Authors:
Marie-Madeleine Dolmans, M.D., Ph.D., Valérie Luyckx, M.D., Jacques Donnez, M.D., Ph.D., Claus Yding Andersen, D.M.Sc., Tine Greve, M.D.

Volume 99, Issue 6, Pages 1514-1522, May 2013

Abstract:

Ovarian tissue cryopreservation and transplantation is a real option to preserve and restore fertility in young cancer patients. However, there is a concern regarding the possible presence of malignant cells in the ovarian tissue, which could lead to recurrence of the primary disease after reimplantation. A review of the existing literature was done to evaluate the risk of transplanting malignant cells in case of the main malignant indications for ovarian tissue cryopreservation. For ovarian tissue from patients with haematological malignancies, it is of primordial importance to identify minimal residual disease prior to ovarian tissue transplantation. Indeed, these pathologies, here reviewed in details, are considered the most at risk of ovarian metastasis.

The post Risk of transferring malignant cells with transplanted frozen thawed ovarian tissue appeared first on Fertility & Sterility Discussion Forums.

Author:
José Bellver, M.D.

Volume 99, Issue 6, Pages 1558-1559, May 2013

Abstract:

Reflections on “The influence of female and male body mass index on live-births after Assisted Reproductive Technology treatment – a nationwide register-based cohort study” by Petersen et al.

The post Obesity and poor reproductive outcome Female and male body weight matter appeared first on Fertility & Sterility Discussion Forums.

Author:
Scott M. Nelson, M.R.C.O.G., Ph.D.

Volume 99, Issue 6, Pages 1563-1564, May 2013

Abstract:

Reflections on “Antimüllerian hormone in GnRH antagonist cycles: Prediction of ovarian response and cumulative treatment outcome in good-prognosis patients” by Arce et al.

The post Antimüllerian hormone is the writing on the wall for antral follicle count appeared first on Fertility & Sterility Discussion Forums.

Authors:
Hélène Cappy, M.D., Pascal Pigny, Ph.D., Maryse Leroy-Billiard, M.D., Didier Dewailly, M.D., Sophie Catteau-Jonard, Ph.D.

Volume 99, Issue 6, Pages 1729-1732, May 2013

Abstract:

Objective:
To describe a case of falsely elevated serum antimüllerian hormone (AMH) level in an infertile 37-year-old woman suffering from rheumatoid arthritis.

Design:
Case report.

Setting:
Lille University IVF center.

Patient:
A 37-year-old woman with rheumatoid arthritis demonstrating a high serum AMH level (74.5 ng/mL) and a low antral follicle count.

Intervention:
Assay with a Heterophilic Blocking Tube (HBT) to avoid heterophilic interference.

Main Outcome Measure(s):
Serum AMH level, ultrasound antral follicle count, hormonal assays on the 4th day of a spontaneous cycle.

Results:
The results of the infertility work-up were as follows: serum AMH: 74.5 ng/mL (15 fold the upper normal limit) (immunoassay: Immunotech®), LH: 3.2 IU/L, FSH: 4.5 IU/L, E2: 27 pg/mL, Prolactin: 10 ng/mL. The Antral Follicle Count (AFC: follicles from 2 to 9 mm) at ultrasound was 7 for both ovaries. As there were discrepancies between the serum AMH level and the results of the infertility work up using the bioassays, we suspected a case of falsely elevated AMH level due to heterophilic interference. A HBT® tube revealed a serum AMH level of 0.63 ng/mL.

Conclusion:
This case illustrates, for the first time, the possibility of falsely high serum AMH level due to heterophilic interference.

The post Falsely elevated serum antimüllerian hormone level in a context of heterophilic interference appeared first on Fertility & Sterility Discussion Forums.

Authors:
Claude Régis Lacoste, Alix Clemenson, Suzanne Lima, Romain Lecointre, Michel Peoc’h, Gautier Chene

Volume 99, Issue 6, Pages 1768-1773.e8, May 2013

Abstract:

Objective:
To assess tubo-ovarian dysplasia with a morphological and immunohistochemical study in rats exposed to ovulation stimulation protocols.

Design:
Animal experimental study.

Setting:
Academic research hospital.

Animals:
72 female Wistar rats divided into three groups.

Interventions:
Stimulation protocols using follicle-stimulating hormone (FSH) or clomiphene citrate for 3, 6, or 12 cycles, after which the animals were killed.

Main Outcome measures:
An ovarian and tubal dysplasia score and an immunohistochemical assessment using p53 and Ki67.

