Women infected with human immunodeficiency virus type 1 have poorer assisted reproduction outcomes A case control study

Capsule:
Human immunodeficiency virus 1 infection in women is associated with poorer assisted reproductive technology (ART) outcomes in a match-paired, case-control study, which indicates no ART delay in cases with HIV-1 controlled infection.

Authors:
Camille Stora, M.D., Sylvie Epelboin, M.D., Emmanuel Devouche, Ph.D., Sophie Matheron, M.D., PhD., Loïc Epelboin, M.D., Chadi Yazbeck, M.D., Florence Damond, M.D., Pascale Longuet, M.D., Frederick Dzineku, M.D., Mandovi Rajguru, M.D., Lucie Delaroche, M.D., Laurent Mandelbrot, M.D., Ph.D., Dominique Luton, M.D., Ph.D., Catherine Patrat, M.D., Ph.D.

Volume 105, Issue 5, Pages 1193-1201

Abstract:

Objective:
To compare the efficacy of assisted reproductive technology (ART) in women infected with human immunodeficiency virus type 1 (HIV-1) versus HIV-negative controls.

Design:
Retrospective case-control study.

Setting:
University hospital ART unit.

Patient(s):
Eighty-two women infected with HIV-1 and 82 women as seronegative controls.

Intervention(s):
Ovarian stimulation, oocytes retrieval, standard in vitro fertilization (IVF) or intracytoplasmic sperm injection, embryo transfer.

Main Outcome Measure(s):
Clinical pregnancies and live-birth rates.

Result(s):
After oocyte retrieval, all women infected with HIV-1 infected were matched 1:1 to HIV-negative controls according to the following criteria: date of ART attempt, age, parity, main cause of infertility, ART technique, and rank of attempt. Only the first IVF cycle during the study period was considered for each couple. We found no statistically significant differences between the two groups for ovarian stimulation data, fertilization rate, or average number of embryos transferred. The clinical pregnancy rate per transfer was statistically significantly lower for the cases compared with the controls (12% vs. 32%), as were the implantation rate (10% vs. 21%) and the live-birth rate (7% vs. 19%).

Conclusion(s):
In one of the largest studies to pair six factors that influence the results of ART, HIV infection in women was associated with poorer outcomes after ART. These results suggest that women with controlled HIV-1-infection should be counseled not to delay ART in cases of self-insemination failure or other causes of infertility. Fertility preservation by vitrification of oocytes in women whose pregnancy should be delayed may be an important future consideration.

Effects of maternal age on euploidy in a large cohort of embryos analyzed with 24 chromosome single nucleotide polymorphism based preimplantation genetic screening

Capsule:
For 37,711 embryos analyzed with 24-chromosome single-nucleotide polymorphism–based preimplantation genetic screening, the number, proportion, and probability of embryos testing as euploid per IVF cycle were stratified by maternal age.

Authors:
Zachary P. Demko, Ph.D., Alexander L. Simon, B.S., Rajiv C. McCoy, Ph.D., Dmitri A. Petrov, Ph.D., Matthew Rabinowitz, Ph.D.

Volume 105, Issue 5, Pages 1307-1313

Abstract:

Objective:
To determine the effect of maternal age on the average number of euploid embryos retrieved during oocyte harvest as part of an in vitro fertilization (IVF) cycle, including the probability of retrieving at least one euploid embryo in a cohort (PrE).

Design:
Retrospective study.

Setting:
Preimplantation genetic screening (PGS) laboratory.

Patient(s):
Women aged 18 to 48 years undergoing IVF treatment.

Intervention(s):
Use of 24-chromosome single-nucleotide polymorphism (SNP)-based PGS of day-3 and day-5 embryo biopsies.

Main Outcome Measure(s):
Relationships between maternal age and the rate of embryos that tested as euploid (hereafter referred to as “euploid embryos”), the average number and proportion of euploid embryos per IVF cycle, and PrE.

