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1.
Fertil Steril ; 96(4): 856-9, 2011 Oct.
Article in English | MEDLINE | ID: mdl-21851938

ABSTRACT

OBJECTIVE: To evaluate the impact of multinucleation of a sibling blastomere of day 2 embryos on the rate of aneuploidy detected by day 3 preimplantation genetic screening (PGS) biopsy and the effect on subsequent implantation and pregnancy rates. DESIGN: Retrospective cohort study. SETTING: University-based IVF center. PATIENT(S): A total of 141 couples undergoing their first IVF-PGS cycle for idiopathic recurrent pregnancy loss (RPL) or multiple failed IVF implantations. INTERVENTION(S): Biopsy of single-nucleated blastomeres for PGS analysis of chromosomes X, Y, 13, 15, 16, 17, 18, 21, and 22 by fluorescence in situ hybridization. MAIN OUTCOME MEASURE(S): Aneuploidy, implantation, and pregnancy rates. RESULT(S): PGS revealed an increased incidence of aneuploidy when comparing multinucleated day 2 embryos with single-nucleated embryos (85% vs. 78%; relative risk 0.92 (95% confidence interval 0.84-1.00). Transfer of single-nucleated euploid embryos resulted in clinical pregnancy and implantation rates of 28% and 24%. Transfer of multinucleated euploid embryos resulted in no implantations. CONCLUSION(S): The presence of multinucleated blastomeres on day 2 of embryo development, 1 day before biopsy, predicts an increase of aneuploidy and poor pregnancy outcomes in IVF-PGS cycles.


Subject(s)
Blastomeres/physiology , Embryo Transfer , Fertilization in Vitro , Genetic Testing , Preimplantation Diagnosis , Siblings , Adult , Aneuploidy , Blastomeres/chemistry , Cell Nucleus/physiology , Cohort Studies , Embryo Transfer/standards , Female , Fertilization in Vitro/standards , Genetic Testing/standards , Humans , Organ Culture Techniques , Pregnancy , Pregnancy Outcome/genetics , Preimplantation Diagnosis/standards , Retrospective Studies
2.
Fertil Steril ; 95(3): 1130-2, 2011 Mar 01.
Article in English | MEDLINE | ID: mdl-21071020

ABSTRACT

A retrospective review of 237 initial, fresh nondonor IVF cycles in which all embryos generated during the cycle were transferred on either day 2 (n = 109) or day 3 (n = 128) were evaluated with regards to reproductive outcomes. Patients who underwent a day 2 ET had similar conception (18% vs. 16%; relative risk [RR], 1.1; 95% confidence interval [CI], 0.64-1.95), clinical pregnancy (13% vs. 16%; RR, 0.8; 95% CI, 0.44-1.55), implantation (6% vs. 7%; RR, 0.9; 95% CI, 0.50-1.68), and live-birth (10% vs. 16%; RR, 0.7; 95% CI, 0.32-1.29) rates as those who underwent a day 3 ET.


Subject(s)
Embryo Transfer/methods , Fertilization in Vitro , Pregnancy Outcome , Pregnancy Rate , Adult , Cleavage Stage, Ovum , Embryo Transfer/statistics & numerical data , Female , Humans , Pregnancy , Pregnancy Outcome/epidemiology , Retrospective Studies , Risk Factors , Time Factors
3.
4.
Fertil Steril ; 92(4): 1497.e13-1497.e16, 2009 Oct.
Article in English | MEDLINE | ID: mdl-19683711

ABSTRACT

OBJECTIVE: To describe laparoscopically assisted hysteroscopy as a unique surgical intervention for a cesarean section scar ectopic pregnancy. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 44-year-old woman, pregnant at 5 weeks and 6 days' gestational age with a cesarean section scar ectopic pregnancy. INTERVENTION(S): The patient underwent serial transvaginal ultrasound examinations with Doppler flow studies, followed by a laparoscopically assisted operative hysteroscopy for evacuating the cesarean scar ectopic pregnancy. MAIN OUTCOME MEASURE(S): Conservation of the uterus, fertility preservation. RESULT(S): Successful conservative surgical treatment of cesarean section scar ectopic pregnancy. CONCLUSION(S): Conservative laparoscopically assisted operative hysteroscopy can be used successfully in hemodynamically stable patients with a cesarean section scar ectopic pregnancy.


