To evaluate whether adjusting timing of modified natural cycle frozen embryo transfer (mNC-FET) 1 day earlier in the setting of a spontaneous LH surge has an impact on pregnancy outcomes. This retrospective cohort study evaluated all mNC-FET with euploid blastocysts from May 1, 2016 to March 30, 2019, at a single academic institution. Standard protocol for mNC-FET included ultrasound monitoring and hCG trigger when the dominant follicle and endometrial lining were appropriately developed. Patients had serum LH, estradiol, and progesterone checked on day of trigger. If LH was ≥ 20 mIU/mL, trigger was given that day and FET was performed 6 days after surge (LH/HCG+6), with the intent of transferring 5 days after ovulation. If LH was < 20 mIU/mL, FET was performed 7 days after trigger (hCG+7). Primary outcomes included clinical pregnancy and live birth rates. To account for correlation between cycles, a generalized estimating equation (GEE) method for multivariable logistic regression was used. Four hundred fifty-three mNC-FET cycles met inclusion criteria, of which 205 were in the LH/HCG+6 group and 248 were in the HCG+7 group. The overall clinical pregnancy rate was 64% and clinical miscarriage rate was 4.8%, with similar rates between the two groups. The overall live birth rate was 60.9% (61.0% in LH/HCG+6 group and 60.9% in HCG+7 group). After implementing GEE, the odds of CP (aOR 0.97, 95% CI [0.65–1.45], p = 0.88) and LB (aOR 0.98, 95% CI [0.67–1.45], p = 0.93) were similar in both groups. In our study cohort, mNC-FET based on LH/HCG+6 versus HCG+7 had similar pregnancy outcomes.

Endometriosis is one of the most common gynecologic disorders and is significantly more prevalent in the setting of infertility. The prevalence of endometriosis in infertile women ranges from 25% to 50% compared to 5% in fertile women. Successful laparoscopic management of all stages of endometriosis was reported as early as 1986. This has revolutionized the management of endometriosis. The benefits of surgical therapy for infertility associated with endometriosis have been well documented.

overweight (25-29.9kg/m 2 ), obese (30-34.9kg/m 2 ), and severely obese (R35 kg/m 2 ).The main outcome of the study was live birth, which was analyzed by univariate and multivariate analysis, adjusted for recipients' race, status of sperm, day of ET, number of transferred embryos and embryo quality.Secondary outcomes were ovarian response to stimulation, biochemical, clinical, and ongoing pregnancy.RESULTS: Mean age was 26.1 years (4.8), 41.7 (4.7), 42.4 (6.9) in donors, recipients and male partners respectively.Mean (SD) BMI was 22.7 kg/m 2 (3.2), 23.7 (4.3), 25.6 (3.5) in donors, recipients and male partners respectively.Live birth rate was 37.9%, 33.7%, 32.3%, 23.9% and 21.7% for underweight, normoweight, overweight, and obese recipients, respectively.Live birth rate in recipients was slightly but significantly affected by BMI in donors (OR 0.98 [0.96-0.99]),recipients (OR 0.98 [0.97-0.99])and male partners ).Biochemical, clinical, and ongoing pregnancy rates were similarly slightly affected by BMI.We obtained 14.8 (SD 7.3), 15.0 (SD 7.5), 14.3 (SD 6.9), 12.7 mature oocytes (SD 6.1) for underweight, normoweight and overweight donors, respectively.Ovarian response to stimulation was significantly reduced in underweight compared to normoweight donors after adjustment (B¼-1.52.96%CI -2.83, -0.21; p<0.001), but not in overweight or obese ones.CONCLUSIONS: We found a weak but statistically significant negative association between BMI and live birth rate in oocyte donation cycles.However, the clinical relevance of this association remains to be defined.

