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Woodruff TK, Ataman-Millhouse L, Acharya KS, Almeida-Santos T, Anazodo A, Anderson RA, Appiah L, Bader J, Becktell K, Brannigan RE, Breech L, Bourlon MT, Bumbuliene Ž, Burns K, Campo-Engelstein L, Campos JR, Centola GM, Chehin MB, Chen D, De Vos M, Duncan FE, El-Damen A, Fair D, Famuyiwa Y, Fechner PY, Fontoura P, Frias O, Gerkowicz SA, Ginsberg J, Gracia CR, Goldman K, Gomez-Lobo V, Hazelrigg B, Hsieh MH, Hoyos LR, Hoyos-Martinez A, Jach R, Jassem J, Javed M, Jayasinghe Y, Jeelani R, Jeruss JS, Kaul-Mahajan N, Keim-Malpass J, Ketterl TG, Khrouf M, Kimelman D, Kusuhara A, Kutteh WH, Laronda MM, Lee JR, Lehmann V, Letourneau JM, McGinnis LK, McMahon E, Meacham LR, Mijangos MFV, Moravek M, Nahata L, Ogweno GM, Orwig KE, Pavone ME, Peccatori FA, Pesce RI, Pulaski H, Quinn G, Quintana R, Quintana T, de Carvalho BR, Ramsey-Goldman R, Reinecke J, Reis FM, Rios J, Rhoton-Vlasak AS, Rodriguez-Wallberg KA, Roeca C, Rotz SJ, Rowell E, Salama M, Saraf AJ, Scarella A, Schafer-Kalkhoff T, Schmidt D, Senapati S, Shah D, Shikanov A, Shnorhavorian M, Skiles JL, Smith JF, Smith K, Sobral F, Stimpert K, Su HI, Sugimoto K, Suzuki N, Thakur M, Victorson D, Viale L, Vitek W, Wallace WH, Wartella EA, Westphal LM, Whiteside S, Wilcox LH, Wyns C, Xiao S, Xu J, Zelinski M. A View from the past into our collective future: the oncofertility consortium vision statement. J Assist Reprod Genet 2021; 38:3-15. [PMID: 33405006 PMCID: PMC7786868 DOI: 10.1007/s10815-020-01983-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/14/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose Today, male and female adult and pediatric cancer patients, individuals transitioning between gender identities, and other individuals facing health extending but fertility limiting treatments can look forward to a fertile future. This is, in part, due to the work of members associated with the Oncofertility Consortium. Methods The Oncofertility Consortium is an international, interdisciplinary initiative originally designed to explore the urgent unmet need associated with the reproductive future of cancer survivors. As the strategies for fertility management were invented, developed or applied, the individuals for who the program offered hope, similarly expanded. As a community of practice, Consortium participants share information in an open and rapid manner to addresses the complex health care and quality-of-life issues of cancer, transgender and other patients. To ensure that the organization remains contemporary to the needs of the community, the field designed a fully inclusive mechanism for strategic planning and here present the findings of this process. Results This interprofessional network of medical specialists, scientists, and scholars in the law, medical ethics, religious studies and other disciplines associated with human interventions, explore the relationships between health, disease, survivorship, treatment, gender and reproductive longevity. Conclusion The goals are to continually integrate the best science in the service of the needs of patients and build a community of care that is ready for the challenges of the field in the future.
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Affiliation(s)
- Teresa K Woodruff
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Lauren Ataman-Millhouse
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kelly S Acharya
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Duke Fertility Center, Durham, NC, USA
| | - Teresa Almeida-Santos
- Reproductive Medicine Unit, Coimbra Hospital and University Centre, Coimbra, Portugal.,Clinical Academic Center of Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Nelune Comprehensive Cancer Centre, Sydney, Australia.,Prince of Wales Hospital, Sydney, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Richard A Anderson
- Centre for Reproductive Health, University of Edinburgh, Edinburgh, Scotland, UK
| | - Leslie Appiah
- Department of Obstetrics and Gynecology, The University of Colorado School of Medicine, Aurora, CO, USA
| | - Joy Bader
- ReproTech, Ltd., Saint Paul, MN, USA
| | | | - Robert E Brannigan
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lesley Breech
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Maria T Bourlon
- Hemato-Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Žana Bumbuliene
- Clinic of Obstetrics and Gynecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Karen Burns
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lisa Campo-Engelstein
- Institute for the Medical Humanities, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Grace M Centola
- Dadi, Inc., Brooklyn, NY, USA.,Phoenix Sperm Bank of Seattle Sperm Bank, Phoenix, AZ, USA.,New England Cryogenic Center/New England Cord Blood Bank, Marlborough, MA, USA
| | | | - Diane Chen
- Potocsnak Family Division of Adolescent and Young Adult Medicine and Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Departments of Psychiatry and Behavioral Sciences, and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michel De Vos
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium.,Follicle Biology Laboratory (FOBI), Vrije Universiteit Brussel, Brussels, Belgium.,Department of Obstetrics, Gynecology, Perinatology and Reproductology, Institute of Professional Education, Sechenov University, Moscow, Russia
| | - Francesca E Duncan
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ahmed El-Damen
- IVIRMA Middle East Fertility Clinic, Abu Dhabi, United Arab Emirates.,Division of Embryology and Comparative Anatomy, Faculty of Science, Cairo University, Giza, Egypt
| | - Douglas Fair
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah, Primary Children's Hospital, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Yemi Famuyiwa
- Montgomery Fertility Center, Rockville, MD, USA.,Department of Obstetrics and Gynecology, George Washington University School of Medicine, Washington, DC, USA
| | - Patricia Y Fechner
- Department of Pediatrics, Division of Endocrinology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | | | - Olivia Frias
- Department of Obstetrics and Gynecology, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | | | - Jill Ginsberg
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Clarisa R Gracia
- Division of Reproductive Endocrinology & Infertility, University of Pennsylvania, Philadelphia, PA, USA
| | - Kara Goldman
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Veronica Gomez-Lobo
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | | | - Michael H Hsieh
- Department of Urology, George Washington University, Washington, DC, USA
| | - Luis R Hoyos
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA
| | - Alfonso Hoyos-Martinez
- Department of Pediatrics, Section of Pediatric Diabetes and Endocrinology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Robert Jach
- Department of Obstetrics and Gynecology, Medical College Jagiellonian University, Krakow, Poland
| | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Murid Javed
- OriginElle Fertility Clinic and Women's Health Centre, Ottawa, ON, Canada
| | - Yasmin Jayasinghe
- Department of Obstetrics & Gynaecology Royal Women's Hospital, University of Melbourne, Royal Children's Hospital, Melbourne, Australia
| | - Roohi Jeelani
- Vios Fertility Institute, Chicago, IL, USA.,Department of Obstetrics and Gynecology, Wayne State School of Medicine, Detroit, MI, USA
| | - Jacqueline S Jeruss
- Departments of Surgery, Pathology, and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Nalini Kaul-Mahajan
- Mother & Child Hospital, New Delhi, India.,Ferticity Fertility Clinics, New Delhi, India
| | - Jessica Keim-Malpass
- School of Nursing, University of Virginia, Charlottesville, VA, USA.,Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Tyler G Ketterl