Subject(s)
Cesarean Section, Repeat/adverse effects , Cicatrix/complications , Hysteroscopy/methods , Laparoscopy , Pregnancy, Ectopic/surgery , Adult , Cicatrix/pathology , Diagnosis, Differential , Female , Humans , Pregnancy , Pregnancy, Ectopic/diagnosis , Pregnancy, Ectopic/etiology
5.
Fertil Steril ; 92(6): 2047-9, 2009 Dec.
Article in English | MEDLINE | ID: mdl-19591990

ABSTRACT

In this prospective, randomized study, waiting for the lead follicle to reach 14 mm before initiating GnRH antagonist administration effectively prevents an LH surge and ovulation during an IVF cycle. Furthermore, delaying GnRH start until the dominant follicle reaches 14 mm neither impacts the clinical pregnancy, implantation, or live birth rates nor increases the incidence of severe ovarian hyperstimulation syndrome.


Subject(s)
Embryo Implantation , Fertilization in Vitro/methods , Gonadotropin-Releasing Hormone/antagonists & inhibitors , Ovarian Follicle/anatomy & histology , Pregnancy Outcome , Adult , Birth Rate , Female , Humans , Infant, Newborn , Luteinizing Hormone/metabolism , Ovarian Hyperstimulation Syndrome/prevention & control , Ovulation/drug effects , Pregnancy , Prospective Studies , Time Factors
6.
Fertil Steril ; 91(1): 101-5, 2009 Jan.
Article in English | MEDLINE | ID: mdl-18249397

ABSTRACT

OBJECTIVE: To evaluate the impact on the rates of clinical pregnancy and live birth of polyploidy after intracytoplasmic sperm injection (ICSI). DESIGN: Retrospective cohort study. SETTING: University-based IVF center. PATIENT(S): One hundred forty-three patients undergoing their first IVF-embryo transfer cycle requiring ICSI. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Patients were divided into two groups on the basis of the proportion of post-ICSI triploid fertilization that was observed at the time of fertilization assessment: group 1 included patients with 20% 3PN zygotes. The primary outcomes compared between groups were pregnancy and implantation rates; secondary outcome measures included clinical-pregnancy rate and live-birth rate per embryo transfer. RESULT(S): Pregnancy, implantation, clinical-pregnancy, and live-birth rates were significantly higher in the cohort of patients who had 20% of zygotes appearing triploid (relative risk [RR] for pregnancy, 2.4 [95% confidence interval {CI}, 1.22-4.77]; RR for implantation, 2.6 [95% CI, 1.17-5.56]; RR for clinical pregnancy, 2.8 [95% CI, 1.16-6.85]; and RR for live birth, 2.6 [95% CI, 1.06-6.38]). The proportion of 3PN zygotes after ICSI had a statistically significant inverse relationship to clinical-pregnancy rate. CONCLUSION(S): The proportion of triploid zygotes after ICSI serves as a negative prognostic indicator for IVF cycle outcome. This finding suggests that triploidy proportion is a surrogate marker of oocyte competence that represents the integrity of the oocytes in the entire recruited cohort. Such findings therefore may influence recommendations for embryo transfer number and freezing of supernumerary embryos.


Subject(s)
Fertilization in Vitro/methods , Fertilization , Polyploidy , Sperm Injections, Intracytoplasmic/methods , Embryo Implantation/physiology , Embryonic Development/physiology , Female , Fertilization in Vitro/standards , Humans , Infant, Newborn , Male , Pregnancy , Pregnancy Outcome , Pregnancy, Multiple/statistics & numerical data , Sperm Injections, Intracytoplasmic/standards , Twins
7.
Fertil Steril ; 91(6): 2414-8, 2009 Jun.
Article in English | MEDLINE | ID: mdl-18691706