BACKGROUND: Several studies have demonstrated a disparity in pregnancy outcome when comparing Asian and Caucasian women undergoing fresh in vitro fertilization (IVF) cycles. Despite controlling for embryo quality, this reproductive inequality persisted, suggesting that endometrial factors may be responsible for the lower implantation rate. The objective of this study was to investigate whether this difference was seen after frozen blastocyst transfer.METHOD(S): 58 frozen blastocyst transfers (FET) in Asian and Caucasian patients from December 2004 to December 2007 were reviewed. Patient demographics, treatment protocols and outcomes were collected. Only frozen, nondonor, nongestational carrier cycles with blastocyst transfer were included. If a patent had multiple frozen transfer cycles, only the first was included. Ethnicity was obtained by patient self-reporting questionnaires, where only women who self-identified as white/Caucasian or Asian were included. All embryos were blastocyts of 3BB quality or better upon freezing. Frozen cycles were either monitored natural cycles (NC) with HCG trigger and luteal support, or medicated using ovarian stimulation and hormonal replacement. Statistics were calculated using z test, Student t test, and χ2 test. Implantation rate was defined as the number of gestational sacs seen between 6 and 7 weeks per number of embryos transferred. Pregnancy rate equals the number of clinical pregnancies (with one or more gestational sacs) divided by the total number of patients.RESULT(S): In these 58 embryo transfers, there were 24 Asian and 34 Caucasian patients. Comparing the two groups, there was no difference in age at retrieval or transfer. There was, however, a difference in BMI (P=0.03), with Asian women having a lower BMI than Caucasians (mean BMI 22.0 kg/m2, and 24.2 kg/m2, respectively). There was no difference in distribution of FET treatment protocol (91.2% of Caucasians and 75% of Asians had NC FET), cycle length, endometrial thickness and number of embryos transferred between treatment groups. Implantation rates (IR)), pregnancy rates (PR), and live birth rates between both groups are shown in Table 2.Table 2Comparing FET Cycles Between Asian and Caucasian Ethnicity.Asian EthnicityCaucasian EthnicityP ValueAge at retrievala36.3336.090.795BMI (kg/m2)2224.220.034Cycle lengthb32.128.910.268Endometriumc8.528.570.930Embryos transferred1.922.210.153Implantation rate0.360.220.176Pregnancy rate37.5 (9/24)32.3 (11/34)0.900Live birth rate33.3 (8/24)23.5 (8/34)0.603a = mean age (years), b = mean cycle legth (days),c=meand endondtrial thickness (mm). Open table in a new tab DISCUSSION: Pregnancy outcomes were not statistically different in this small study of Asian and Caucasian women. There was a non-significant trend toward improved IR and LBR in the Asian population that deserves further study. This study suggests that if an endometrial factor is responsible for the difference in fresh IVF cycle outcomes, it may not persist in a FET cycles. Continued investigation is needed to determine whether stimulation protocols may have a negative effect on the endometrium in Asian patients. BACKGROUND: Several studies have demonstrated a disparity in pregnancy outcome when comparing Asian and Caucasian women undergoing fresh in vitro fertilization (IVF) cycles. Despite controlling for embryo quality, this reproductive inequality persisted, suggesting that endometrial factors may be responsible for the lower implantation rate. The objective of this study was to investigate whether this difference was seen after frozen blastocyst transfer. METHOD(S): 58 frozen blastocyst transfers (FET) in Asian and Caucasian patients from December 2004 to December 2007 were reviewed. Patient demographics, treatment protocols and outcomes were collected. Only frozen, nondonor, nongestational carrier cycles with blastocyst transfer were included. If a patent had multiple frozen transfer cycles, only the first was included. Ethnicity was obtained by patient self-reporting questionnaires, where only women who self-identified as white/Caucasian or Asian were included. All embryos were blastocyts of 3BB quality or better upon freezing. Frozen cycles were either monitored natural cycles (NC) with HCG trigger and luteal support, or medicated using ovarian stimulation and hormonal replacement. Statistics were calculated using z test, Student t test, and χ2 test. Implantation rate was defined as the number of gestational sacs seen between 6 and 7 weeks per number of embryos transferred. Pregnancy rate equals the number of clinical pregnancies (with one or more gestational sacs) divided by the total number of patients. RESULT(S): In these 58 embryo transfers, there were 24 Asian and 34 Caucasian patients. Comparing the two groups, there was no difference in age at retrieval or transfer. There was, however, a difference in BMI (P=0.03), with Asian women having a lower BMI than Caucasians (mean BMI 22.0 kg/m2, and 24.2 kg/m2, respectively). There was no difference in distribution of FET treatment protocol (91.2% of Caucasians and 75% of Asians had NC FET), cycle length, endometrial thickness and number of embryos transferred between treatment groups. Implantation rates (IR)), pregnancy rates (PR), and live birth rates between both groups are shown in Table 2. a = mean age (years), b = mean cycle legth (days),c=meand endondtrial thickness (mm). DISCUSSION: Pregnancy outcomes were not statistically different in this small study of Asian and Caucasian women. There was a non-significant trend toward improved IR and LBR in the Asian population that deserves further study. This study suggests that if an endometrial factor is responsible for the difference in fresh IVF cycle outcomes, it may not persist in a FET cycles. Continued investigation is needed to determine whether stimulation protocols may have a negative effect on the endometrium in Asian patients.

OBJECTIVE: Freezing excess embryos at the blastocyst stage offers the benefit of improved assessment of suitability for cryopreservation and is standard in many IVF centers. Potential uses for PGS and PGD are increasing. Patients who have excess embryos stored at the blastocyst stage may desire PGS but there is little data available on options for these patients. The objective of this report is to describe our preliminary experience of trophectoderm biopsy (TB) of frozen thawed blastocysts. DESIGN: Case series. MATERIALS AND METHODS: Patients desiring PGS on frozen blastocysts were included. All patients were treated with GnRH analogs, supplemental estrogen and progesterone according to standard FET protocols. Embryos were thawed the day prior to the day of biopsy. TB was performed in the morning and samples sent immediately to PGD testing facilities off-site. Results were available within a day, when embryo transfer would take place if embryos were appropriate for transfer. RESULTS: In a 4 year period of time, there were 7 patients who underwent 8 cycles of PGS-FET. 6 patients (7 cycles) utilized PGS using FISH and one underwent PGS with 24 chromosome micro-array testing. The mean maternal age at the time of embryo transfer was 38. On average 5.3 embryos were thawed per patient and 3.8 embryos were biopsied. 6 patients had embryos suitable for transfer and underwent transfer of 1-3 embryos. A total of 10 embryos were transferred resulting in 5 gestations with an implantation rate of 50%. Of the 5 clinical pregnancies, 2 had live births, 1 has an ongoing pregnancy with normal CVS, one had a miscarriage at 8 weeks of a trisomy 20 fetus, and one had a miscarriage at 7 weeks without chromosome analysis. CONCLUSION: Trophectoderm biopsy can be performed on cryopreserved embryos, and still maintain a good implantation rate and pregnancy rate. This preliminary report shows that day 6 embryo transfer is possible after TB if genetic testing results are obtainable within 26 hours of biopsy.

