• First Human Multiorgan Donor Uterus Transplant: ...

    Wednesday, February 6, 2013

    Absolute uterine infertility is one of the last frontiers in fertility therapy. Interview by Dr Steven Palter of Munire Akar who performed the world’s first successful human organ donor uterus transplant. They discuss how and and why it was done and if if this should be an option for patients.

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  • When Should Progesterone be Stopped in IVF Cycle...

    Sunday, October 7, 2012

    october 2012 author interview on new research on when to stop progesterone treatment in IVF cycles

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  • Haploid Sperm-Like Cells Created From Human Stem...

    Sunday, September 16, 2012

    September 2012 Featured Author Interview  – Drs.…

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  • November 2011 Featured Author Interview Video: G...

    Saturday, May 5, 2012

    Author Interview  – Drs. Dominique deZiegler & Steven Palter

    Fertility and Sterility’s November, 2011 feature article author interview.…

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  • Welcome to the New Electronic Fertility & S...

    Saturday, May 5, 2012

    Welcome to the New Electronic Fertility & Sterility!

    Posted by stevenpalter on Saturday, May 5, 2012 · Leave a Comment (Edit)

    The digital revolution is here… now… See the exciting new developments in multimedia interactivity in Fertility & Sterility and how they can help you keep up with the explosive volume of new developments. Author interview videos, original video articles, discussion forums, and more!

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Prognosis factors of pregnancy after intrauterine insemination with the husbands sperm Conclusions of an analysis of 2019 cycles

sperm

Capsule:
Positive predictive factors of pregnancy after IUI-H were woman’s secondary infertility, woman basal FSH levels 7 IU/L, ovulation triggering and inseminated progressive motile spermatozoa 1 million.

Authors:
Laka Dinelli, M.D., Blandine Courbiere, M.D., Ph.D., Vincent Achard, M.D., Ph.D., Elisabeth Jouve, M.Sc., Carole Deveze, M.D., Audrey Gnisci, M.D., Jean-Marie Grillo, M.D., Ph.D., Odile Paulmyer-Lacroix, M.D., Ph.D.

Volume 101, Issue 4, Pages 994-1000

Abstract:

Objective:
To identify the prognostic factors for pregnancy after intrauterine insemination with the husband’s sperm (IUI-H).

Design:
Retrospective study.

Setting:
A single university medical center.

Patient(s):
851 couples, for 2,019 IUI-H cycles.

Intervention(s):
After controlled ovarian stimulation, IUI-H performed 36 hours after ovulation triggering or 24 hours after a spontaneous luteinizing hormone (LH) surge.

Main Outcome Measure(s):
Clinical pregnancy rate per cycle (PR) and delivery rate per cycle (DR).

Result(s):
The overall PR was 14.8% and DR 10.8%. Higher PR and DR were observed for patients presenting with ovulation disorders (particularly polycystic ovary syndrome) or with male infertility. Secondary infertility in the woman appeared to be a positive prognostic factor as did a basal follicle-stimulating hormone (FSH) level ≤7 IU/L and ovulation triggering over spontaneous LH rise. The other parameters influencing the results were the women’s age, the number of mature follicles obtained (≥2), the endometrial thickness (10–11 mm), and the number of progressive motile spermatozoa inseminated (>1 million).

Conclusion(s):
In women aged ≤38 years, IUI-H should be considered as an option, particularly in cases of female infertility from ovulation disorders, in cases of a normal ovarian reserve, in cases of secondary infertility, or when ≥1 million progressive sperm are inseminated. Bifollicular stimulation is required. In other cases, in vitro fertilization should be discussed as the first-line treatment.

Enhanced follicular recruitment and atresia in cortex derived from ovaries with endometriomas

endometrioma

Capsule:
Formation of endometriomas may cause focal exhaustion of the stockpile of primordial follicles by upregulation of recruitment and atresia of follicles at early developmental stages, which may eventually result in a decreased ovarian reserve.

Authors:
Michio Kitajima, M.D., Ph.D., Marie-Madeleine Dolmans, M.D., Ph.D., Olivier Donnez, M.D., Ph.D., Hideaki Masuzaki, M.D., Ph.D., Michelle Soares, M.D., Jacques Donnez, M.D., Ph.D.

Volume 101, Issue 4, Pages 1031-1037

Abstract:

Objective:
To evaluate the effects of endometriomas on the regulation of early follicular development.

Design:
Histologic analysis of prospectively collected biopsy samples.

Setting:
Research unit in a university hospital.

Patient(s):
Women <40 years of age who have ovarian endometriomas.

Intervention(s):
Biopsy of healthy cortex from ovaries affected by endometriomas (≤4 cm) and contralateral ovaries without cysts.