ABSTRACT

OBJECTIVE: To determine if ethnicity influences IVF birth outcome. DESIGN: Retrospective cohort study. SETTING: University-based IVF program. PATIENT(S): All African American women (n = 71) and Caucasian women (n = 180) who underwent initial fresh, nondonor IVF/embryo transfer (ET) cycles between January 1, 2004 and December 31, 2005. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Gonadotropin dose, duration of stimulation, peak estradiol levels, oocyte yield, implantation, clinical pregnancy, and live birth rates. RESULT(S): African American women generated significantly fewer embryos than Caucasian women (5.3 +/- 3.7 vs. 6.6 +/- 4.8) despite having similar ages, day 3 FSH, peak estradiol levels, length of stimulation, and number of oocytes retrieved. In addition, compared with Caucasian women, African American had significantly greater body mass indices (26.5 +/- 5.2 vs. 23.7 +/- 4.8) and required significantly more total gonadotropin (IU) (4,791 +/- 2,161 vs. 3,725 +/- 2,005) for ovarian stimulation. African American women were more likely to have uterine fibroids (21% vs. 3%) and tubal factor infertility (23% vs. 9%). Caucasian women were more likely to have unexplained infertility (53% vs. 32%). Differences in embryo yield between patient groups persisted after accounting for differences in infertility diagnosis and prevalence of fibroids. Biochemical, clinical pregnancy, and live birth rates as well as implantation rates (number of sacs visualized/number of embryos transferred) did not significantly differ between groups. CONCLUSION(S): Although African Americans yield fewer embryos than Caucasian women with IVF, these ethnic groups do not seem to differ with regard to IVF pregnancy outcomes.


Subject(s)
Ethnicity , Fertilization in Vitro/statistics & numerical data , Pregnancy Outcome , Adult , Black People , Cohort Studies , Embryo Transfer , Estradiol/blood , Female , Humans , Oocytes/cytology , Oocytes/physiology , Ovulation Induction/methods , Pregnancy , Retrospective Studies , White People
8.
Fertil Steril ; 89(6): 1665-9, 2008 Jun.
Article in English | MEDLINE | ID: mdl-17727848

ABSTRACT

OBJECTIVE: To evaluate the impact of abnormal sperm morphology on the rates of aneuploidy, implantation, and clinical pregnancy. DESIGN: Retrospective cohort study. SETTING: University-based IVF center. PATIENT(S): Fifty-two patients undergoing their first IVF-preimplantation genetic diagnosis (PGD) cycle. INTERVENTION(S): The PGD analysis of embryos. MAIN OUTCOME MEASURE(S): Patients were divided into two groups based on sperm morphology: teratospermic group (TSG) and normal sperm group (NSG). The primary outcome measures of rates of aneuploidy, implantation, clinical pregnancy rate (PR) per cycle, and clinical PR per embryo transfer were compared between TSG and NSG according to PGD analysis results. RESULTS: A higher percentage of normal embryos was seen in the NSG (32%) versus the TSG (20%). Overall, 30% of IVF-PGD cycles had no normal embryos for transfer. The clinical PR per cycle was 44% in the NSG compared to 14% in the TSG (relative risk [RR] = 3.19; 95% confidence interval [CI] 1.1-9.0). A similar trend was noted with the clinical PR per embryo transfer with 57% patients becoming pregnant in the NSG versus 20% patients in the TSG (RR = 2.76; 95% CI 1.2-7.2). Implantation was twice as likely to occur in the NSG as compared to TSG (RR = 2.5; 95% CI 1.1-7.2). CONCLUSION(S): Rates of euploidy, implantation, clinical PR per cycle, and clinical PR per embryo transfer were higher in the NSG compared to the TSG, suggesting that sperm morphology plays an important role in the outcome of IVF-PGD cycles.


Subject(s)
Preimplantation Diagnosis/methods , Spermatozoa/cytology , Adult , Aneuploidy , Blastocyst/pathology , Blastocyst/physiology , Embryo Implantation , Embryo Transfer/statistics & numerical data , Embryo, Mammalian/cytology , Embryo, Mammalian/physiology , Female , Fertilization in Vitro/methods , Humans , Male , Oocyte Retrieval , Oocytes/cytology , Pregnancy , Pregnancy Rate , Preimplantation Diagnosis/statistics & numerical data , Spermatozoa/abnormalities , Spermatozoa/physiology
9.
Fertil Steril ; 88(3): 718-20, 2007 Sep.
Article in English | MEDLINE | ID: mdl-17320876

ABSTRACT

The objective of this study was to assess the impact of assisted hatching (AH) on pregnancy rate (PR), clinical pregnancy rate (CPR), and implantation rate (IR) after a single failed, fresh, nondonor IVF cycle. Accordingly, we report that patients with one prior implantation failure benefit from AH with improved PR, CPR, and IR in a subsequent cycle.