Background: Embryonic defects are the most frequently identified cause of first trimester miscarriage. Cytogenetic testing of products of conception (POC) has been shown to predict future pregnancy outcomes in studies of women with recurrent pregnancy loss (RPL), however little is known about the prognostic value of karyotype in first or second losses.Objective: The purpose of this study was to evaluate the value of the karyotype of sporadic miscarriages as a predictor of live birth in the subsequent pregnancy.Materials and Methods: Infertility patients were identified from an established database of first trimester miscarriages with available cytogenetic evaluations of POC. Medical records were reviewed for subsequent pregnancies, obstetric history, and fertility treatments. Subjects were included if they were first entered into the database at the time of the first or second miscarriage. Patients undergoing donor egg or PGD were excluded from this study. Subsequent live birth rate and miscarriage rates were compared using chi squared analysis, with P<0.05 considered significant.Tabled 1Normal karyotype (Group A)Abnormal karyotype (Group B)P valueNo. of Patients4885Mean age (range)34.5 ± 4.0 (27–44)35.6 ± 4.3 (23–45).14Mean CRL (mm)6.4 ± 4.6 (2–22)7.7 ± 5.3 (2–21).24No. of Previous live births0.17 ± 0.37 (0–1)0.23 ± 0.45 (0–2).21No. of Previous miscarriages0.13 ± 0.33 (0–1)0.27 ± 0.45 (0–1).02Method of conceptionIVF29 (60.4%)48 (57.3%)Non-IVF ovarian stimulation13 (27.1%)24 (27.1%)Natural cycles6 (12.5%)13 (15.6%)Subsequent miscarriage12 (25.0%)22 (25.9%)Subsequent LB + OGP36 (75.0%)63 (74.1%).91Note: CRL = crown rump length; LB = live birth; OGP = documented ongoing pregnancy. Open table in a new tab Conclusions: No difference was found in the likelihood of a successful subsequent pregnancy for women with normal and abnormal embryonic karyotypes in sporadic miscarriages. Patients with infertility and first trimester miscarriages have an excellent prognosis for successful pregnancy, which is independent of chromosome status of POC. Background: Embryonic defects are the most frequently identified cause of first trimester miscarriage. Cytogenetic testing of products of conception (POC) has been shown to predict future pregnancy outcomes in studies of women with recurrent pregnancy loss (RPL), however little is known about the prognostic value of karyotype in first or second losses. Objective: The purpose of this study was to evaluate the value of the karyotype of sporadic miscarriages as a predictor of live birth in the subsequent pregnancy. Materials and Methods: Infertility patients were identified from an established database of first trimester miscarriages with available cytogenetic evaluations of POC. Medical records were reviewed for subsequent pregnancies, obstetric history, and fertility treatments. Subjects were included if they were first entered into the database at the time of the first or second miscarriage. Patients undergoing donor egg or PGD were excluded from this study. Subsequent live birth rate and miscarriage rates were compared using chi squared analysis, with P<0.05 considered significant. Note: CRL = crown rump length; LB = live birth; OGP = documented ongoing pregnancy. Conclusions: No difference was found in the likelihood of a successful subsequent pregnancy for women with normal and abnormal embryonic karyotypes in sporadic miscarriages. Patients with infertility and first trimester miscarriages have an excellent prognosis for successful pregnancy, which is independent of chromosome status of POC.