Main Outcome Measure(s):
Histomorphological staging of early follicles, measurement of follicle, oocyte, and oocyte nucleus diameters, immunohistochemistry of proliferating cell nuclear antigen, and caspase-3.

Result(s):
Thirteen cortical samples from ovaries with endometriomas and 13 samples from contralateral ovaries without endometriomas were evaluated. Cortex from ovaries with endometriomas contained significantly more morphologically atretic early follicles than cortex from contralateral ovaries without cysts. These follicles showed cleaved caspase-3 immunostaining. Diameters of primordial follicles and oocytes were decreased in cortex from ovaries with endometriomas, whereas early follicles with proliferating cell nuclear antigen-positive granulosa cells (GCs) were significantly increased in number.

Conclusion(s):
Ovaries with endometriomas, which may be more prone to local pelvic inflammation, showed activated follicular recruitment and atresia of early follicles. The potential contribution of inflammation to follicle “burnout” in case of endometriomas is discussed.

A multicenter prospective study to assess the effect of early cleavage on embryo quality implantation and live birth rate

embryo palter

Capsule:
The presence of early cleavage does not seem to improve implantation after the usual morphologic evaluation of cleavage-stage embryos.

Authors:
Maria J. de los Santos, Ph.D., Gemma Arroyo, Ph.D., Ana Busquet, Ph.D., Gloria Calderón, Ph.D., Jorge Cuadros, Ph.D., Maria Victoria Hurtado de Mendoza, Ph.D., Marta Moragas, Ph.D., Raquel Herrer, Ph.D., Agueda Ortiz, Ph.D., Carme Pons, Ph.D., Jorge Ten, Ph.D., Miguel Angel Vilches, Ph.D., Maria J. Figueroa, Ph.D.

Volume 101, Issue 4, Pages 981-987

Abstract:

Objective:
To investigate the impact of early cleavage (EC) on embryo quality, implantation, and live-birth rates.

Design:
Prospective cross-sectional study.

Setting:
Multicenter study.

Patient(s):
Seven hundred embryo transfers and 1,028 early-stage human embryos.

Intervention(s):
None.

Main Outcome Measure(s):
Implantation according to the presence of EC and embryo quality.

Result(s):
The presence of EC is associated with embryo quality, especially in cycles with autologous oocytes. However, the use of EC as an additional criterion for selecting an embryo for transfer does not appear to significantly improve likelihood of implantation. Furthermore, embryos that presented EC had live-birth rates per implanted embryo similar to those that did not show any sign of cleavage.

Conclusion(s):
At least for conventional embryo culture and morphologic evaluations, the additional evaluation of EC in embryos may not be valuable to improve embryo implantation.

Value of antimüllerian hormone as a prognostic indicator of in vitro fertilization outcome

ivf

Capsule:
Antimüllerian hormone is highly correlated with number of eggs retrieved. Very low levels are associated with diminished yet reasonable pregnancy rates, mediated through number of oocytes retrieved as opposed to oocyte quality.

Authors:
David E. Reichman M.D., Dan Goldschlag M.D., Zev Rosenwaks M.D.

Volume 101, Issue 4, Pages 1012-1018.e1

Abstract:

Objective:
To determine the predictive attributes of antimüllerian hormone (AMH) in terms of oocyte yield, cycle cancellation, and pregnancy outcomes.

Design:
Retrospective cohort.

Setting:
Academic center.

Patient(s):
All patients initiating IVF at the Weill-Cornell Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine from April 2010 through January 2013.

Intervention(s):
In vitro fertilization without preimplantation genetic testing.

Main Outcome Measure(s):
Number of oocytes retrieved, cycle cancellation, clinical and ongoing pregnancy, implantation, and miscarriage rates.

Result(s):
Antimüllerian hormone was positively correlated with number of eggs retrieved. Number of oocytes retrieved increased with increasing AMH within each age group and diminished slightly within AMH groupings as age increased. Overall, AMH was significantly correlated with risk of cycle cancellation, with an area under the curve (AUC) of 0.74. Patients with undetectable AMH had a 13.3-fold increased risk of cancellation as compared with patients with an AMH >2.0 ng/mL. Antimüllerian hormone had an AUC of 0.83 for prediction of three or fewer oocytes; undetectable AMH exhibited sensitivity and specificity of 21.1% and 98.2%, respectively, for three or fewer oocytes retrieved. Antimüllerian hormone was less predictive of pregnancy, with AUCs ranging from 0.55 to 0.65. Even with undetectable AMH, 23.5% of patients

Conclusion(s):
Antimüllerian hormone is a fairly robust metric for the prediction of cancellation and how many oocytes may be retrieved after stimulation but is a relatively poor test for prediction of pregnancy after any given treatment cycle. Patients with extremely low levels of AMH still can achieve reasonable treatment outcomes and should not be precluded from attempting IVF solely on the basis of an AMH value.