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Washington, Seattle, WA, USA.,Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA, USA
| | | | - Dana Kimelman
- Centro de Esterilidad Montevideo, Montevideo, Uruguay
| | - Atsuko Kusuhara
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - William H Kutteh
- Department of Reproductive Endocrinology, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Monica M Laronda
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jung Ryeol Lee
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Fertility Preservation and Enhancement Research Laboratory, Seongnam, Korea
| | - Vicky Lehmann
- Department of Medical Psychology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Joseph M Letourneau
- University of Utah Center for Reproductive Medicine, Salt Lake City, UT, USA
| | - Lynda K McGinnis
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Eileen McMahon
- Sinai Health System, Mount Sinai Fertility, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Lillian R Meacham
- Department of Pediatrics, Aflac Cancer Center of Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Monserrat Fabiola Velez Mijangos
- Biology of Human Reproduction Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Molly Moravek
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.,Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Leena Nahata
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - George Moses Ogweno
- Reproductive Endocrinology and Fertility, Department of Obstetrics and Gynecology, The Nairobi Hospital, Nairobi, Kenya.,Esis Health Services (EHS), Nairobi, Kenya
| | - Kyle E Orwig
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mary Ellen Pavone
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Fedro Alessandro Peccatori
- Fertility & Procreation Unit, Division of Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Romina Ileana Pesce
- Reproductive Medicine Unit, Obstetrics and Gynecology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Hanna Pulaski
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gwendolyn Quinn
- Departments of Obstetrics and Gynecology, Center for Medical Ethics, Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | | | | | | | - Rosalind Ramsey-Goldman
- Department of Medicine/Division of Rheumatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Fernando M Reis
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Julie Rios
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Obstetrics and Gynecology, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Alice S Rhoton-Vlasak
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Kenny A Rodriguez-Wallberg
- Department of Reproductive Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Cassandra Roeca
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Seth J Rotz
- Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Erin Rowell
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mahmoud Salama
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amanda J Saraf
- Riley Hospital for Children at Indiana University, Indianapolis, IN, USA
| | - Anibal Scarella
- Centro de Reproducción Humana, Facultad Medicina, Universidad de Valparaíso, Valparaíso, Chile.,Departamento de Obstetricia y Ginecología, Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile
| | | | - Deb Schmidt
- Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Suneeta Senapati
- Division of Reproductive Endocrinology & Infertility, University of Pennsylvania, Philadelphia, PA, USA
| | - Divya Shah
- Division of Reproductive Endocrinology & Infertility, University of Pennsylvania, Philadelphia, PA, USA
| | - Ariella Shikanov
- Department of Biomedical Engineering, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Margarett Shnorhavorian
- Department of Urology, Division of Pediatric Urology, Seattle Children's Hospital, Seattle, University of Washington, Seattle, WA, USA
| | - Jodi L Skiles
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - James F Smith
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
| | - Kristin Smith
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Fabio Sobral
- Pregna Medicina Reproductiva, Buenos Aires, Argentina
| | - Kyle Stimpert
- Department of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - H Irene Su
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, CA, USA
| | - Kouhei Sugimoto
- International Center for Reproductive Medicine, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Mili Thakur
- Reproductive Genomics Program, The Fertility Center, Grand Rapids, MI, USA.,Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - David Victorson
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Wendy Vitek
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA.,Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA
| | - W Hamish Wallace
- Paediatric Oncology, University of Edinburgh & Royal Hospital for Sick Children, Edinburgh, Scotland, UK
| | - Ellen A Wartella
- Center on Media and Human Development, School of Communication, Northwestern University, Evanston, IL, USA
| | - Lynn M Westphal
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Stacy Whiteside
- Fertility & Reproductive Health Program, Department of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Christine Wyns
- Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Shuo Xiao
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Environmental Health Sciences Institute, Rutgers University, New Brunswick, NJ, USA
| | - Jing Xu
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA.,Department of Obstetrics & Gynecology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Mary Zelinski
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA.,Department of Obstetrics & Gynecology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
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Inhorn MC, Birenbaum-Carmeli D, Westphal LM, Doyle J, Gleicher N, Meirow D, Dirnfeld M, Seidman D, Kahane A, Patrizio P. Patient-centered elective egg freezing: a binational qualitative study of best practices for women's quality of care. J Assist Reprod Genet 2019; 36:1081-1090. [PMID: 31104290 PMCID: PMC6603102 DOI: 10.1007/s10815-019-01481-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE How can elective egg freezing (EEF) be made patient centered? This study asked women to reflect on their experiences of EEF, which included their insights and recommendations on the optimal delivery of patient-centered care. METHODS In this binational, qualitative study, 150 women (114 in the USA, 36 in Israel) who had completed at least one cycle of EEF were recruited from four American IVF clinics (two academic, two private) and three in Israel (one academic, two private) over a two-year period (June 2014-August 2016). Women who volunteered for the study were interviewed by two medical anthropologists. Interviews were audio recorded, transcribed, and entered into a qualitative data management program (Dedoose) for analysis. RESULTS The majority (85%) of women were without partners at the time of EEF, and thus were undertaking EEF alone in mostly couples-oriented IVF clinics. Following the conceptual framework known as "patient-centered infertility care," we identified two broad categories and eleven specific dimensions of patient-centered EEF care, including (1) system factors: information, competence of clinic and staff, coordination and integration, accessibility, physical comfort, continuity and transition, and cost and (2) human factors: attitude and relationship with staff, communication, patient involvement and privacy, and emotional support. Cost was a unique factor of importance in both countries, despite their different healthcare delivery systems. CONCLUSIONS Single women who are pursuing EEF alone in the mostly couples-oriented world of IVF have distinct and multifaceted needs. IVF clinics should strive to make best practices for patient-centered EEF care a high priority.