Results:
The ovarian dysplasia score was statistically significantly higher after 12 stimulation cycles in the groups receiving FSH (group B) or clomiphene citrate (group C) compared with control (group A). The tubal dysplasia score was statistically significantly increased after only three stimulation cycles in groups B and C. The Ki67 proliferation marker was statistically significantly expressed in the ovaries from group C, and in the fallopian tubes from groups B and C. P53 was constantly low in all three groups.

Conclusions:
Ovulation stimulation may induce tubal and ovarian histopathologic and immunohistochemical abnormalities with a dose effect. The role of the fallopian tubes and their interaction with the ovaries require further study.

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Authors:
Sara S. Malchau, M.D., Anne Loft, M.D., Elisabeth C. Larsen, M.D., Ph.D., Anna-Karina Aaris Henningsen, M.D., Steen Rasmussen, M.Sc., Anders Nyboe Andersen, M.D., D.M.Sci., Anja Pinborg, M.D., D.M.Sci.

Volume 99, Issue 6, Pages 1637-1643.e3, May 2013

Abstract:

Objective:
To describe perinatal outcome in children born after oocyte donation (OD) compared to in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) and spontaneous conception (SC).

Design:
National cohort study.

Setting:
Danish fertility clinics.

Patients:
Three hundred seventy-five children born after OD during the period 1995–2010.

Interventions:
None.

Main Outcome Measures:
Mean birth weight, mean gestational age, risks of low birth weight (LBW), preterm birth (PTB), congenital malformations, Caesarian section, preeclampsia and admittance to neonatal intensive care unit.

Results:
We found an increased risk of PTB in OD pregnancies. The adjusted odds ratio (AOR) of PTB in OD singletons was 1.8 (95% CI, 1.2–2.69), 2.5 (95% CI, 1.7–3.6), and 3.4 (95% CI, 2.3–4.9) compared with IVF, ICSI, and SC, respectively. The risk of LBW was also increased. The AOR of LBW was 1.4 (95% CI, 0.9–2.2), 1.8 (95% CI, 1.2–2.8), and 2.6 (95% CI, 1.7–4.0) compared with IVF, ICSI, and SC. The risk of preeclampsia was increased in OD pregnancies with an AOR of 2.9 (95% CI, 1.8–4.6), 2.8 (95% CI, 1.7–4.5), and 3.1 (95% CI, 1.9–4.9) compared with IVF, ICSI, and SC. After additional adjustment for preeclampsia, perinatal outcome improved. Among the twins, the difference between the groups was less pronounced.

Conclusions:
OD pregnancies have poorer perinatal outcome than standard IVF and ICSI, mainly due to the high prevalence of preeclampsia.

The post Perinatal outcomes in 375 children born after oocyte donation a Danish national cohort study appeared first on Fertility & Sterility Discussion Forums.

Authors:
Amanda Skillern, M.D., Marcelle Cedars, M.D., Heather Huddleston, M.D.

Volume 99, Issue 6, Pages 1733-1738.e4, May 2013

Abstract:

Objective:
To develop and validate a novel tool to assess the objective and subjective understanding oocyte donors have of the process and potential risks of oocyte donation.

Design:
Prospective cohort study.

Setting:
University based, tertiary reproductive health practice.

Patients:
Prospective oocyte donors.

Interventions:
We developed an informed consent questionnaire specific to oocyte donors, the Egg Donor Informed Consent Tool (EDICT) using published informed consent guidelines and known egg donation risks.

Main Outcome Measures:
We assessed content validity, readability, and reliability after pilot testing of the EDICT.

Results:
The Subjective EDICT assesses donors’ perceived understanding and the Objective EDICT measures donors’ actual knowledge. Questions cover the process of oocyte donation, potential risks, legal, and psychological issues. We demonstrated good content validity, a readability level of the EDIC T consistent with goal readability of informed consent documents, and good reliability upon pilot testing.

Conclusions:
For the first time, we describe development of a valid, reliable, novel tool for assessing oocyte donors’ understanding of the process and risks associated with oocyte donation.

The post Egg Donor Informed Consent Tool EDICT development and validation of a new informed consent tool for oocyte donors appeared first on Fertility & Sterility Discussion Forums.

Authors:
Karine Chung, M.D., M.S.C.E., Jacques Donnez, M.D., Elizabeth Ginsburg, M.D., Dror Meirow, M.D.

Volume 99, Issue 6, Pages 1534-1542, May 2013

Abstract:

Hundreds of thousands of women in their reproductive years are diagnosed with cancer each year. As the number of female patients who survive cancer increases, the demand for effective and individualized fertility preservation options grows. Currently there are limited clinical options for fertility preservation, and the paucity of publications describing clinical experience and outcomes data has limited accessibility to these options. Decision-making for patients diagnosed with cancer requires up-to-date knowledge of the efficacy and safety of available techniques. This article describes a step-by-step approach to evaluation of the cancer patient and presents an accumulation of clinical experience with challenges unique to patients with breast cancer and leukemia. Current data on reproductive outcomes of fertility preservation techniques are examined, demonstrating increasing evidence that these techniques are becoming efficacious enough to offer routinely to patients facing gonadotoxic cancer therapies, including those still considered “experimental.”

