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1.
Reprod Biomed Online ; 34(2): 154-161, 2017 Feb.
Article in English | MEDLINE | ID: mdl-27887992

ABSTRACT

The aim of this study was to evaluate if premature progesterone elevation on the last day of assisted reproduction technique stimulation contributes to racial disparities in IVF outcome. A total of 3289 assisted reproduction technique cycles were evaluated in Latino, Asian, African American, and white women. Live birth was more likely in white women (42.6%) compared with Asian (34.8%) and African American women (36.3%), but was similar to Latino women (40.7%). In all racial groups, progesterone was negatively associated with live birth and the negative effect of progesterone persisted when adjusting for confounders. Although the effect of elevated progesterone was similar in all racial groups, the prevalence of elevated progesterone differed. Progesterone > 1.5 ng/ml occurred in only 10.6% of cycles in white women compared with 18.0% in Latino and 20.2% in Asian women. Progesterone > 2 ng/ml occurred in only 2.3% of cycles in white women compared with 6.3% in Latino, 5.9% in Asian and 4.4% in African American women. The increased prevalence of premature elevated progesterone persisted when controlling for IVF stimulation parameters. In conclusion, premature progesterone elevation had a negative effect on live birth in all racial groups studied. The prevalence of elevated progesterone was higher in racial minorities.


Subject(s)
Fertilization in Vitro , Oocytes/cytology , Pregnancy Outcome/ethnology , Progesterone/blood , Adult , Black or African American , Asian People , Black People , Chorionic Gonadotropin/administration & dosage , Embryo Transfer , Female , Health Status Disparities , Humans , Live Birth , Ovulation Induction , Pregnancy , Pregnancy Rate , Prevalence , Reproductive Techniques, Assisted , Retrospective Studies , Treatment Outcome , White People
2.
Fertil Steril ; 102(2): 435-9, 2014 Aug.
Article in English | MEDLINE | ID: mdl-24951366

ABSTRACT

OBJECTIVE: To compare the cost effectiveness of proceeding with oocyte retrieval vs. converting to intrauterine insemination (IUI) in patients with ≤4 mature follicles during assisted reproductive technology (ART) cycles. DESIGN: Probabilistic decision analysis. The cost effectiveness of completing ART cycles in poor responders was compared to that for converting the cycles to IUI. SETTING: Not applicable. PATIENT(S): Not applicable. INTERVENTION(S): Cost-effectiveness analysis. MAIN OUTCOME MEASURE(S): Cost effectiveness, which was defined as the average direct medical costs per ongoing pregnancy. RESULT(S): In patients with 1-3 mature follicles, completing ART was more cost effective if the cost of a single ART cycle was between $10,000 and $25,000. For patients with 4 mature follicles, if an ART cycle cost<$18,025, it was more cost effective to continue with oocyte retrieval than to convert to IUI. CONCLUSION(S): In patients with ≤4 mature follicles following ovarian stimulation in ART cycles, it was on average more cost effective to proceed with oocyte retrieval rather than convert to IUI. However, important factors, such as age, prior ART failures, other fertility factors, and medications used in each individual case need to be considered before this analysis model can be adapted by individual practices.


Subject(s)
Cost-Benefit Analysis , Fertility Agents, Female/administration & dosage , Fertility Agents, Female/economics , Health Care Costs , Infertility/therapy , Insemination, Artificial/economics , Ovarian Follicle/drug effects , Ovulation Induction/economics , Ovulation/drug effects , Decision Support Techniques , Decision Trees , Drug Costs , Female , Fertility Agents, Female/adverse effects , Humans , Infertility/diagnosis , Infertility/physiopathology , Insemination, Artificial/adverse effects , Models, Economic , Oocyte Retrieval/economics , Ovulation Induction/adverse effects , Pregnancy , Pregnancy Rate , Risk Factors , Treatment Outcome
3.
J Reprod Med ; 57(9-10): 415-20, 2012.
Article in English | MEDLINE | ID: mdl-23091989

ABSTRACT

OBJECTIVE: To compare pregnancy outcomes between shorter and longer in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles using GnRH antagonist protocol. STUDY DESIGN: Retrospective cohort analysis at a large military academic hospital. A total of 351 patients underwent 412 IVF/ICSI cycles using a GnRH antagonist protocol from September 2002 through May 2008. Clinical pregnancy and live birth rates for all IVF/ICSI cycles were compared independently for both total length of ovarian stimulation with gonadotropins (< 10 days vs. > or = 10 days) and GnRH antagonist use (< 4 days vs. > or = 4 days), respectively. RESULTS: Clinical pregnancy rates were 54.6% among cycles with total gonadotropin use <10 days vs. 48.6% for those cycles > or = 10 days, odds ratio 0.82 (0.53-1.27); live birth rates were 50.0% vs. 47.7%, odds ratio 0.91 (0.59-1.42). Clinical pregnancy rates were 54.0% among cycles with GnRH antagonist use < 4 days vs. 52.8% with GnRH antagonist use > or = 4 days, odds ratio 0.95 (0.62-1.45); live birth rates were 46.8% vs. 50.4%, odds ratio 1.15 (0.76-1.76). CONCLUSION: Clinical pregnancy and live birth rates are not adversely affected by longer IVF/ICSI cycles using GnRH antagonists.


Subject(s)
Fertilization in Vitro , Gonadotropin-Releasing Hormone/analogs & derivatives , Hormone Antagonists/therapeutic use , Ovulation Induction/methods , Adult , Chorionic Gonadotropin/administration & dosage , Cohort Studies , Female , Gonadotropin-Releasing Hormone/antagonists & inhibitors , Gonadotropin-Releasing Hormone/therapeutic use , Humans , Live Birth , Oocyte Retrieval , Ovarian Follicle , Pregnancy , Pregnancy Rate , Reproductive Control Agents/administration & dosage , Retrospective Studies , Sperm Injections, Intracytoplasmic
4.
J Clin Microbiol ; 42(8): 3850-2, 2004 Aug.
Article in English | MEDLINE | ID: mdl-15297547

ABSTRACT

We report a prospective comparison of human immunodeficiency virus type 1 testing by enzyme immunoassay and Western blot with four rapid tests of 486 subjects performed in rural Kenya. Rapid test sensitivity was 100%. Specificity ranged from 99.1 to 100%. Combined use of two Food and Drug Administration-approved rapid tests yielded a single false-positive result.


Subject(s)
Acquired Immunodeficiency Syndrome/diagnosis , HIV Infections/diagnosis , HIV-1/isolation & purification , Acquired Immunodeficiency Syndrome/epidemiology , Blotting, Western/methods , HIV Infections/epidemiology , Humans , Immunoenzyme Techniques/methods , Kenya/epidemiology , Mass Screening/methods , Predictive Value of Tests , Prevalence , Reproducibility of Results , Sensitivity and Specificity
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