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Affiliation(s)
- Marcia C. Inhorn
- Department of Anthropology, Yale University, 10 Sachem Street, New Haven, CT 06520 USA
| | | | - Lynn M. Westphal
- Stanford Fertility and Reproductive Medicine Center, Stanford University, 1195 W. Fremont Ave, Sunnyvale, CA 94087 USA
| | - Joseph Doyle
- Shady Grove Fertility, 9600 Blackwell Road, Rockville, MD 20850 USA
| | - Norbert Gleicher
- Center for Human Reproduction, 21 E. 69th Street, New York, NY 10021 USA
| | - Dror Meirow
- Division Reproductive Endocrinology-IVF, Department of Obstetrics & Gynecology, Carmel Medical Center, Ruth & Bruce Faculty of Medicine, Technion, 3436212 Haifa, Israel
| | - Martha Dirnfeld
- Clinical Center for Fertility Preservation and Fertility Preservation Research Laboratory, Department of Obstetrics and Gynecology, Sheba Medical Center, IVF and Fertility Unit, 1 Emek Ha’ella St, 52621 Ramat Gan, Israel
| | - Daniel Seidman
- Department of Obstetrics and Gynecology, Sheba Medical Center, IVF and Fertility Unit, 1 Emek Ha’ella St, 52621 Ramat Gan, Israel
| | - Arik Kahane
- Assuta Medical Center, 13 Eliezer Mazal, 75653 Rishoon Lezion, Israel
| | - Pasquale Patrizio
- Yale Fertility Center, Yale University, 150 Sargent Drive, New Haven, CT 06511 USA
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Wang A, Westphal LM. Type of frozen transfer in relation to euploid miscarriage outcomes. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.02.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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4
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5
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Smith BM, Duncan FE, Ataman L, Smith K, Quinn GP, Chang RJ, Finlayson C, Orwig K, Valli-Pulaski H, Moravek MB, Zelinski MB, Irene Su H, Vitek W, Smith JF, Jeruss JS, Gracia C, Coutifaris C, Shah D, Nahata L, Gomez-Lobo V, Appiah LC, Brannigan RE, Gillis V, Gradishar W, Javed A, Rhoton-Vlasak AS, Kondapalli LA, Neuber E, Ginsberg JP, Muller CH, Hirshfeld-Cytron J, Kutteh WH, Lindheim SR, Cherven B, Meacham LR, Rao P, Torno L, Sender LS, Vadaparampil ST, Skiles JL, Schafer-Kalkhoff T, Frias OJ, Byrne J, Westphal LM, Schust DJ, Klosky JL, McCracken KA, Ting A, Khan Z, Granberg C, Lockart B, Scoccia B, Laronda MM, Mersereau JE, Marsh C, Pavone ME, Woodruff TK. The National Physicians Cooperative: transforming fertility management in the cancer setting and beyond. Future Oncol 2018; 14:3059-3072. [PMID: 30474429 PMCID: PMC6331694 DOI: 10.2217/fon-2018-0278] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Once unimaginable, fertility management is now a nationally established part of cancer care in institutions, from academic centers to community hospitals to private practices. Over the last two decades, advances in medicine and reproductive science have made it possible for men, women and children to be connected with an oncofertility specialist or offered fertility preservation soon after a cancer diagnosis. The Oncofertility Consortium's National Physicians Cooperative is a large-scale effort to engage physicians across disciplines – oncology, urology, obstetrics and gynecology, reproductive endocrinology, and behavioral health – in clinical and research activities to enable significant progress in providing fertility preservation options to children and adults. Here, we review the structure and function of the National Physicians Cooperative and identify next steps.
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Affiliation(s)
- Brigid M Smith
- Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Francesca E Duncan
- Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Lauren Ataman
- Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Kristin Smith
- Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.,Department of Obstetrics & Gynecology, Division of Reproductive Endocrinology & Infertility, Feinberg School of Medicine, Northwestern Medicine, Chicago, IL 60611, USA
| | - Gwendolyn P Quinn
- Department of Obstetrics & Gynecology, New York University School of Medicine, New York, NY 10016, USA
| | - R Jeffrey Chang
- Department of OB/GYN & Reproductive Sciences, Division of Reproductive Endocrinology & Infertility, University of California San Diego, La Jolla, CA 92093, USA
| | - Courtney Finlayson
- Division of Endocrinology, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL 60611 USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Kyle Orwig
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.,Magee-Womens Research Institute, Pittsburgh, PA 15213, USA
| | - Hanna Valli-Pulaski
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.,Magee-Womens Research Institute, Pittsburgh, PA 15213, USA
| | - Molly B Moravek
- Department of Obstetrics & Gynecology, Division of Reproductive Endocrinology & Infertility, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mary B Zelinski
- Division of Reproductive & Developmental Science, Oregon National Primate Research Center, Beaverton, OR 97006, USA.,Department of Obstetrics & Gynecology, Oregon Health & Sciences University, Portland, OR 97239, USA
| | - H Irene Su
- Department of Reproductive Medicine & Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA
| | - Wendy Vitek
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine & Dentistry, Rochester, NY 14642, USA
| | - James F Smith
- Department of Urology, University of California San Francisco, San Francisco, CA 94110, USA
| | - Jacqueline S Jeruss
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Clarisa Gracia
- Department of Obstetrics & Gynecology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Christos Coutifaris
- Department of Obstetrics & Gynecology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Divya Shah
- Department of Obstetrics & Gynecology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Leena Nahata
- Department of Pediatrics, Division of Endocrinology, The Ohio State University College of Medicine/Nationwide Children's Hospital, Columbus, OH 43210, USA.,Center for Behavioral Health, the Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Veronica Gomez-Lobo
- Division of Pediatric & Adolescent Gynecology, MedStar Washington Hospital Center, Children's National Health System, Washington, DC 20010, USA
| | - Leslie Coker Appiah
- The James Cancer Center, Nationwide Children's Hospital, The Ohio State University, Columbus, OH 43210, USA
| | - Robert E Brannigan
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Valerie Gillis
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - William Gradishar
- Department of Medicine, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Asma Javed
- Department of Pediatric & Adolescent Medicine, Division of Pediatric & Adolescent Gynecology, Mayo Clinic, Rochester, MN 55905, USA
| | - Alice S Rhoton-Vlasak
- Department of Obstetrics & Gynecology, Division of Reproductive Endocrinology & Infertility, University of Florida, Gainesville, FL 32608, USA
| | | | - Evelyn Neuber
- Center for Advanced Reproductive Services, University of Connecticut, Farmington, CT 06032, USA
| | - Jill P Ginsberg
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Charles H Muller
- Department of Urology, University of Washington School of Medicine, Seattle, WA 98195, USA
| | | | - William H Kutteh
- Division of Reproductive Endocrinology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Department of Surgery, St Jude Children's Research Hospital, Memphis, TN 38105, USA.,Fertility Associates of Memphis, Memphis, TN 38120, USA
| | - Steven R Lindheim
- Department of Obstetrics & Gynecology, Wright State University, Boonshoft School of Medicine, Dayton, OH 45435, USA
| | - Brooke Cherven
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA
| | - Lillian R Meacham
- Aflac Cancer & Blood Disorders Center & Department of Pediatrics, Division of Hematology/Oncology & Division of Endocrinology, Emory University, Atlanta, GA 30322, USA
| | - Pooja Rao
- Division of Pediatric Hematology/Oncology, Penn State Health Children's Hospital, Hershey, PA 17033, USA
| | - Lilibeth Torno
- Division of Oncology, CHOC Children's Hospital, Orange, CA 92868, USA
| | - Leonard S Sender
- Division of Oncology, CHOC Children's Hospital, Orange, CA 92868, USA
| | - Susan T Vadaparampil
- Department of Health Outcomes & Behavior, Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.,Department of Health Outcomes and Behaviors, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | - Jodi L Skiles
- Department of Pediatrics, Division of Hematology and Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.,Riley Hospital for Children at IU Health, Indianapolis, IN 46202, USA