OBJECTIVE: Uterine cavity evaluation is routinely performed prior to IVF. Pregnancy rates at our center have improved among those patients undergoing hysteroscopy immediately prior to IVF stimulation compared to patients receiving evaluation remote from treatment (Mooney and Milki 2005). It is unknown if this benefit is secondary to mechanical stimulation of the endometrium or fluid distention and flushing of the endometrial cavity. The objective of this analysis is to examine the effects of mechanical stimulation of the endometrium at the time of hysteroscopy.DESIGN: Prospective cohort.MATERIALS AND METHODS: Patients undergoing office hysteroscopy while on oral contraceptives the month prior to IVF were reviewed. IV sedation and a paracervical block preceded cervical dilation. A rigid 5-mm hysteroscope with a 2 mm operative channel was placed using saline for distention. Charts were reviewed for hysteroscopic findings and IVF parameters. Hysteroscopic graspers were used to trim the endometrium if there were areas that appeared thickened. Patients with congenital uterine anomaly, intrauterine adhesion, submucosal fibroids, or polyps (>5mm) were excluded.Table 1Demographics and pregnancy rateDiagnostic hysteroscopyEndometrial disruptionp-valueAge36.637.5.10Gravida0.941.010.34Parity0.180.320.05# of oocytes retrieved10.711.00.37Pregnancy rate33.3%39.2%0.45Ongoing pregnancy rate28.2%25.7%0.73 Open table in a new tab CONCLUSIONS: We found no significant difference in the ongoing pregnancy rate between patients undergoing endometrial trimming at the time of hysteroscopy and those undergoing diagnostic hysteroscopy alone. The endometrial tickle theory suggests that mechanical disruption of the endometrium may increase receptivity in the infertile population. However, this study shows no additional benefit (or harm) of mechanical disruption of the endometrium at the time of hysteroscopy compared to diagnostic hysteroscopy alone. OBJECTIVE: Uterine cavity evaluation is routinely performed prior to IVF. Pregnancy rates at our center have improved among those patients undergoing hysteroscopy immediately prior to IVF stimulation compared to patients receiving evaluation remote from treatment (Mooney and Milki 2005). It is unknown if this benefit is secondary to mechanical stimulation of the endometrium or fluid distention and flushing of the endometrial cavity. The objective of this analysis is to examine the effects of mechanical stimulation of the endometrium at the time of hysteroscopy. DESIGN: Prospective cohort. MATERIALS AND METHODS: Patients undergoing office hysteroscopy while on oral contraceptives the month prior to IVF were reviewed. IV sedation and a paracervical block preceded cervical dilation. A rigid 5-mm hysteroscope with a 2 mm operative channel was placed using saline for distention. Charts were reviewed for hysteroscopic findings and IVF parameters. Hysteroscopic graspers were used to trim the endometrium if there were areas that appeared thickened. Patients with congenital uterine anomaly, intrauterine adhesion, submucosal fibroids, or polyps (>5mm) were excluded. CONCLUSIONS: We found no significant difference in the ongoing pregnancy rate between patients undergoing endometrial trimming at the time of hysteroscopy and those undergoing diagnostic hysteroscopy alone. The endometrial tickle theory suggests that mechanical disruption of the endometrium may increase receptivity in the infertile population. However, this study shows no additional benefit (or harm) of mechanical disruption of the endometrium at the time of hysteroscopy compared to diagnostic hysteroscopy alone.

OBJECTIVE: The number of embryos transferred has been shown to be the most important factor for IVF-associated multiple pregnancies. Although several reports have suggested the value of single fresh embryo transfer in good prognostic patients, very few data is available with regard to the feasibility of single frozen embryo transfer. In this study, we evaluated single-embryo transfer in our frozen blastocyst program. DESIGN: Retrospective study performed in an academic assisted reproduction program. MATERIALS AND METHODS: Day 5 and day 6 blastocysts graded as 3BB or better were frozen and thawed between January 2004 and December 2007. A frozen-thawed blastocyst with good blastomere survival (>80%) and blastocoele re-expansion was defined as a good-quality embryo. A single good quality frozen-thawed blastocyst was transferred in 39 patients who had good prognosis of pregnancy establishment following the fresh IVF. To compare the outcome between single- and double-embryo transfers, double-embryo transfers were divided into 2 groups, those with only 1 good quality blastocyst and those with 2 good-quality blastocysts. Double-embryo transfers without good-quality embryos were excluded from this study. The rates of pregnancy and implantation were compared among groups. RESULTS: As shown in Table1, no difference exists in patient age at blastocyst freezing among groups. A similar rate of clinical pregnancy was obtained for selective single-embryo transfer when compared to double-embryo transfer containing only 1 good embryo (30.8% vs 34.8%). No twins were observed in the selective single-embryo transfer group. Although there was a significant trend towards higher clinical pregnancy rate in double-embryo transfers with 2 good-quality blastocysts, 28.8% of the pregnancies were twins.Table 1Selective single transferDouble transfers with 1 good-quality embryoDouble transfers with 2 good-quality embryosP ValueNo. of transfers3966140Age at freezing (mean ± SD)33.8 ± 3.634.5 ± 3.834.2 ± 3.80. 8422No. of positive HCG [n (%)]14 (35.9)∗28 (35.1)75 (53.7)∗0.0886, ∗,∗ 0.0509No. of clinical pregnancy [n (%)]12 (30.8)23 (34.8)59 (42.1)0.3427No. of implantation [n (%)]12 (30.8) ∗25 (18.9)∗76 (27.1)0.0952, ∗,∗ 0.034No. of twins [n (%)]02 (8.7)17 (28.8)0.0004 Open table in a new tab CONCLUSIONS: Single-embryo transfer in selected patients with a good-quality frozen-thawed blastocyst yields acceptable clinical pregnancy rate without multiple pregnancies.

