,115 immediate and 675 delayed treatment). Each patient had one included cycle and no subsequent data from additional frozen embryo transfer cycles were included. Since all cycle outcomes evaluated were from fresh embryo transfers, no genetically tested embryos were included. Patients were grouped by whether their cycle started 1-90 days after presentation (immediate) or 91-180 days (delayed). The primary outcome was live birth (≥24 weeks of gestation). A subgroup analysis of more severe forms of diminished ovarian reserve was performed to evaluate outcomes for patients with an AMH <0.5 and for patients >40 years old with an AMH <1.1 ng/mL (Bologna criteria for diminished ovarian reserve). Logistic regression analysis, adjusted a priori for patient age, was used to estimate the odds ratio (OR) with a 95% CI. All pregnancy outcomes were additionally adjusted for the number of embryos transferred.The mean ± SD number of days from presentation to IVF start was 50.5 ± 21.9 (immediate) and 128.8 ± 25.9 (delayed). After embryo transfer, the live birth rate was similar between groups (immediate: 23.9%;delayed: 25.6%;OR 1.08, 95% CI 0.85-1.38). Additionally, a similar live birth rate was observed in a subgroup analysis of patients with an AMH <0.5 ng/mL (immediate: 18.8%;delayed: 19.1%;OR 0.99, 95% CI 0.65-1.51) and in patients >40 years old with an AMH <1.1 ng/mL (immediate: 12.3%;delayed: 14.7%;OR 1.21, 95% CI 0.77-1.91).Overall, we observed that a delay in initiating IVF treatment up to 180 days does not affect the live birth rate for women with diminished ovarian reserve when compared to women who initiate IVF treatment within 90 days of presentation. This observation persisted for patients who in the highest-risk categories for poor response to ovarian stimulation. Providers and patients should be reassured that when a short-term treatment delay is deemed necessary for medical, logistical, or financial reasons, treatment outcomes will not be negatively affected.
ABSTRACT
Objective: To describe our single-center experience and results of universal SARS-CoV-2 testing in asymptomatic patients undergoing controlled ovarian hyperstimulation (COH). Design: Retrospective cohort study conducted at a university-affiliated center. Materials and Methods: On March 21, 2020, New York-Presbyterian Hospital, where our retrieval suite is located, instituted a policy of universal SARS-CoV-2 testing prior to surgical procedures requiring anesthesia. As a result, we began testing all patients undergoing COH for SARS-CoV-2 using reverse transcription-polymerase chain reaction via nasopharyngeal swabs (Roche Cobas 6800). Tests were performed on the morning of cycle start and repeated 24 hours before oocyte retrieval. A positive test at either time point excluded patients from continuing with treatment. During the testing period, all patients and staff were required to wear surgical masks at all times when at our center and consented to symptom and temperature screening at every monitoring visit. Results: Between March 21 and May 20, 2020, 169 asymptomatic patients underwent nasopharyngeal swabs at cycle start, four of which returned positive for SARS-CoV-2 for a center prevalence of 2.4%. All four patients were asymptomatic at the time of cycle start and were not permitted to begin their COH cycle. One of these patients had previously had a positive PCR swab over 60 days prior and had been symptom-free during this interval. One patient with a negative PCR swab on cycle start subsequently converted to positive 15 days later on her PCR swab prior to retrieval, despite the absence of COVID-19 symptoms. Per our hospital policy, she was not allowed to proceed with oocyte retrieval and was started on a course of daily GnRH antagonist and asked to abstain from intercourse for 14 days. None of the 5 patients went on to develop COVID-19 symptoms following their positive test result. All patients were referred to follow-up with their primary care provider. Prior to returning for further COH treatment, all patients will be required to undergo repeat PCR testing with a negative result. Conclusions: While rare, asymptomatic carriers of the SARS-CoV-2 virus were identified for a center prevalence of 2.4% in patients undergoing COH. Despite initial negative PCR testing, patients may convert to positive over the course of a COH cycle and not demonstrate symptoms. Strict personal protective equipment and social distancing use is essential to protect patients and staff alike.