| | - Tara Schafer-Kalkhoff
- Division of Pediatric & Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Oliva J Frias
- Division of Pediatric & Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Julia Byrne
- Children's Research Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Lynn M Westphal
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Danny J Schust
- Department of Obstetrics, Gynecology & Women's Health, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - James L Klosky
- Aflac Cancer & Blood Disorders Center & Department of Pediatrics, Division of Hematology/Oncology & Division of Endocrinology, Emory University, Atlanta, GA 30322, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30307, USA
| | - Kate A McCracken
- Section of Pediatric & Adolescent Gynecology, Nationwide Children's Hospital, Columbus, OH 43205, USA.,Department of Obstetrics & Gynecology, The Ohio State University, Columbus, OH 43210, USA
| | - Alison Ting
- Division of Reproductive & Developmental Science, Oregon National Primate Research Center, Beaverton, OR 97006, USA.,21st Century Medicine, Inc., Fontana, CA 92336, USA
| | - Zaraq Khan
- Division of Reproductive Endocrinology & Infertility, Mayo Clinic, Rochester, MN 55905, USA.,Division of Minimally Invasive Gynecologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Barbara Lockart
- Division of Hematology, Oncology & Stem Cell Transplant, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.,Division of General Pediatric Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Bert Scoccia
- Department of Obstetrics & Gynecology, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Monica M Laronda
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.,Stanley Manne Children's Research Institute, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Jennifer E Mersereau
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology & Infertility, University of North Carolina, Raleigh, NC 27599, USA
| | - Courtney Marsh
- Department of Obstetrics & Gynecology, University of Kansas Health System, Kansas City, KS 66160, USA
| | - Mary Ellen Pavone
- Department of Obstetrics & Gynecology, Division of Reproductive Endocrinology & Infertility, Feinberg School of Medicine, Northwestern Medicine, Chicago, IL 60611, USA
| | - Teresa K Woodruff
- Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Inhorn MC, Birenbaum-Carmeli D, Westphal LM, Doyle J, Gleicher N, Meirow D, Dirnfeld M, Seidman D, Kahane A, Patrizio P. Ten pathways to elective egg freezing: a binational analysis. J Assist Reprod Genet 2018; 35:2003-2011. [PMID: 30074130 DOI: 10.1007/s10815-018-1277-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/24/2018] [Indexed: 11/30/2022] Open
Abstract
PURPOSE What are the specific pathways that lead women to freeze their eggs? In this binational study, women were asked directly about the life circumstances that led them on the path to elective egg freezing (EEF). METHODS From June 2014 to August 2016, 150 women (114 in the USA, 36 in Israel) who had completed at least 1 cycle of EEF were interviewed by two medical anthropologists. Study participants were recruited through four American IVF clinics (two academic, two private) and three in Israel (one academic, two private). Interviews were audio-recorded, transcribed verbatim, and entered into a qualitative data management program (Dedoose) for analysis. RESULTS The majority (85%) of women in the study were without partners, while 15% had partners at the time of EEF. Six pathways to EEF were found among women without partners (being single, divorced, broken up, deployed overseas, single mother, career planner), with career planning being the least common pathway to EEF. Among women with partners, four pathways to EEF were found (relationship too new or uncertain, partner not ready to have children, partner refusing to have children, or partner having multiple partners). With only one exception, the pathways and their frequencies were similar in both countries. CONCLUSIONS Partnership problems, not career planning, lead most women on pathways to EEF. These pathways should be studied in a variety of national settings, and fertility clinics should offer patient-centered care for single women pursuing EEF in the couples-oriented world of IVF.
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Affiliation(s)
- Marcia C Inhorn
- Department of Anthropology, Yale University, 10 Sachem Street, New Haven, CT, 06511, USA.
| | | | - Lynn M Westphal
- Stanford Fertility and Reproductive Medicine Center, Stanford University Medical Center, 1195 W. Fremont Ave., Sunnyvale, CA, 94087, USA
| | - Joseph Doyle
- Shady Grove Fertility, 9601 Blackwell Road, Rockville, MD, 20850, USA
| | - Norbert Gleicher
- Center for Human Reproduction, 21 E. 69th Street, New York, NY, 10021, USA
| | - Dror Meirow
- Clinical Center for Fertility Preservation and Fertility Preservation Research Laboratory, Sheba Medical Center, Department of Obstetrics and Gynecology, IVF and Fertility Unit, 1 Emek Ha'ella St., 52621, Ramat Gan, Israel
| | - Martha Dirnfeld
- Israeli Fertility Society, Division Reproductive Endocrinology-IVF, Department of Obstetrics & Gynecology, Carmel Medical Center, Ruth & Bruce Faculty of Medicine, Technion, 343621, Haifa, Israel
| | - Daniel Seidman
- Department of Obstetrics and Gynecology, Sheba Medical Center, IVF and Fertility Unit, 1 Emek Ha'ella St., 52621, Ramat Gan, Israel
| | - Arik Kahane
- Assuta Medical Center, 13 Eliezer Mazal, 75653, Rishon LeZion, Israel
| | - Pasquale Patrizio
- Yale Fertility Center and Fertility Preservation Program, 150 Sargent Drive, New Haven, CT, 06511, USA
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7
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Wang A, Kort J, Behr B, Westphal LM. Euploidy in relation to blastocyst sex and morphology. J Assist Reprod Genet 2018; 35:1565-1572. [PMID: 30030712 DOI: 10.1007/s10815-018-1262-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/06/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The objective of our study is to assess the relationship of embryo ploidy status in relation to embryo sex, morphological characteristics, and transfer parameters. METHODS This is a retrospective cohort study at an academic medical center of patients who underwent in vitro fertilization with preimplantation genetic screening (PGS) from 2010 to 2015. Embryos were screened with 24-chromosome preimplantation genetic screening with day 5/6 trophectoderm biopsy. We investigated embryo euploidy in relation to morphology (expansion, inner cell mass, trophectoderm), embryo sex, biopsy day, and blastocyst cohort size. We used multivariate logistic regression to calculate odds ratios of euploidy in relation to these parameters. RESULTS A total of 1559 embryos from 316 cycles and 233 patients (mean maternal age = 37.8 ± 4.2 years) were included in the analysis. Six hundred and twenty-eight blastocysts (40.3%) were found to be euploid. Expansion (p < 0.001), inner cell mass (ICM) (p < 0.01), and trophectoderm grade (p < 0.001) were significantly associated with embryo ploidy in bivariate models controlling for maternal age, while embryo sex, biopsy day, and blastocyst cohort size were not associated with embryo ploidy. In a multivariate model, we found that maternal age (p < 0.001), higher grade of expansion (p < 0.01), and better quality trophectoderm (p < 0.001 for A compared to C grade) remained significantly associated with increased embryo euploidy, but ICM grade was no longer significant. Embryo sex was not associated with ploidy status, though male embryos were found to be associated with higher trophectoderm scores (p < 0.02). CONCLUSIONS This is the largest study to date to investigate PGS-tested embryo sex and ploidy status. While maternal age and some morphological parameters (expansion, trophectoderm grade) are associated with euploidy in our cohort, other parameters such as embryo sex, biopsy day, and cohort size are not. Though embryo sex was not associated with euploidy, male embryos were found to be associated with higher trophectoderm grades. Additional investigation in larger studies is warranted.
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Affiliation(s)
- Ange Wang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Jonathan Kort
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Barry Behr
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lynn M Westphal
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA. .,Fertility and Reproductive Health Services Sunnyvale, 1195 W. Fremont Ave, Sunnyvale, CA, 94087, USA.