Background: Ethnic differences in ART outcomes have been reported but are poorly understood. Data from a national registry showed that Asian patients had a lower pregnancy rate than caucasian patients, even when controlling for baseline characteristics. Earlier studies do not control for differences in embryo quality which may account for differences in implantation. Patients undergoing embryo transfer on day 5 have more information available about embryo quality than patients with cleavage-stage embryo transfers. At our center, patients must have 3 or more good-quality embryos on day 3 to proceed with blastocyst culture and therefore are considered to have the best fertility potential. Objective: To compare blastocyst formation rate and live birth rate in caucasian and Asian women. Materials and Methods: This is a retrospective review of all blastocyst transfer cycles in Asian and caucasian women from January 1, 2005, through December 31, 2005, at a university fertility center. Data collected include demographic information, infertility diagnosis, cycle day 3 FSH, antral follicle count (AFC), treatment protocol details, and pregnancy outcomes. Statistical analyses include chi-squared test for categoric variables and t tests for continuous variables. Results: A total of 102 patients (65 caucasian and 37 Asian) met our inclusion criteria. The groups were similar in age, obstetric history, FSH level, AFC, infertility diagnosis, treatment history, and length of infertility. The groups were also similar in treatment details and cycle outcomes, including total ampules of gonadotropins, days of stimulation, follicle count, number of oocytes, ICSI, blastocyst formation rate, and number of embryos transfered. Clinical pregnancy rate and live birth rate were significantly lower in Asians compared to caucasians: 35% vs. 69% (P=.001) and 32% vs. 51% (P=.004), respectively.Tabled 1Caucasian (n = 65)Asian (n = 37)P valueAge36.92 ± 3.3336.52 ± 6.72NSBMI23.522.4NSCycle day 3 FSH6.17 ± 2.285.80 ± 2.03NSTotal amount of gonadotropins used in IU4114.54107.0NSNo. of oocytes16.4414.19NSBlast formation rateaNumber of blasts/number of 2PN.0.380.42NSNumber of embryos transfered2.081.95NS% patients with at least one AA blastocyst transfered66%59%NSClinical pregnancy ratebIntrauterine pregnancy with cardiac motion at 8-week sonogram per IVF cycle.69%35%.008Live birth rate51%32%.004a Number of blasts/number of 2PN.b Intrauterine pregnancy with cardiac motion at 8-week sonogram per IVF cycle. Open table in a new tab Conclusions: Asian patients had a similar blastocyst formation rate but lower pregnancy and live birth rates after blastocyst transfer compared with caucasian women, despite similar baseline characteristics and treatment parameters. Further studies are needed to determine the cause for this outcome disparity.

ObjectiveExogenous FSH is frequently used in the treatment of infertility. High rates of aneuploidy are seen when preimplantation genetic diagnosis is performed after ovarian stimulation in all ages, however the etiology is not clear. Animal studies have shown that exposure to exogenous FSH leads to chromosome dysfunction in oocytes, thus providing a possible link between elevated levels of FSH and increased risk of aneuploidy. We examine the rate of aneuploidy in missed abortions in relation to exposure to exogenous FSH in the follicular phase of the menstrual cycle in which patients conceive.DesignRetrospective cohort.Materials and methodsPatients with cytogenetic evaluation of products of conception from a missed abortion at a University Infertility practice from January 1999 through December 2006 were identified. Data collected included patient age, obstetric history, method of conception, ovarian stimulation with FSH, and cytogenetic results from products of conception (POC). Rate of aneuploidy was compared between a control group of patients with a history of infertility who conceived naturally and a study group of patients with a history of infertility who conceived with FSH treatment, including intrauterine insemination (IUI) and in vitro fertilization (IVF) cycles.Results219 patients met inclusion criteria. See Table 1 for results. 67% of all patients had an abnormal karyotype diagnosed on POC from a missed abortion; the rate of aneuploidy was 78% in the control group and 64% in the study group. This difference was not statistically significant (P value >0.05). In the study group, 30 patients had an IUI with an average age of 35.3 and a 57% aneuploidy rate, and 138 patients had an IVF cycle with an average age of 37.6 and a 67% aneuploidy rate. Recurrent pregnancy loss (RPL, 3 or more miscarriages) was seen in 9% of all patients, 24% in the control group and 4% in the study group, however the rate of aneuploidy did not change if these patients were excluded.ConclusionsIn this study, the incidence of abnormal results in the cytogenetic analysis of POC was not higher in pregnancies conceived with FSH stimulation compared to spontaneous conceptions in infertility patients. This suggests that exogenous FSH exposure does not increase the risk of aneuploidy. Further studies are still needed to examine this relationship.Tabled 1Table 1.Natural ConceptionFSH ExposureTotalNumber of Patients49168219Average Age in Years37.736.537.4Abnormal Karyotype Overall78%64%67%Abnormal Karyotype Cases without RPL73%66%67% Open table in a new tab ObjectiveExogenous FSH is frequently used in the treatment of infertility. High rates of aneuploidy are seen when preimplantation genetic diagnosis is performed after ovarian stimulation