Result(s):
We analyzed 22,599 day-3 embryos and 15,112 day-5 embryos. In women aged 27 to 35 years, the median proportion of euploid embryos in each cycle remained constant at ∼35% in day-3 biopsies and ∼55% in day-5 biopsies, but it decreased rapidly after age 35. On average, women in their late 20s had four euploid embryos (day 3 or day 5) per cycle, but this number decreased linearly (R2 ≥ 0.983) after 35 years of age. The effect of maternal age on PrE was similar, with a rapid exponential decline (R2 = 0.986). Across all maternal ages, the euploid proportion and number of embryos per cycle were counterbalanced, so the number of euploid embryos per cycle was the same for day-3 and day-5 biopsies. This suggests that the loss of embryos from day 3 to day 5 was primarily due to aneuploidy.

Conclusion(s):
Our results confirm the known inverse relationship between advanced maternal age (>35 years) and embryo euploidy, demonstrating that equal numbers of euploid embryos are available at day 3 and day 5.

Low dose human chorionic gonadotropin alone can complete follicle maturity Successful application to modified natural cycle in vitro fertilization

Capsule:
Low-dose human chorionic gonadotropin can be used to complete follicle maturity after gonadotropin releasing hormone antagonist administration in the late follicular phase of a natural cycle, leading to successful pregnancies in modified natural cycle in vitro fertilization.

Authors:
Richard J. Paulson, M.D., Karine Chung, M.D., M.S.C.E., Alexander M. Quaas, M.D., Ph.D., Sara J. Mucowski, M.D., Sami I. Jabara, M.D., Kristin A. Bendikson, M.D.

Volume 105, Issue 5, Pages 1228-1231

Abstract:

Objective:
To investigate the feasibility of utilizing low-dose hCG alone to complete follicle maturity in a natural cycle, without the need for antecedent exogenous FSH stimulation.

Design:
Case series.

Setting:
Academic fertility program.

Patient(s):
Normally ovulatory women with infertility thought to be predominantly due to male factor.

Intervention(s):
Modified natural IVF cycles were conducted as follows: natural ovulatory cycles were monitored with serial ultrasound examinations and serum E2 determinations. When the lead follicle reached preovulatory status according to cycle day, ultrasound, and E2 levels, 0.25 mg of the GnRH antagonist ganirelix acetate was administered along with 200 IU of hCG. These medications were repeated daily for 2 to 3 days with further serial monitoring. A trigger dose of 10,000 IU of hCG was followed by follicle aspiration, IVF, and ET in a standard manner.

Main Outcome Measure(s):
Follicle maturity, live births, documentation of the feasibility of this new approach.

Result(s):
In all cases, E2 levels rose and the dominant follicle continued to increase in size in response to low-dose hCG after GnRH antagonist administration. Follicle aspiration yielded one or more mature oocytes. In vitro fertilization and ET resulted in live births.

Conclusion(s):
Low-dose hCG can be used to complete follicle maturity in a natural cycle without the need for antecedent exogenous FSH stimulation. This finding may have strong clinical utility in modified natural cycle IVF.

Articles of Special Interest

Women infected with human immunodeficiency virus type 1 have poorer assisted reproduction outcomes A case control study

Sunday, May 1, 2016
Human immunodeficiency virus 1 infection in women is associated with poorer assisted reproductive technology (ART) outcomes in a match-paired, case-control study, which indicates no ART delay in cases with HIV-1 controlled infection.

Effects of maternal age on euploidy in a large cohort of embryos analyzed with 24 chromosome single nucleotide polymorphism based preimplantation genetic screening

Sunday, May 1, 2016
For 37,711 embryos analyzed with 24-chromosome single-nucleotide polymorphism–based preimplantation genetic screening, the number, proportion, and probability of embryos testing as euploid per IVF cycle were stratified by maternal age.

Low dose human chorionic gonadotropin alone can complete follicle maturity Successful application to modified natural cycle in vitro fertilization

Sunday, May 1, 2016
Low-dose human chorionic gonadotropin can be used to complete follicle maturity after gonadotropin releasing hormone antagonist administration in the late follicular phase of a natural cycle, leading to successful pregnancies in modified natural cycle in vitro fertilization.

Can we modify assisted reproductive technology practice to broaden reproductive care access

Sunday, May 1, 2016
Access to care may be enhanced by modifying standard assisted reproductive technology practice to make fertility treatment cheaper, simpler, and better tolerated by patients.
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