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8
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Kort J, Westphal LM. Leave the intrauterine device! Fertil Steril 2018; 110:57-58. [DOI: 10.1016/j.fertnstert.2018.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 10/28/2022]
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9
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Salama M, Isachenko V, Isachenko E, Rahimi G, Mallmann P, Westphal LM, Inhorn MC, Patrizio P. Cross border reproductive care (CBRC): a growing global phenomenon with multidimensional implications (a systematic and critical review). J Assist Reprod Genet 2018; 35:1277-1288. [PMID: 29808382 PMCID: PMC6063838 DOI: 10.1007/s10815-018-1181-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 04/05/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Many people travel abroad to access fertility treatments. This growing phenomenon is known as cross border reproductive care (CBRC) or fertility tourism. Due to its complex nature and implications worldwide, CBRC has become an emerging dilemma deserving more attention on the global healthcare agenda. METHODS According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review of the literature was performed for all relevant full-text articles published in PubMed in English during the past 18 years to explore CBRC phenomenon in the new millennium. RESULTS Little is known about the accurate magnitude and scope of CBRC around the globe. In this systematic and critical review, we identify three major dimensions of CBRC: legal, economic, and ethical. We analyze each of these dimensions from clinical and practical perspectives. CONCLUSION CBRC is a growing reality worldwide with potential benefits and risks. Therefore, it is very crucial to regulate the global market of CBRC on legal, economic, and ethical bases in order to increase harmonization and reduce any forms of exploitation. Establishment of accurate international statistics and a global registry will help diminish the current information gap surrounding the CBRC phenomenon.
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Affiliation(s)
- Mahmoud Salama
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany.
- Department of Reproductive Medicine, National Research Center, Cairo, Egypt.
| | - Vladimir Isachenko
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany
| | - Evgenia Isachenko
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany
| | - Gohar Rahimi
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany
| | - Lynn M Westphal
- Department of Reproductive Endocrinology and Infertility, Stanford University, Stanford, CA, USA
| | - Marcia C Inhorn
- Department of Anthropology, Yale University, New Haven, CT, USA
| | - Pasquale Patrizio
- Department of Reproductive Endocrinology and Infertility, Yale University, New Haven, CT, USA
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10
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Inhorn MC, Birenbaum-Carmeli D, Westphal LM, Doyle J, Gleicher N, Meirow D, Raanani H, Dirnfeld M, Patrizio P. Medical egg freezing: How cost and lack of insurance cover impact women and their families. Reprod Biomed Soc Online 2018; 5:82-92. [PMID: 30014045 PMCID: PMC6024226 DOI: 10.1016/j.rbms.2017.12.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/28/2017] [Accepted: 12/18/2017] [Indexed: 05/03/2023]
Abstract
Medical egg freezing (MEF) is being recommended increasingly for women at risk of losing their reproductive ability due to cancer chemotherapy or other fertility-threatening medical conditions. This first, binational, ethnographic study of women who had undergone MEF sought to explore women's experiences under two different funding systems: (i) the USA, where the cost of MEF is rarely covered by private or state health insurance; and (ii) Israel, where the cost of MEF is covered by national health insurance. Women were recruited from four American and two Israeli in-vitro fertilization clinics where MEF is offered. In-depth, semi-structured interviews were conducted with 45 women (33 Americans, 12 Israelis) who had completed at least one cycle of MEF. All of the Israeli women had cancer diagnoses, but were not faced with the additional burden of funding an MEF cycle. In marked contrast, the American women - 23 with cancer diagnoses and 10 with other fertility-threatening medical conditions - struggled, along with their families, to 'piece together' MEF funding, which added significant financial pressure to an already stressful situation. Given the high priority that both American and Israeli women in this study placed on survival and future motherhood, it is suggested that insurance funding for MEF should be mandated in the USA, as it is in Israel. This article concludes by describing new state legislative efforts in this regard.
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Affiliation(s)
| | | | - Lynn M. Westphal
- Stanford Fertility and Reproductive Medicine Center, Stanford University, Sunnyvale, CA, USA
| | | | | | - Dror Meirow
- Department of Obstetrics and Gynecology, IVF and Fertility Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Hila Raanani
- Department of Obstetrics and Gynecology, IVF and Fertility Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Martha Dirnfeld
- Division of Reproductive Endocrinology-IVF, Department of Obstetrics and Gynecology, Carmel Medical Center, Ruth & Bruce Faculty of Medicine, Technion, Haifa, Israel
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11
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Inhorn MC, Birenbaum-Carmeli D, Westphal LM, Doyle J, Gleicher N, Meirow D, Raanani H, Dirnfeld M, Patrizio P. Medical egg freezing: the importance of a patient-centered approach to fertility preservation. J Assist Reprod Genet 2018; 35:49-59. [PMID: 29124460 PMCID: PMC5758476 DOI: 10.1007/s10815-017-1081-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 11/01/2017] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This binational qualitative study of medical egg freezing (MEF) examined women's motivations and experiences, including their perceived needs for patient-centered care in the midst of fertility- and life-threatening diagnoses. METHODS Forty-five women who had undertaken MEF were interviewed in the USA (33 women) and in Israel (12 women) between June 2014 and August 2016. Interviews lasted approximately 1 h and were conducted by two senior medical anthropologists, one in each country. Women were recruited from four American IVF clinics (two academic, two private) and two Israeli clinics (both academic) where MEF is being offered to cancer patients and women with other fertility-threatening medical conditions. RESULTS Women who undertake MEF view their fertility and future motherhood as important components of their identities and recovery and, thus, are grateful for the opportunity to pursue fertility preservation. However, women who undergo MEF have special needs, given that they tend to be a "vulnerable" population of young (age < 30), unmarried, resource-constrained women, who are facing not only fertility loss but also the "double jeopardy" of cancer. Through in-depth, qualitative interviews, these women's MEF stories reveal 10 dimensions of care important to fertility preservation, including five "system factors" (information, coordination and integration, accessibility, physical comfort, cost) and five "human factors" (adolescent issues, male partner involvement, family involvement, egg disposition decisions, emotional support). Together, these dimensions of care constitute an important framework that can be best described as "patient-centered MEF." CONCLUSIONS Women pursuing MEF have special medical needs and concerns, which require particular forms of patient-centered care. This study outlines 10 dimensions of patient-centered fertility preservation that are appropriate for MEF patients. This approach may help IVF clinics to be better prepared for delivering top-quality care to mostly young, single women facing the daunting prospect of fertility loss and life-threatening medical diagnoses.