Chronic endometritis in women with recurrent early pregnancy loss and or fetal demise

pregnant

Capsule:
There was a high prevalence of chronic endometritis in a cohort of 395 women with pregnancy loss. “Test of cure” was 100% with antibiotics. Subsequent live-birth rates were encouraging.

Authors:
Dana B. McQueen, M.D., Lia A. Bernardi, M.D., Mary D. Stephenson, M.D., M.Sc.

Volume 101, Issue 4, Pages 1026-1030

Abstract:

Objective:
To assess the prevalence of chronic endometritis in women with a history of recurrent early pregnancy loss (REPL) and/or fetal demise (FD).

Design:
Observational cohort study using prospectively collected data.

Setting:
Recurrent pregnancy loss program in an academic medical center.

Patient(s):
Three hundred ninety-five women with a history of two or more pregnancy losses of less than 10 weeks’ size or a fetal demise of 10 or more weeks’ size.

Intervention(s):
All women had an endometrial biopsy. Chronic endometritis was treated with antibiotics, and a second endometrial biopsy was recommended as a “test of cure.”

Main Outcome Measure(s):
Subsequent live-birth rate (LBR).

Result(s):
The overall prevalence of chronic endometritis was 9% (35/395) in this cohort; 7% (21/285) in the REPL group, 14% (8/57) in the FD group, and 11% (6/53) in the combined REPL/FD group. The cure rate was 100% after a course(s) of antibiotics. The subsequent cumulative LBR was 88% (21/24) for the treated chronic endometritis group versus 74% (180/244) for the group without chronic endometritis. The per-pregnancy LBR for the treated chronic endometritis group was 7% (7/98) before treatment versus 56% (28/50) after treatment.

Conclusion(s):
There was a high prevalence of chronic endometritis in this cohort. The test of cure was 100% with antibiotics. Subsequent LBRs after treatment were encouraging.

Ovarian endometriomas and oocyte quality insights from in vitro fertilization cycles

Ovary

Capsule:
In women with unilateral unoperated endometriomas undergoing IVF, ovarian responsiveness and oocyte developmental competence did not differ between the affected and intact gonads.

Authors:
Francesca Filippi, M.D., Laura Benaglia, M.D., Alessio Paffoni, M.Sc., Liliana Restelli, D.Sc., Paolo Vercellini, M.D., Edgardo Somigliana, M.D., Ph.D., Luigi Fedele, M.D.

Volume 101, Issue 4, Pages 988-993.e1

Abstract:

Objective:
To evaluate whether the presence of endometriomas affects ovarian function.

Design:
Prospective cohort study.

Setting:
Infertility unit of an academic setting.

Patient(s):
Twenty-nine women undergoing an IVF cycle.

Intervention(s):
Prospective evaluation of women with unoperated unilateral endometriomas undergoing IVF. The affected and contralateral intact gonads were compared in terms of responsiveness and oocyte quality.

Main Outcome Measure(s):
Oocyte developmental competence.

Results:
Ovarian responsiveness and oocyte quality did not significantly differ between the affected and intact gonads. The number of codominant follicles, the number of oocytes retrieved, and the number of suitable oocytes in affected and intact gonads were 3.7 ± 2.4 and 4.1 ± 1.7, 4.2 ± 3.1 and 4.7 ± 2.5, and 3.1 ± 2.6 and 3.5 ± 2.3, respectively. The number of viable embryos and the number of high-quality embryos were 1.8 ± 2.1 and 1.8 ± 1.4 and 1.0 ± 1.7 and 0.8 ± 0.7, respectively. The fertilization rate in the affected and intact gonads was 64% and 64%, respectively. The cleavage rate was 58% and 51%, respectively. The rate of high-quality embryos was 31% and 21%, respectively.

Conclusion(s):
In women undergoing IVF, the presence of ovarian endometriomas does not affect oocyte developmental competence.

Treatment of pelvic pain associated with endometriosis A committee opinion

flower

Capsule:
Pain associated with endometriosis may involve many mechanisms and requires careful evaluation to confirm the diagnosis and exclude other potential causes. Both medical and surgical treatments for pain related to endometriosis are effective, and choice of treatment must be individualized.

Author:
Practice Committee of the American Society for Reproductive Medicine

Volume 101, Issue 4, Pages 927-935

Abstract:
Pain associated with endometriosis may involve a number of different mechanisms and requires careful evaluation to confirm the diagnosis and exclude other potential causes. Both medical and surgical treatments for pain related to endometriosis are effective, and choice of treatment must be individualized. This document replaces the document by the same name last published in 2008 (Fertil Steril 2008;90[3]:S260-269).

