Knowledge of ovarian reserve and reproductive choices.

OBJECTIVE: To determine the factors that influence the reproductive choices of health care professionals, and to assess whether knowledge of ovarian reserve would modify those choices. METHOD: A cross-sectional survey utilizing anonymous questionnaires that assessed demographics, knowledge, attitudes and choices of female and male health care professionals between the ages of 20-55 (N = 185) who work at an academic medical center RESULT(S): Of the 185 respondents, 75% were female, 35% were residents and 35% were married. Among those who were delaying childbearing 39% wanted to complete their education, 25% had no identified partner, 10% were too active professionally and 4% could not afford children at the time. If testing of the individual or individual's partner indicated diminished ovarian reserve, 48% of those responding would try to have a child sooner, 21% would opt for oocyte cryopreservation, 7% would try to find a partner sooner, 7% would pursue adoption, and 3% would select embryo cryopreservation. Only 14% would not actively pursue treatment or make lifestyle changes. These results varied significantly with marital status but did not differ between participants with and without children. Similarly, choices did not vary significantly with religious belief or ethnicity. CONCLUSION(S): Increased information about a woman's reproductive reserve would lead individuals to modify life choices. Physicians caring for reproductive-age women and men should inquire about their childbearing plans, and educate those who are postponing childbearing regarding the normal pattern of reproductive decline.

Assessing morphokinetic parameters via time lapse microscopy (TLM) to predict euploidy: are aneuploidy risk classification models universal?

PURPOSE: To determine if Aneuploidy Risk Classification Models are predictive of euploidy/aneuploidy amongst IVF facilities. METHODS: We retrospectively applied key time lapse imaging events of embryos (Campbell et al.[5, 6]) to stratify embryos into 3 groups: low, medium and high risk of aneuploidy. The actual ploidy results (from array comparative genomic hybridization) were compared with expectations [5, 6]. Sources of variability in morphokinetic parameters were determined using Analysis of Variance (ANOVA). RESULTS: The model failed to segregate euploid embryos from aneuploid embryos cultured at our facility. Further analysis indicated that the variability of embryos among patients was too great to allow selection of euploid embryos based on simple morphokinetic thresholds. Clinical selection of embryos based on morphokinetics alone is unlikely to identify euploid embryos accurately for transfer or yield higher rates of live delivery. CONCLUSIONS: The use of non-invasive morphokinetics is unlikely to discriminate aneuploid from euploid embryos. Further, it does not approach the accuracy of preimplantation genetic screening with array comparative genomic hybridization.

Experiences in fertility preservation: lessons learned to ensure that fertility and reproductive autonomy remain options for cancer survivors.

PURPOSE: Assess fertility preservation (FP) measures chosen by patients newly diagnosed with malignancy and their outcomes. METHODS: Reproductive-age patients referred for FP underwent counseling and elected cryopreservation vs. no treatment. Outcome measures included ovarian stimulation, FP choice, oocytes/zygotes retrieved/cryopreserved and pregnancy outcome. RESULTS: From 2005 to 2012, 136 patients were counseled with 124 electing treatment: 83 oocyte-only, 21 oocyte + zygote and 20 zygote-only cryopreservation. Age, partnership and financial status factored into FP choice. Treatment was completed in 12 ± 2 days with 14 ± 11 metaphase-II oocytes harvested and cryopreserved/cycle. Eight patients returned to attempt pregnancy; three succeeded. CONCLUSIONS: Our data demonstrate that oocyte and/or zygote banking are feasible FP options for women with malignancy; given the choice, the majority elected oocyte cryopreservation, highlighting desire for reproductive autonomy. Continued growth and research, combined with interdisciplinary communication, will ensure that appropriate candidates are offered FP and the potential for future parenthood, an important quality-of-life marker for survivors.

Ectopic pregnancy in a cesarean-section scar: the patient >6 weeks into an ectopic pregnancy, underwent local treatment.

Cesarean scar ectopic pregnancies may be difficult to diagnose and may result in uterine rupture or hysterectomy. Based on location and vascularity, especially in the presence of fetal cardiac activity, local treatment with transvaginal ultrasound-guided injection of methotrexate is an excellent option which also optimizes the chance for fertility preservation.

Oocyte cryopreservation as a fertility preservation measure for cancer patients.

Advances in cancer treatment have allowed women to live longer, fuller lives. However, gonadotoxic therapies used to effect cancer 'cures' often significantly impair a woman's reproductive potential. Thus, in accordance with improved survival rates,there is an increase in demand for fertility preservation. Initially, fertility preservation was limited to embryo cryopreservation;therefore, the number of patients enrolling was relatively low. Recently, substantial improvements have increased available options, specifically oocyte cryopreservation, thereby expanding and altering the make-up of the patient population under going treatment for fertility preservation. Patient diversity requires the treating physician(s) to be cognizant of issues specific to cancer type and stage. Furthermore, patients often have comorbidities which must be attended to and addressed. Although not all patients will be candidates for, or will elect to pursue, fertility preservation, all should receive counselling regarding their options. This practice will ensure that the reproductive rights of those patients facing impending sterility are maintained. Here, fertility preservation protocols, practices and special considerations, categorized by most frequently encountered cancer types, are reviewed to guide reproductive endocrinologists in the management of fertility preservation in such patients. The formation of a multidisciplinary patient-structured team will ensure a successful, yet safe, fertility-preservation outcome .