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Affiliation(s)
- Marcia C. Inhorn
- Department of Anthropology, Yale University, 10 Sachem Street, New Haven, CT 06520 USA
| | | | - Lynn M. Westphal
- Stanford Fertility and Reproductive Medicine Center, Stanford University, 1195 W. Fremont Ave., Sunnyvale, CA 94087 USA
| | - Joseph Doyle
- Shady Grove Fertility, 9600 Blackwell Road, Rockville, MD 20850 USA
| | - Norbert Gleicher
- Center for Human Reproduction, 21 E. 69th Street, New York, NY 10021 USA
| | - Dror Meirow
- Department of Obstetrics and Gynecology, IVF and Fertility Unit, Sheba Medical Center, 1 Emek Ha’ella St, 52621 Ramat Gan, Israel
| | - Hila Raanani
- Department of Obstetrics and Gynecology, IVF and Fertility Unit, Sheba Medical Center, 1 Emek Ha’ella St, 52621 Ramat Gan, Israel
| | - Martha Dirnfeld
- Division Reproductive Endocrinology-IVF, Department of Obstetrics and Gynecology, Carmel Medical Center, Ruth and Bruce Faculty of Medicine, Technion, 3436212 Haifa, Israel
| | - Pasquale Patrizio
- Yale Fertility Center, Yale University, 150 Sargent Drive, New Haven, CT 06511 USA
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12
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Shochet T, Comstock IA, Ngoc NTN, Westphal LM, Sheldon WR, Loc LT, Blum J, Winikoff B, Blumenthal PD. Results of a pilot study in the U.S. and Vietnam to assess the utility and acceptability of a multi-level pregnancy test (MLPT) for home monitoring of hCG trends after assisted reproduction. BMC Womens Health 2017; 17:67. [PMID: 28830483 PMCID: PMC5567887 DOI: 10.1186/s12905-017-0422-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 08/11/2017] [Indexed: 11/22/2022]
Abstract
Background To evaluate the utility and acceptability of using multi-level pregnancy tests (MLPTs) at home to monitor hCG trends following assisted reproductive technology (ART). Methods One hundred and four women presenting for ART at either Stanford Medicine Fertility and Reproductive Health Clinic (Stanford, CA) or Hung Vuong Hospital (Ho Chi Minh City, Vietnam) participated in this pilot study. Women were asked to perform the MLPT at home, primarily on days when they were also scheduled to receive standard clinic-based serum hCG testing. These tests were administered up to 6 times over the 6-week period following embryo transfer or intrauterine insemination (IUI). Concordance of serial hCG readings for each time point was assessed by comparing trends in urine MLPT results with trends in serum hCG. Stable or increasing hCG level was interpreted as an indication of a progressing pregnancy, while a declining hCG was interpreted as a lack of established or progressing pregnancy. At study end, all participants were asked about the acceptability and convenience of using the MLPT at home for monitoring hCG trends following ART. Results Data from both urine and serum testing are available for 156 of 179 clinic visits (87.2%). There was high concordance of serial trend results between the two types of tests: among the 156 sets of serum and urine hCG data points, 150 (96.2%) showed a matching trend in hCG pattern and 6 (3.8%) resulted in a discordant trend. Seventy-three percent of women reported being satisfied or very satisfied with using the MLPTs at home. Almost all (96.6%) said that the MLPT was easy or very easy to use. Conclusion The MLPT offers women and health care providers a client-friendly diagnostic tool to detect very early pregnancy and monitor its progress. Trial registration This study was registered on clinicaltrials.gov as NCT01846403 (May 1, 2013), and NCT01919502 (August 5, 2013).
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Affiliation(s)
- Tara Shochet
- Gynuity Health Projects, 15 East 26th Street, Suite 801, New York, NY, 10010, USA.
| | - Ioanna A Comstock
- George Washington University, 2150 Pennsylvania Ave NW, Washington, DC, 20036, USA
| | - Nguyen Thi Nhu Ngoc
- Center for Research and Consultancy in Reproductive Health, 16D, Luy Ban Bich, Tan Thoi Hoa, Tan Phu District, Ho Chi Minh City, 70000, Vietnam
| | - Lynn M Westphal
- Reproductive Endocrinology, Stanford University, 900 Welch Road, Suite 20, Palo Alto, CA, 94304, USA
| | - Wendy R Sheldon
- Gynuity Health Projects, 15 East 26th Street, Suite 801, New York, NY, 10010, USA
| | - Ly Thai Loc
- Hung Vuong Hospital, 128 Hong Bang Street, Ward 12, District 5, Ho Chi Minh City, Vietnam
| | - Jennifer Blum
- Gynuity Health Projects, 15 East 26th Street, Suite 801, New York, NY, 10010, USA
| | - Beverly Winikoff
- Gynuity Health Projects, 15 East 26th Street, Suite 801, New York, NY, 10010, USA
| | - Paul D Blumenthal
- Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA, 94304, USA
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13
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Chavez SL, McElroy SL, Bossert NL, De Jonge CJ, Rodriguez MV, Leong DE, Behr B, Westphal LM, Reijo Pera RA. Comparison of epigenetic mediator expression and function in mouse and human embryonic blastomeres. Hum Mol Genet 2014; 23:4970-84. [PMID: 24821703 PMCID: PMC4140471 DOI: 10.1093/hmg/ddu212] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A map of human embryo development that combines imaging, molecular, genetic and epigenetic data for comparisons to other species and across pathologies would be greatly beneficial for basic science and clinical applications. Here, we compared mRNA and protein expression of key mediators of DNA methylation and histone modifications between mouse and human embryos, embryos from fertile/infertile couples, and following growth factor supplementation. We observed that individual mouse and human embryos are characterized by similarities and distinct differences in DNA methylation and histone modification patterns especially at the single-cell level. In particular, while mouse embryos first exhibited sub-compartmentalization of different histone modifications between blastomeres at the morula stage and cell sub-populations in blastocysts, differential histone modification expression was detected between blastomeres earlier in human embryos at the four- to eight-cell stage. Likewise, differences in epigenetic mediator expression were also observed between embryos from fertile and infertile couples, which were largely equalized in response to growth factor supplementation, suggesting that select growth factors might prevent alterations in epigenetic profiles during prolonged embryo culture. Finally, we determined that reduced expression via morpholino technologies of a single histone-modifying enzyme, Rps6ka4/Msk2, resulted in cleavage-stage arrest as assessed by time-lapse imaging and was associated with aneuploidy generation. Taken together, data document differences in epigenetic patterns between species with implications for fertility and suggest functional roles for individual epigenetic factors during pre-implantation development.
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Affiliation(s)
- Shawn L Chavez
- Center for Reproductive and Stem Cell Biology, Institute for Stem Cell Biology and Regenerative Medicine, Department of Obstetrics and Gynecology and Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Sohyun L McElroy
- Center for Reproductive and Stem Cell Biology, Institute for Stem Cell Biology and Regenerative Medicine, Department of Obstetrics and Gynecology and Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Nancy L Bossert
- Reproductive Medicine Center, University of Minnesota, Minneapolis, MN 55414, USA
| | | | - Maria Vera Rodriguez
- Center for Reproductive and Stem Cell Biology, Institute for Stem Cell Biology and Regenerative Medicine, Department of Obstetrics and Gynecology and Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA Iviomics, Valencia, Spain
| | - Denise E Leong
- Center for Reproductive and Stem Cell Biology, Institute for Stem Cell Biology and Regenerative Medicine, Department of Obstetrics and Gynecology and Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Barry Behr
- Department of Obstetrics and Gynecology and
| | | | - Renee A Reijo Pera
- Center for Reproductive and Stem Cell Biology, Institute for Stem Cell Biology and Regenerative Medicine, Department of Obstetrics and Gynecology and Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
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14
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Kort JD, Eisenberg ML, Millheiser LS, Westphal LM. Fertility issues in cancer survivorship. CA Cancer J Clin 2014; 64:118-34. [PMID: 24604743 DOI: 10.3322/caac.21205] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 08/21/2013] [Accepted: 08/28/2013] [Indexed: 12/28/2022] Open
Abstract
Breakthroughs in cancer diagnosis and treatment have led to dramatic improvements in survival and the need to focus on survivorship issues. Chemotherapy and radiotherapy can be gonadotoxic, resulting in impaired fertility. Techniques to help cancer survivors reproduce have been improving over the past decade. Discussion of the changes to a patient's reproductive health after cancer treatment is essential to providing comprehensive quality care. The purpose of this review is to aid in pre- and posttreatment counseling, focusing on fertility preservation and other strategies that may mitigate risks to the patient's reproductive, sexual, and overall health.