in all ages, however the etiology is not clear. Animal studies have shown that exposure to exogenous FSH leads to chromosome dysfunction in oocytes, thus providing a possible link between elevated levels of FSH and increased risk of aneuploidy. We examine the rate of aneuploidy in missed abortions in relation to exposure to exogenous FSH in the follicular phase of the menstrual cycle in which patients conceive. Exogenous FSH is frequently used in the treatment of infertility. High rates of aneuploidy are seen when preimplantation genetic diagnosis is performed after ovarian stimulation in all ages, however the etiology is not clear. Animal studies have shown that exposure to exogenous FSH leads to chromosome dysfunction in oocytes, thus providing a possible link between elevated levels of FSH and increased risk of aneuploidy. We examine the rate of aneuploidy in missed abortions in relation to exposure to exogenous FSH in the follicular phase of the menstrual cycle in which patients conceive. DesignRetrospective cohort. Retrospective cohort. Materials and methodsPatients with cytogenetic evaluation of products of conception from a missed abortion at a University Infertility practice from January 1999 through December 2006 were identified. Data collected included patient age, obstetric history, method of conception, ovarian stimulation with FSH, and cytogenetic results from products of conception (POC). Rate of aneuploidy was compared between a control group of patients with a history of infertility who conceived naturally and a study group of patients with a history of infertility who conceived with FSH treatment, including intrauterine insemination (IUI) and in vitro fertilization (IVF) cycles. Patients with cytogenetic evaluation of products of conception from a missed abortion at a University Infertility practice from January 1999 through December 2006 were identified. Data collected included patient age, obstetric history, method of conception, ovarian stimulation with FSH, and cytogenetic results from products of conception (POC). Rate of aneuploidy was compared between a control group of patients with a history of infertility who conceived naturally and a study group of patients with a history of infertility who conceived with FSH treatment, including intrauterine insemination (IUI) and in vitro fertilization (IVF) cycles. Results219 patients met inclusion criteria. See Table 1 for results. 67% of all patients had an abnormal karyotype diagnosed on POC from a missed abortion; the rate of aneuploidy was 78% in the control group and 64% in the study group. This difference was not statistically significant (P value >0.05). In the study group, 30 patients had an IUI with an average age of 35.3 and a 57% aneuploidy rate, and 138 patients had an IVF cycle with an average age of 37.6 and a 67% aneuploidy rate. Recurrent pregnancy loss (RPL, 3 or more miscarriages) was seen in 9% of all patients, 24% in the control group and 4% in the study group, however the rate of aneuploidy did not change if these patients were excluded. 219 patients met inclusion criteria. See Table 1 for results. 67% of all patients had an abnormal karyotype diagnosed on POC from a missed abortion; the rate of aneuploidy was 78% in the control group and 64% in the study group. This difference was not statistically significant (P value >0.05). In the study group, 30 patients had an IUI with an average age of 35.3 and a 57% aneuploidy rate, and 138 patients had an IVF cycle with an average age of 37.6 and a 67% aneuploidy rate. Recurrent pregnancy loss (RPL, 3 or more miscarriages) was seen in 9% of all patients, 24% in the control group and 4% in the study group, however the rate of aneuploidy did not change if these patients were excluded. ConclusionsIn this study, the incidence of abnormal results in the cytogenetic analysis of POC was not higher in pregnancies conceived with FSH stimulation compared to spontaneous conceptions in infertility patients. This suggests that exogenous FSH exposure does not increase the risk of aneuploidy. Further studies are still needed to examine this relationship.Tabled 1Table 1.Natural ConceptionFSH ExposureTotalNumber of Patients49168219Average Age in Years37.736.537.4Abnormal Karyotype Overall78%64%67%Abnormal Karyotype Cases without RPL73%66%67% Open table in a new tab In this study, the incidence of abnormal results in the cytogenetic analysis of POC was not higher in pregnancies conceived with FSH stimulation compared to spontaneous conceptions in infertility patients. This suggests that exogenous FSH exposure does not increase the risk of aneuploidy. Further studies are still needed to examine this relationship.

We observed that there was good survivability, fertilization, and cleavage of the oocytes after the freeze-thaw process.Recipient patients can now avoid the difficulties arising from conflicts in scheduling the egg donor's availability with the recipient's cycle, or the possibility of the egg donor's noncompliance with medical instructions, thereby jeopardizing the cycle outcome.Furthermore, the recipient can minimize the legal fees involved in preparing the donor's contract prior to starting a fresh donor egg cycle.For most patients who elect to use a frozen egg bank, the cycle can be initiated without months of waiting.Currently, we are conducting an IRB-approved study to compare the embryo quality between freshly oocytes and frozen-thawed oocytes.The results of further research focusing on the outcome of oocyte cryopreservation can potentially make this a viable choice for patients.