Oocyte number as a predictor for ovarian hyperstimulation syndrome and live birth an analysis of 256381 in vitro fertilization cycles

woman-breastfeeding

Capsule:
The retrieval of >15 oocytes in fresh autologous IVF cycles significantly increases the risk of ovarian hyperstimulation syndrome without improving live-birth rate.

Authors:
Ryan G. Steward, M.D., Lan Lan, Ph.D., Anish A. Shah, M.D., M.H.S., Jason S. Yeh, M.D., Thomas M. Price, M.D., James M. Goldfarb, M.D., Suheil J. Muasher, M.D.

Volume 101, Issue 4, Pages 967-973

Abstract:

Objective:
To investigate the association between oocyte number and the rates of ovarian hyperstimulation syndrome (OHSS) and live birth (LB) in fresh autologous in vitro fertilization (IVF) cycles.

Design:
Retrospective cohort study.

Setting:
An academic reproductive medicine practice.

Patient(s):
We analyzed data from 256,381 IVF cycles using the 2008–2010 Society for Assisted Reproductive Technology national registry. Patients were divided into five groups based on retrieved oocyte number.

Main Outcome Measure(s):
Rates of OHSS and LB were calculated for each group. A generalized estimating equation (GEE) was used to assess differences in OHSS and LB between groups. Receiver operating characteristic (ROC) curves were used to evaluate oocyte number as a predictor of OHSS and LB.

Intervention(s):
None.

Result(s):
The LB rate increased up to 15 oocytes, then plateaued (0–5: 17%, 6–10: 31.7%; 11–15: 39.3%; 16–20: 42.7%; 21–25: 43.8%; and >25 oocytes: 41.8%). However, the rate of OHSS became much more clinically significant after 15 oocytes (0–5: 0.09%; 6–10: 0.37%; 11–15: 0.93%; 16–20: 1.67%; 21–25: 3.03%; and >25 oocytes: 6.34%). These trends remained after adjustment with the use of GEE. ROC curves revealed that although oocyte number is not useful in the prediction of LB, 15 retrieved oocytes is the number that best predicts OHSS risk.

Conclusion(s):
Retrieval of >15 oocytes significantly increases OHSS risk without improving LB rate in fresh autologous IVF cycles. In general, less aggressive stimulation protocols should be considered, especially in high-responders, to optimize outcomes.

Articles of Special Interest

sperm

In vitro effects of coital lubricants and synthetic and natural oils on sperm motility

Monday, March 31, 2014

Effects of coital lubricants and oils on sperm motility were evaluated. Astroglide, KY lubricants (Sensitive, Warming, and Tingling), and sesame oil reduced sperm motility significantly, and mustard oil exposure caused sperm hyperactivation.

stockvault-marguerite108891

Association of physical activity in the past year and immediately after in vitro fertilization on pregnancy

Monday, March 31, 2014

Higher self-reported past year physical activity was associated with favorable pregnancy outcomes following in vitro fertilization (IVF). Physical activity and sedentary behavior following IVF were not associated with pregnancy outcomes.

Oocyte retrieval timing based on spontaneous luteinizing hormone surge during natural cycle in vitro fertilization treatment

Monday, March 31, 2014

In ncIVF treatment OR scheduling based on the occurrence of spontaneous LH surge yields acceptable oocyte recovery, fertilization, and embryo cleavage rates.

Chemistry

A new step toward the artificial ovary Survival and proliferation of isolated murine follicles after autologous transplantation in a fibrin scaffold

Monday, March 31, 2014

Fibrin formulations with low concentrations of fibrinogen and thrombin can potentially be used as an artificial ovary, allowing follicle survival and development, cell proliferation, and formation of capillaries.

stockvault-stethoscope129087

Menopausal hormone treatment cardiovascular disease Another look at an unresolved conundrum

Monday, March 31, 2014

Coronary vascular disease remains the most common cause of death in older women, but studies to date have not resolved whether menopausal hormone treatment protects against cardiovascular disease.

stockvault-egg98437

Assisted reproductive technologies impair the expression and methylation of insulin induced gene 1 and sterol regulatory element binding factor 1 in the fetus and placenta

Monday, March 31, 2014

Assisted reproductive technology induces alterations in the expression and methylation status of INSIG1 and SREBF1 in the fetus and the placenta.

pregnant-woman130916

Comparing indicators of health and development of singleton young adults conceived with and without assisted reproductive technology

Monday, March 31, 2014

Compared with non–assisted reproductive technology (ART) population control subjects, ART mothers and their adult offspring (18–28 years old) reported increased hospitalizations and respiratory problems, but no differences in quality of life, body mass index, or educational achievements.

flower

Menopausal hormone therapy and menopausal symptoms

Monday, March 31, 2014

Menopausal symptoms and risks of hormonal treatment are better understood than ever before. This knowledge can be mobilized to provide safer and more effective treatments for symptomatic postmenopausal women.