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Affiliation(s)
- Jonathan D Kort
- Resident, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, CA
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15
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Kharsa ZC, Gustin SLF, Westphal LM. Pregnancy During Recovery from Hematopoietic Stem Cell Transplant for Mycosis Fungoides. J Adolesc Young Adult Oncol 2013; 2:133-5. [PMID: 26812191 DOI: 10.1089/jayao.2013.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
We report a case of spontaneous pregnancy with subsequent full-term live birth following hematopoietic stem cell transplantation (HSCT) for mycosis fungoides in a 24-year-old nulligravida with 4 years of prior infertility due to primary ovarian insufficiency. Four months post-transplant, the patient was found to be 10 weeks pregnant. Her pregnancy was complicated by first trimester fetal exposure to mycophenolate mofetil (pregnancy category D), delayed-onset acute gastrointestinal graft-versus-host disease, and multiple systemic infections. This report highlights the importance of discussing potential fertility outcomes in patients undergoing HSCT, including the necessity for adequate contraception post-transplant, even in the setting of previous infertility.
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Affiliation(s)
- Zena C Kharsa
- 1 University of California , San Diego School of Medicine, La Jolla, California
| | - Stephanie L F Gustin
- 2 Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Stanford University Medical Center , Stanford, California
| | - Lynn M Westphal
- 2 Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Stanford University Medical Center , Stanford, California.,3 Stanford Fertility and Reproductive Medicine Center , Palo Alto, California
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16
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Turner K, Reynolds-May MF, Zitek EM, Tisdale RL, Carlisle AB, Westphal LM. Stress and anxiety scores in first and repeat IVF cycles: a pilot study. PLoS One 2013; 8:e63743. [PMID: 23717472 PMCID: PMC3662783 DOI: 10.1371/journal.pone.0063743] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 04/05/2013] [Indexed: 12/02/2022] Open
Abstract
Background The role of stress in reproduction, particularly during treatment for infertility, has been of considerable interest; however, few studies have objectively measured stress and anxiety over the course of the IVF cycle or compared the experience of first-time and repeat patients. Methods This prospective cohort pilot study enrolled 44 women undergoing IVF at a university-based clinic to complete the State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS) and Infertility Self-Efficacy Scale (ISES) at three time points prior to ovarian stimulation (T1), one day prior to oocyte retrieval (T2), and 5–7 days post embryo transfer (T3). Results Mean STAI State scores were significantly elevated at all three time points (p<0.01). STAI State and PSS mean values did not change over time and did not differ in first-time vs. repeat patients. Self-efficacy (ISES) scores declined over time, with a greater decline for repeat patients. Of the 36 women who completed a cycle, 15 achieved clinical pregnancy. Using logistic regression modeling, all scores at T2 were correlated with pregnancy outcome with lower scores on the STAI State and PSS and higher scores on the ISES associated with higher pregnancy rates. Conclusions Stress and anxiety levels remained elevated across all cycles. Women with lower stress and anxiety levels on the day prior to oocyte retrieval had a higher pregnancy rate. These results emphasize the need to investigate stress reduction modalities throughout the IVF cycle.
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Affiliation(s)
- Kathy Turner
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Margaret F. Reynolds-May
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California, United States of America
| | - Emily M. Zitek
- Department of Psychology, Stanford University, Stanford, California, United States of America
| | - Rebecca L. Tisdale
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Allison B. Carlisle
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Lynn M. Westphal
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail:
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Eisenberg ML, Lathi RB, Baker VL, Westphal LM, Milki AA, Nangia AK. Frequency of the Male Infertility Evaluation: Data from the National Survey of Family Growth. J Urol 2013; 189:1030-4. [DOI: 10.1016/j.juro.2012.08.239] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 08/13/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Michael L. Eisenberg
- Department of Urology, Stanford, California
- Department of Obstetrics and Gynecology, Stanford, California
| | - Ruth B. Lathi
- Department of Obstetrics and Gynecology, Stanford, California
| | | | | | - Amin A. Milki
- Department of Obstetrics and Gynecology, Stanford, California
| | - Ajay K. Nangia
- Department of Urology, Kansas University School of Medicine, Kansas City, Kansas
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18
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Lathi RB, Massie JA, Gilani M, Milki AA, Westphal LM, Baker VL, Behr B. Outcomes of trophectoderm biopsy on cryopreserved blastocysts: a case series. Reprod Biomed Online 2012; 25:504-7. [DOI: 10.1016/j.rbmo.2012.06.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Revised: 06/04/2012] [Accepted: 06/26/2012] [Indexed: 11/29/2022]
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19
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Krieg SA, Fan X, Hong Y, Sang QX, Giaccia A, Westphal LM, Lathi RB, Krieg AJ, Nayak NR. Global alteration in gene expression profiles of deciduas from women with idiopathic recurrent pregnancy loss. Mol Hum Reprod 2012; 18:442-50. [PMID: 22505054 DOI: 10.1093/molehr/gas017] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Recurrent pregnancy loss (RPL) occurs in ∼5% of women. However, the etiology is still poorly understood. Defects in decidualization of the endometrium during early pregnancy contribute to several pregnancy complications, such as pre-eclampsia and intrauterine growth restriction (IUGR), and are believed to be important in the pathogenesis of idiopathic RPL. We performed microarray analysis to identify gene expression alterations in the deciduas of idiopathic RPL patients. Control patients had one antecedent term delivery, but were undergoing dilation and curettage for current aneuploid miscarriage. Gene expression differences were evaluated using both pathway and gene ontology (GO) analysis. Selected genes were validated using quantitative reverse transcription-polymerase chain reaction (qRT-PCR). A total of 155 genes were found to be significantly dysregulated in the deciduas of RPL patients (>2-fold change, P < 0.05), with 22 genes up-regulated and 133 genes down-regulated. GO analysis linked a large percentage of genes to discrete biological functions, including immune response (23%), cell signaling (18%) and cell invasion (17.1%), and pathway analysis revealed consistent changes in both the interleukin 1 (IL-1) and IL-8 pathways. All genes in the IL-8 pathway were up-regulated while genes in the IL-1 pathway were down-regulated. Although both pathways can promote inflammation, IL-1 pathway activity is important for normal implantation. Additionally, genes known to be critical for degradation of the extracellular matrix, including matrix metalloproteinase 26 and serine peptidase inhibitor Kazal-type 1, were also highly up-regulated. In this first microarray approach to decidual gene expression in RPL patients, our data suggest that dysregulation of genes associated with cell invasion and immunity may contribute significantly to idiopathic recurrent miscarriage.