The post Emergency IVF versus ovarian tissue cryopreservation decision making in fertility preservation for female cancer patients appeared first on Fertility & Sterility Discussion Forums.

Authors:
Laura Benaglia, M.D., Alfonso Bermejo, M.D., Edgardo Somigliana, M.D., Ph.D., Sonia Faulisi, M.D., Guido Ragni, M.D., Luigi Fedele, M.D., Juan A. Garcia-Velasco, M.D.

Volume 99, Issue 6, Pages 1714-1719, May 2013

Abstract:

Objective:
To evaluate IVF outcome in women with unoperated bilateral endometriomas.

Design:
Multicenter retrospective cohort study.

Settings:
Two infertility units.

Patients:
Thirty-nine women with bilateral endometriomas matched to 78 unexposed controls.

Interventions:
Analysis of data from patients who underwent in vitro fertilization (IVF)–intracytoplasmic sperm injection.

Main Outcome measures:
Ovarian responsiveness and oocyte quality.

Results:
Responsiveness to ovarian hyperstimulation was significantly reduced in women with bilateral endometriomas. The total number of developing follicles in cases and controls was 9.6 ± 3.3 and 14.1 ± 6.8, respectively. The number of oocytes retrieved was 7.1 ± 3.2 and 9.8 ± 5.5, respectively. Conversely, oocyte retrieval was not hampered by the presence of the ovarian endometriomas. The rate (Interquatile Range-IQR) of oocytes retrieved per total number of developing follicle in cases and controls was 77% (57-88%) and 71% (63-79%), respectively. Moreover, the quality of the retrieved oocytes did not differ. The fertilization rate (IQR) was 67% (56-100%) and 70% (57-100%), respectively. The rate (IQR) of top quality embryos per oocyte used was 33% (25-50%) and 33% (20-43%), respectively. The implantation rate was 22% and 23%, respectively. The clinical pregnancy rate and the delivery rate also did not differ.

Conclusions:
Although the presence of bilateral endometriomas at the time of IVF affects responsiveness to hyper-stimulation, the quality of the oocytes retrieved and the chances of pregnancy are not influenced.

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Authors:
Luiz Guilherme Louzada Maldonado, M.D., José Gonçalves Franco Jr., M.D., Ph.D., Amanda Souza Setti, M.Sc., Assumpto Iaconelli, Jr., M.D., Edson Borges, Jr., M.D., Ph.D.

Volume 99, Issue 6, Pages 1615-1622, May 2013

Abstract:

Objective:
To compare cost-effectiveness between pituitary down-regulation with a GnRH agonist (GnRHa) short regimen on alternate days and GnRH antagonist (GnRHant) multidose protocol on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcome.

Study design:
Prospective, randomized.

Setting:
A private center.

Patient(s):
Patients were randomized in two groups: GnRHa (n=48) and GnRHant (n=48) groups.

Intervention(s):
The GnRHa stimulation protocol: administration of the triptorelin in alternate days starting on the 1st day of the cycle, recombinant FSH (rFSH) and recombinant hCG (rhCG) microdose. The GnRHant protocol: administration of a daily dose of rFSH, cetrorelix and rhCG microdose.

Main Outcome Measure(s):
ICSI outcomes and treatments costs.

Result(s):
A significant lower number of patients underwent embryo transfer in the GnRHa group. Clinical pregnancy rate was significantly lower and miscarriage rate was significantly higher in the GnRHa group. It was observed a significant lower cost per cycle in the GnRHa group as compared to the GnRHant group ($5,327.80 ± 387.30 and $5,900.40 ± 472.50). However, mean cost per pregnancy in the GnRHa was higher than in the GnRHant group ($19,671.80 ± 1430.0 and $11,328.70 ± 907.20).

Conclusion(s):
Although the short controlled ovarian stimulation protocol with GnRHa on alternate days, rFSH, and rhCG microdose may lower the cost of an individual IVF cycle, it requires more cycles to achieve pregnancy.

Clinical Trial Registration Number:
NCT01468441.

The post Cost effectiveness comparison between pituitary down regulation with a gonadotropin releasing hormone agonist short regimen on alternate days and an antagonist protocol for assisted fertilization treatments appeared first on Fertility & Sterility Discussion Forums.