Subject(s)
Fertilization in Vitro/statistics & numerical data , Female , Humans , Male , Pregnancy , Pregnancy Outcome , Prognosis
10.
Int J Fertil Womens Med ; 51(3): 136-9, 2006.
Article in English | MEDLINE | ID: mdl-17039858

ABSTRACT

OBJECTIVE: To assess the rate of blastocyst development (BDR) from embryos remaining in culture after day-3 embryo transfer (ET), and its relationship to cause of infertility. STUDY DESIGN: Retrospective cohort study in tertiary-care IVF Center. Blastocyst development rate (BDR) after day-3 ET was assessed in 126 women who underwent either conventional IVF or ICSI. RESULTS: Mean age, early follicular FSH levels, number of 2PN zygotes, number of excess embryos, and number of ET were similar between patients that underwent IVF and ICSI. Overall, 20% of extra embryos from conventional IVF patients developed into blastocysts compared to 14% of embryos obtained from ICSI. Cause of infertility did not affect BDR, even in patients who required ICSI due to male factors. CONCLUSIONS: Low rates of blastocyst development from excess embryos are similar between IVF and ICSI patients. Only 15 to 25% of excess embryos left in culture develop into blastocysts, regardless of cause of infertility. Physicians and patients can use this information to adjust both AR treatment protocols and patient expectations.


Subject(s)
Blastocyst , Embryo Transfer/statistics & numerical data , Embryonic Development/physiology , Fertilization in Vitro/statistics & numerical data , Pregnancy Rate , Sperm Injections, Intracytoplasmic/statistics & numerical data , Adult , Blastocyst/physiology , Cohort Studies , Culture Techniques , Female , Fertilization in Vitro/methods , Humans , Pregnancy , Retrospective Studies , Sperm Injections, Intracytoplasmic/methods , Statistics, Nonparametric
11.
Contraception ; 68(4): 273-9, 2003 Oct.
Article in English | MEDLINE | ID: mdl-14572891

ABSTRACT

Spermicides containing nonoxynol-9 (N-9) may increase HIV transmission. In women, intravaginal N-9 is found in the uterus shortly after its insertion. Exposure of the female upper reproductive tract to N-9 may alter epithelial integrity, thereby increasing HIV transmission risk. Our goal was to characterize the histological effects of N-9 on uterine epithelium in an animal model. Female mice were exposed to intravaginal or intrauterine Advantage-S (N-9), Replens, K-Y(R) jelly or water. After various exposure times, mice were sacrificed and stained uterine tissue sections were analyzed by a pathologist blinded to treatment.Intravaginal and intrauterine N-9 administration resulted in disruption of uterine epithelium compared to Replens, K-Y jelly or water. N-9 caused rapid (within 10 min), focal, uterine epithelial sloughing and complete epithelial loss within 24 h. Epithelial regeneration began 48 h after exposure N-9 and was completely restored within 72 h; the new epithelial layer, however, was composed of cuboidal cells instead of normally present columnar cells. In addition, hemorrhage and necrosis were present are all time points examined. Our results demonstrate for the first time that N-9 has a deleterious effect on uterine epithelium. Although these results were observed in a mouse model, similar disruption of the upper reproductive tract epithelium in women by N-9 may facilitate HIV infection and serve as an unrecognized portal of human HIV transmission.


Subject(s)
Nonoxynol/adverse effects , Spermatocidal Agents/adverse effects , Uterus/drug effects , Administration, Intravaginal , Animals , Disease Models, Animal , Epithelium/drug effects , Female , HIV Infections/prevention & control , Mice , Mice, Inbred Strains , Nonoxynol/administration & dosage , Spermatocidal Agents/administration & dosage , Uterus/pathology
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