Emotional Impact of Reduced Access to Assisted Reproductive Care.

OBJECTIVE: To evaluate the impact of cessation of fertility services on patients with infertility. STUDY DESIGN: A cross-sectional, anonymous mail survey was conducted in a university hospital setting. A total of 281 female infertility patients treated from 2003-2006 were mailed surveys. The main outcome measures of the study were the Perceived Stress Scale 10 (PSS-10) and the Impact of Events Scale (IES). RESULTS: Of the 281 patients, 175 (62.3%) responded to the questionnaire. Of those, 51 (29.1%) reported being affected by the closure. The majority (58.9%) reported a somewhat or very negative impact on their perceived quality of life. Affected patients were more likely than unaffected patients to have an elevated PSS-10 result (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.04-4.3). No significant difference was seen in IES results, with 90.2% of affected and 81.5% of unaffected patients scoring in the high distress range (OR 2.1, 95% CI 0.77-5.65). Self-reported average stress levels were reduced following news of resumption of services (3.3, scale 1-10) as compared to both prior to (5.1) and during (7.4) the closure. CONCLUSION: When fertility services are discontinued, there may be significant emotional distress among the population affected. Health care providers should be aware of the impact infertility has on stress-coping and quality of life and be prepared to offer psychological services.

Peroxides in mineral oil used for in vitro fertilization: defining limits of standard quality control assays.

PURPOSE: To determine the relative sensitivities of the 1 and 2-cell mouse embryo assays (MEA) and the human sperm motility assay (HSMA) for peroxides in mineral oil. The effect of peroxide on blastocyst cell number and apoptosis was also studied. METHODS: One and two-cell MEA and HSMA were performed using mineral oil containing cumene hydroperoxide (CH). RESULTS: The 1-cell MEA was twice as sensitive as the 2-cell MEA and 20-times more sensitive than the HSMA for CH in mineral oil. The sensitivity of the 1-cell MEA doubled when embryos were cultured individually versus group culture. CH decreased blastocyst cell number in a dose dependent manner. CONCLUSIONS: Individually cultured 1-cell embryos had the highest sensitivity for peroxides in mineral oil. Current quality control assays, including group cultured murine embryos and human sperm motility, have limited sensitivity for peroxides in mineral oil and may not detect levels of peroxides that cause sub-lethal cellular damage.

Treatment of ovarian hyperstimulation syndrome using a dopamine agonist and gonadotropin releasing hormone antagonist: a case series.

OBJECTIVE: To describe an outpatient treatment protocol for ovarian hyperstimulation syndrome (OHSS) that results in rapid normalization of symptoms with minimal side effects. DESIGN: Case series. SETTING: Midwestern academic reproductive endocrinology division. PATIENT(S): Four consecutive patients, diagnosed with OHSS, who presented after oocyte retrieval but before embryo transfer. INTERVENTION(S): All embryos were frozen and each patient was treated with the same dopamine agonist and GnRH antagonist protocol. MAIN OUTCOME MEASURE(S): Daily weights, days to resolution of clinical symptoms, side effects of the treatment protocol, and whether or not acute care or hospitalization was necessary. RESULT(S): The most rapid weight loss was within the first 5 days of treatment. The average time to resolution of clinical symptoms was 5.75 days. No side effects were reported and no patients required acute care or hospitalization. CONCLUSION(S): Dopamine agonists and GnRH antagonists, when given together at the time of diagnosis of OHSS, appear to work rapidly and effectively to diminish the clinical symptoms of the disease. The potential benefit of finding an outpatient treatment for OHSS with rapid onset and minimal side effects warrants further investigation into this protocol.

Ovarian stromal hyperthecosis: sonographic features and histologic associations.

OBJECTIVE: Ovarian stromal hyperthecosis (SH) has variable clinical importance but can cause hyperandrogenism, particularly in premenopausal women. Sonography is often used to evaluate the ovaries of women with hyperandrogenism, but there is little published regarding the sonographic appearance of SH. The primary purpose of this study was to describe the sonographic features of SH. METHODS: A computerized search of our institution's pathology and imaging databases from 1996 through 2007 was performed to identify patients with histologically proven SH who had pelvic sonography before surgery. Sonograms and histologic findings were reviewed in each case. RESULTS: Twenty ovaries with SH were identified, occurring in 14 patients with a mean age of 59.8 years (range, 36-83 years). The SH was bilateral in 6 patients, unilateral in 6, and of uncertain laterality in 2 with a unilateral oophorectomy. Sonographic findings were as follows: 5 normal, 1 with a hemorrhagic cyst (later resolved) and otherwise normal, 3 enlarged but otherwise normal, 1 with a solid mass due to the nodular form of SH, 1 with a solid mass due to a fibroma, 2 with polycystic ovaries, and 7 not seen. Six of the 14 patients (43%) also had an ovarian fibrothecoma. CONCLUSIONS: Ovarian SH has variable sonographic features. Most commonly, the affected ovaries are either normal or slightly enlarged. A solid mass may infrequently be visible, and polycystic ovary syndrome changes may coexist with SH. A possible association of SH with fibrothecoma was also noted, which to our knowledge has not been previously reported.

Preimplantation genetic screening in a case of recurrent trisomy 21 offspring.

OBJECTIVE: To describe a unique case of recurrent aneuploidy and the use of preimplantation genetic screening (PGS). DESIGN: Case report. SETTING: Midwest academic medical center. PATIENT(S): A 36-year-old woman with two trisomy 21 offspring. INTERVENTION(S): Preimplantation genetic screening. MAIN OUTCOME MEASURE(S): Karyotype of embryos, liveborn eukaryotic infant. RESULT(S): Preimplantation genetic screening was performed on three cryopreserved embryos, followed by a two-embryo transfer yielding a eukaryotic infant. CONCLUSION(S): Preimplantation genetic screening may prove to be useful as a diagnostic tool to help ensure a euploid pregnancy when termination is not a viable option for a couple.

Magnetic resonance-guided focused ultrasound surgery.

Uterine leiomyomas pose a significant health issue to reproductive-age women. Many women desire uterine conservation, and previously safe and efficacious therapies have been limited. Magnetic resonance-guided focused ultrasound surgery is a new noninvasive therapy that has been proven to be both safe and efficacious in the treatment of fibroids.