Preconception risk stratification before fertility care

Authors:
Kristi S. Borowski, M.D., Brian C. Brost, M.D., Elizabeth A. Stewart, M.D., Eileen J. Hay, M.B., Ch.B., Charles C. Coddington III, M.D.

Volume 104, Issue 1, Pages 28-31

Abstract:

Care for the medically complex woman who desires fertility is an increasingly common event. Deciding when and whether one should proceed to fertility care has implications for the intended parents, the resulting offspring, and the health-care systems that care for these individuals. Significant barriers to assessment and communication with these patients include the patient’s desire to conceive despite major medical concerns, the lack of tools to communicate the risks, and the reluctance of health-care providers to limit access to medically assisted pregnancy.

Concordance among sperm deoxyribonucleic acid integrity assays and semen parameters

Capsule:
The sperm chromatin structure assay and TUNEL assay are moderately correlated measures of sperm DNA integrity but often yield conflicting results. The DNA fragmentation index is well correlated with semen analysis parameters, whereas TUNEL is not.

Authors:
Peter J. Stahl, M.D., Chava Cogan, B.S., Akanksha Mehta, M.D., Alex Bolyakov, M.C.Sc., Darius A. Paduch, M.D., Ph.D., Marc Goldstein, M.D.

Volume 104, Issue 1, Pages 56–61

Abstract:

Objective:
To assess the concordance of sperm chromatin structure assay (SCSA) results, epifluorescence TUNEL assay results, and standard semen parameters.

Design:
Prospective, observational study.

Setting:
Tertiary referral andrology clinic.

Patient(s):
A total of 212 men evaluated for subfertility by a single physician.

Intervention(s):
Clinical history, physical examination, semen analysis, SCSA, and TUNEL assay.

Main Outcome Measure(s):
Spearman’s rank correlation coefficients (r) between SCSA DNA fragmentation index (DFI), percentage TUNEL-positive sperm, and semen analysis parameters.

Result(s):
There was a positive correlation between SCSA DFI and TUNEL (r = 0.31), but the strength of this correlation was weaker than has previously been reported. The discordance rate between SCSA and TUNEL in classifying patients as normal or abnormal was 86 of 212 (40.6%). The SCSA DFI was moderately negatively correlated with sperm concentration and motility. The TUNEL results were unrelated to standard semen parameters.

Conclusion(s):
The SCSA DFI and percentage TUNEL-positive sperm are moderately correlated measures of sperm DNA integrity but yield different results in a large percentage of patients. The DFI is well-correlated with semen analysis parameters, whereas TUNEL is not. These data indicate that the SCSA and TUNEL assay measure different aspects of sperm DNA integrity and should not be used interchangeably.

Autologous endometrial coculture biopsy Is timing everything

Capsule:
Coculture biopsy in the cycle preceding IVF does not increase implantation, clinical pregnancy, or live birth rates compared with biopsies performed more than one cycle before IVF.

Authors:
Alexis P. Melnick, M.D., Erin M. Murphy, M.D., Alexis K. Masbou, M.D., Katherine J. Sapra, M.P.H., Zev Rosenwaks, M.D., Steven D. Spandorfer, M.D.

Volume 104, Issue 1, Pages 104–109

Abstract:

Objective:
To determine whether endometrial biopsy timing affects implantation rates and pregnancy outcomes in patients undergoing in vitro fertilization (IVF) with autologous endometrial coculture (AECC).

Design:
Retrospective cohort study.

Setting:
Academic medical center.

Patient(s):
All patients with a history of at least one failed IVF cycle who underwent an IVF-AECC cycle at our center from May 2004 to November 2013 were included.

Intervention(s):
Patients underwent luteal-phase endometrial biopsy in preparation for IVF. Biopsy samples were used for IVF in either the subsequent menstrual cycle or a future cycle. Embryos were cultured in AECC media and transferred on day 3.

Main Outcome Measure(s):
A total of 2,533 cycles of 1,719 patients who underwent an IVF-AECC cycle were identified. Cycles were stratified by endometrial biopsy timing. Clinical outcomes, including implantation, pregnancy, and live birth rates, were analyzed and compared between the two groups.

Result(s):
A total of 1,416 coculture biopsies were performed in the menstrual cycle before IVF and 1,117 were performed more than one cycle before IVF. The two groups were similar in age, body mass index, number of mature oocytes retrieved, and best embryo grade. There were no significant differences in implantation, clinical pregnancy, or live birth rates, with adjusted relative risks of 1.02 (95% confidence interval [CI] 0.92–1.13), 1.02 (95% CI 0.91–1.14), and 0.99 (95% CI 0.86–1.16), respectively.

Conclusion(s):
Coculture biopsy in the cycle preceding IVF does not increase implantation, clinical pregnancy, or live birth rates compared with biopsies performed more than one cycle before IVF. Previously demonstrated improvements in embryo quality and pregnancy outcomes in patients undergoing IVF with AECC are probably not attributable to biopsy-induced endometrial injury.

Articles of Special Interest

Preconception risk stratification before fertility care

Monday, June 29, 2015

Authors:
Kristi S. Borowski, M.D., Brian C.…

Concordance among sperm deoxyribonucleic acid integrity assays and semen parameters

Monday, June 29, 2015
The sperm chromatin structure assay and TUNEL assay are moderately correlated measures of sperm DNA integrity but often yield conflicting results. The DNA fragmentation index is well correlated with semen analysis parameters, whereas TUNEL is not.

Autologous endometrial coculture biopsy Is timing everything

Monday, June 29, 2015
Coculture biopsy in the cycle preceding IVF does not increase implantation, clinical pregnancy, or live birth rates compared with biopsies performed more than one cycle before IVF.

Ectopic pregnancy after in vitro fertilization Differences between fresh and frozen-thawed cycles

Monday, June 29, 2015
We discuss how embryo transfers in cycles without ovarian hyperstimulation are associated with lower rates of ectopic pregnancy compared with fresh autologous cycles, which suggests a difference in the uterine environment.
Translate »