Endometriosis is commonly seen in infertility patients. Its effect on specific fertility parameters such as embryo quality and endometrial receptivity is controversial. In order to examine the effects of endometriosis on embryo quality, we examined in vitro fertilization (IVF) data in patients before and after surgical treatment for endometriosis. Retrospective cohort. We identified patients who had IVF before and after surgical treatment of endometriosis. Surgery involved complete resection of all endometriosis lesions and removal of endometriomas by laparoscopy. Data collected included patient demographics, stimulation protocol, oocytes retrieved, fertilization type, endometrial thickness, quantity and quality of embryos available, and pregnancy outcomes. If a patient had multiple cycles before surgery, only cycles with similar protocols and closest in time to surgery were included. 26 patients were identified. All patients had failed to conceive with the first IVF cycle. FSH levels (6.9 and 7.0 mIU/mL), days of stimulation (11 and 10), and amount of gonadotropins used (4875 vs. 5025 IU) were similar before and after surgery. The average age at the time of surgery was 35.9 years. The interval between surgery and second IVF cycle was 254 days. No hydrosalpinxes were found at time of surgery. There was no difference in the number or quality of embryos before and after surgery as shown in Table 1. The live birth rate per IVF cycle after surgical treatment of endometriosis was 46% (12/26). The age of patients that conceived was significantly lower, 34.2 vs. 36.8 years, P=0.02. Pregnancy rate was 53% for patients with Stage I-II endometriosis and 36% for those with Stage III–IV endometriosis, this difference did not reach statistical significance. TableIVF cycle before surgeryIVF cycle after surgeryAge35.436.6Endometrial Thickness in mm10.310.2Average Number of Oocytes Retrieved1210Average Number of Embryos6.45.8Average Number of Good Quality Embryos∗6 cell or higher and grade I or II. on Day 34.03.6Average Number of 8 cell Embryos on Day 33.02.6Average Number of Embryos Transferred2.73.2∗ 6 cell or higher and grade I or II. Open table in a new tab Surgical treatment of endometriosis had no impact on embryo quality in patients who had failed IVF. Further studies are needed to better understand how endometriosis and its treatment affect the success of IVF.

ObjectiveStudies suggest that elevated maternal testosterone (T) levels are correlated with adverse perinatal outcomes. Ovarian stimulation increases serum T. However it is unknown how these medications affect T levels in pregnancy. In this study, we compare serum T levels in naturally conceived pregnancies to T levels pregnancies resulting from fertility treatment.DesignProspective cohort study.Materials and methodsSerum T levels were obtained pre- and post-conception (at 4–6 weeks gestation) in 95 infertile controls who conceived spontaneously and 322 subjects who conceived following one of four infertility treatments: clomiphene, gonadotropins, IVF, and oocyte donation. Using multivariate regression, accounting for repeated measures, the change in T level (pre-conception vs. pregnancy) was compared between control and treatment groups adjusting for potential confounders (table 1).ResultsThough all groups demonstrated some increase in pregnancy T levels, compared to preconception, subjects who conceived following superovulation demonstrated a significant increase compared to controls (table 1). Other factors associated with increased T in pregnancy were: PCOS and higher BMI. In contrast, subjects receiving oocyte donation and older women had lower than expected T. Sub-analysis of IVF patients (after controlling for PCOS and age) revealed that the number of eggs retrieved predicted pregnancy testosterone levels (P<0.001).TableSummary of multi-variable regressionTestoserone levels, ng/dLGroupsAge mean (SD)NPreconception, meanPregnancy, mean∗Change from baselineP value^ compared to controlSpontaneous conceptions35.7 (4.3)9550.4270.6820.26ControlsClomiphene34.1 (4.2)6950.5686.8636.30.028Gonadotropins35.7 (4.1)6944.42121.4777.05<0.001IVF36.4 (4.2)15244.52143.7499.22<0.001Oocyte donation41.3 (5.2)4234.4139.445.030.003^relative to control group, ∗Adjusted for: age, BMI, serum beta-hcg, PCOS and number of gestations in-utero. Open table in a new tab ConclusionsOvarian stimulation predicted higher than expected T levels in pregnancy compared to natural cycle conceptions. Not only did the number of eggs retrieved at IVF correlate with pregnancy T levels, but recipients had the lowest levels, suggesting an ovarian etiology for the excess. The impact of elevated testosterone levels in early pregnancy on clinical outcomes deserves further study. ObjectiveStudies suggest that elevated maternal testosterone (T) levels are correlated with adverse perinatal outcomes. Ovarian stimulation increases serum T. However it is unknown how these medications affect T levels in pregnancy. In this study, we compare serum T levels in naturally conceived pregnancies to T levels pregnancies resulting from fertility treatment. Studies suggest that elevated maternal testosterone (T) levels are correlated with adverse perinatal outcomes. Ovarian stimulation increases serum T. However it is unknown how these medications affect T levels in pregnancy. In this study, we compare serum T levels in naturally conceived pregnancies to T levels pregnancies resulting from fertility treatment. DesignProspective cohort study. Prospective cohort study. Materials and methodsSerum T levels were obtained pre- and post-conception (at 4–6 weeks gestation) in 95 infertile controls who conceived spontaneously and 322 subjects who conceived following one of four infertility treatments: clomiphene, gonadotropins, IVF, and oocyte donation. Using multivariate regression, accounting for repeated measures, the change in T level (pre-conception vs. pregnancy) was compared between control and treatment groups adjusting for potential confounders (table 1). Serum T levels were obtained pre- and post-conception (at 4–6 weeks gestation) in 95 infertile controls who conceived spontaneously and 322 subjects who conceived following one of four infertility treatments: clomiphene, gonadotropins, IVF, and oocyte donation. Using multivariate regression, accounting for repeated measures, the change in T level (pre-conception vs. pregnancy) was compared between control and treatment groups adjusting for potential confounders (table 1). ResultsThough all groups demonstrated some increase in pregnancy T levels, compared to preconception, subjects who conceived following superovulation demonstrated a significant increase compared to controls (table 1). Other factors associated with increased T in pregnancy were: PCOS and higher BMI. In contrast, subjects receiving oocyte donation and older women had lower than expected T. Sub-analysis of IVF patients (after controlling for PCOS and age) revealed that the number of eggs retrieved predicted pregnancy testosterone levels (P<0.001).TableSummary of multi-variable regressionTestoserone levels, ng/dLGroupsAge mean (SD)NPreconception, meanPregnancy, mean∗Change from baselineP value^ compared to controlSpontaneous conceptions35.7 (4.3)9550.4270.6820.26ControlsClomiphene34.1 (4.2)6950.5686.8636.30.028Gonadotropins35.7 (4.1)6944.42121.4777.05<0.001IVF36.4 (4.2)15244.52143.7499.22<0.001Oocyte donation41.3 (5.2)4234.4139.445.030.003^relative to control group, ∗Adjusted for: age, BMI, serum beta-hcg, PCOS and number of gestations in-utero. Open table in a new tab Though all groups demonstrated some increase in pregnancy T levels, compared to preconception, subjects who conceived following superovulation demonstrated a significant increase compared to controls (table 1). Other factors associated with increased T in pregnancy were: PCOS and higher BMI. In contrast, subjects receiving oocyte donation and older women had lower than expected T. Sub-analysis of IVF patients (after controlling for PCOS and age) revealed that the number of eggs retrieved predicted pregnancy testosterone levels (P<0.001). ^relative to control group, ∗Adjusted for: age, BMI, serum beta-hcg, PCOS and number of gestations in-utero. ConclusionsOvarian stimulation predicted higher than expected T levels in pregnancy compared to natural cycle conceptions. Not only did the number of eggs retrieved at IVF correlate with pregnancy T levels, but recipients had the lowest levels, suggesting an ovarian etiology for the excess. The impact of elevated testosterone levels in early pregnancy on clinical outcomes deserves further study. Ovarian stimulation predicted higher than expected T levels in pregnancy compared to natural cycle conceptions. Not only did the number of eggs retrieved at IVF correlate with pregnancy T levels, but recipients had the lowest levels, suggesting an ovarian etiology for the excess. The impact of elevated testosterone levels in early pregnancy on clinical outcomes deserves further study.

To report two cases of early onset cholestasis of pregnancy associated with IVF and ovarian hyperstimulation syndrome.Case report.University-based IVF program.Two patients with first-trimester cholestasis of pregnancy after IVF that was associated with ovarian hyperstimulation syndrome.In vitro fertilization-embryo transfer, management of hyperstimulation syndrome, and cholestasis of pregnancy.Clinical pregnancy course and pregnancy outcomes.The first patient was treated with ursodeoxycholic acid and had resolution of symptoms within the first trimester. The second patient initially had a miscarriage but did redevelop cholestasis of pregnancy in the latter stages of a pregnancy resulting from frozen embryo transfer.We report two cases of intrahepatic cholestasis of pregnancy in the first trimester of pregnancies by IVF in association with ovarian hyperstimulation syndrome and markedly elevated maternal serum estrogen levels. Early recognition of this unusual clinical presentation allows for optimal pregnancy management by both the reproductive endocrinologist and the obstetrician.

OBJECTIVE:To compare the rate of ectopic pregnancy (EP) with fresh versus frozen blastocyst transfer in our program during the same time period.DESIGN:Retrospective analysis.SETTING:University IVF program.PATIENT(S):Women who achieved a clinical pregnancy after IVF between 1998 and 2005.INTERVENTION(S):In our program, cryopreservation is performed at the blastocyst stage. Embryo transfer was performed 1 to 1.5 cm short of the fundus by abdominal ultrasound guidance.MAIN OUTCOME MEASURE(S):The incidence of EP was examined in relation to fresh versus frozen blastocyst transfer.RESULT(S):In the frozen blastocyst group, there were 5 EPs out of 180 clinical pregnancies (2.8%), and there were 10 EPs out of 564 clinical pregnancies (1.8%) in the fresh blastocyst group.CONCLUSION(S):The rate of EP is not significantly increased after the transfer of frozen thawed blastocysts compared with fresh blastocyst transfer.