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Affiliation(s)
- S A Krieg
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Kansas University Medical Center, Kansas City, KS 66160, USA.
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20
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Friedman BE, Pao S, Westphal LM, Lathi RB. Oocyte retrieval following continued stimulation five days beyond ovulation yields live birth after frozen embryo transfer. J Assist Reprod Genet 2012; 29:433-5. [PMID: 22327896 DOI: 10.1007/s10815-012-9721-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 01/27/2012] [Indexed: 12/01/2022] Open
Affiliation(s)
- Brooke E Friedman
- Stanford Fertility and Reproductive Medicine Center, Palo Alto, CA 94305, USA.
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21
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Gustin SL, Mukherjee G, Baker VL, Westphal LM, Milki AA, Lathi RB. Early pregnancy testosterone after ovarian stimulation and pregnancy outcome. Fertil Steril 2012; 97:23-7.e1. [DOI: 10.1016/j.fertnstert.2011.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 10/02/2011] [Accepted: 10/15/2011] [Indexed: 11/29/2022]
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22
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Friedman BE, Davis LB, Lathi RB, Westphal LM, Baker VL, Milki AA. Age-Related Success with Elective Single versus Double Blastocyst Transfer. ISRN Obstet Gynecol 2011; 2011:656204. [PMID: 22191047 PMCID: PMC3236401 DOI: 10.5402/2011/656204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 09/26/2011] [Indexed: 12/16/2022]
Abstract
Background. Although the optimal outcome of assisted reproductive technology (ART) is a healthy singleton pregnancy, the rate of twin gestation from ART in women over the age of 35 is persistently high. Methods/Findings. We compared clinical pregnancy rates (PRs), ongoing pregnancy/live birth rates, and multiple gestation rates (MGRs) in 108 women who chose elective single blastocyst transfer (eSBT) to 415 women who chose elective double blastocyst transfer (eDBT) at a hospital-based IVF center. There was no significant difference in PR between eSBT and eDBT (57.4% versus 50.2%, P = 0.47) nor between eSBT and eDBT within each age group: <35, 35–37, 38–40, and >40. The risk of multiple gestations, however, was greatly increased between eSBT and eDBT (1.6 versus 32.4%, P < 0.00005), and this difference did not vary across age groups. Conclusion(s). Women undergoing eDBT are at uniformly high risk of multiple gestation regardless of age. eSBT appears to significantly lower the risk of multiple gestation without compromising PR.
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Affiliation(s)
- Brooke E Friedman
- Stanford Fertility and Reproductive Medicine Center, Stanford University Medical Center, 900 Welch Road, Suite 350, Palo Alto, CA 94304, USA
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23
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Williams KE, Stemmle PG, Westphal LM, Rasgon NL. Mood disorders in oocyte donor candidates: brief report and implications for future research. Hum Reprod 2011; 26:847-52. [PMID: 21242150 DOI: 10.1093/humrep/deq394] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND IVF, using donor oocytes, has become increasingly common. The donation procedure carries psychiatric risks, including depression, anxiety and rarely, psychosis, and this risk increases when there is a past history of psychiatric illness. We report on the psychiatric status, at intake assessment, of a group of candidate oocyte donors. METHODS The authors reviewed clinical records of 63 women continuously presenting to a University medical center for psychiatric evaluation as part of the screening process for oocyte donation. A board certified psychiatrist administered a structured clinical interview to candidate donors, and self-report measures were obtained from 28 women. RESULTS There was a significant discrepancy between psychiatric history of depression and current mood status, as measured by both clinical interview and psychometric self-report data. Nearly one-quarter of candidate donors (22%) reported a history of major depressive disorder; however, all candidate donors denied current mood disturbance on clinical interview, and mean Beck depression inventory and profile of mood states scores were lower than expected compared with psychometric norms (P < 0.0005), epidemiological data and the recurrent nature of depressive disorders. CONCLUSIONS Candidate donors may minimize psychiatric symptoms. Given the potential for ovarian stimulation protocols to induce or exacerbate mood symptoms, and the moderate heritability of mood disorders, careful evaluation of candidate donor affective disorder history is recommended. This evaluation should focus on sensitivity to mood destabilization during times of hormonal change. Measures that examine whether a candidate donor may have a tendency to present herself in an overly favorable manner, and/or a tendency to minimize symptoms, are recommended.
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Affiliation(s)
- Katherine E Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Room 2358, Stanford, CA 94305-5723, USA.
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24
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Noyes N, Knopman JM, Melzer K, Fino ME, Friedman B, Westphal LM. Oocyte cryopreservation as a fertility preservation measure for cancer patients. Reprod Biomed Online 2010; 23:323-33. [PMID: 21570353 DOI: 10.1016/j.rbmo.2010.11.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 11/14/2010] [Accepted: 11/17/2010] [Indexed: 12/21/2022]
Abstract
Advances in cancer treatment have allowed women to live longer, fuller lives. However, gonadotoxic therapies used to effect cancer 'cures' often significantly impair a woman's reproductive potential. Thus, in accordance with improved survival rates,there is an increase in demand for fertility preservation. Initially, fertility preservation was limited to embryo cryopreservation;therefore, the number of patients enrolling was relatively low. Recently, substantial improvements have increased available options, specifically oocyte cryopreservation, thereby expanding and altering the make-up of the patient population under going treatment for fertility preservation. Patient diversity requires the treating physician(s) to be cognizant of issues specific to cancer type and stage. Furthermore, patients often have comorbidities which must be attended to and addressed. Although not all patients will be candidates for, or will elect to pursue, fertility preservation, all should receive counselling regarding their options. This practice will ensure that the reproductive rights of those patients facing impending sterility are maintained. Here, fertility preservation protocols, practices and special considerations, categorized by most frequently encountered cancer types, are reviewed to guide reproductive endocrinologists in the management of fertility preservation in such patients. The formation of a multidisciplinary patient-structured team will ensure a successful, yet safe, fertility-preservation outcome .
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Affiliation(s)
- Nicole Noyes
- NYU Fertility Center, NYU School of Medicine, New York, NY 10016, USA.
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25
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Millheiser LS, Helmer AE, Quintero RB, Westphal LM, Milki AA, Lathi RB. Is infertility a risk factor for female sexual dysfunction? A case-control study. Fertil Steril 2010; 94:2022-5. [DOI: 10.1016/j.fertnstert.2010.01.037] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 01/13/2010] [Accepted: 01/14/2010] [Indexed: 11/28/2022]
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26
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Huang JQ, Shahine LK, Gupta N, Westphal LM. Controlled ovarian hyperstimulation and gestational surrogacy in a patient with lung transplant: a case report. J Reprod Med 2010; 55:509-510. [PMID: 21291038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) is one of the most common genetic disorders that can often lead to chronic pulmonary disease. Patients with respiratory failure due to CF may achieve a good quality of life after lung transplant, and many will desire to have children. CASE A 26-year-old, nulliparous female with CF and double lung transplant presented for fertility treatment. She was successfully treated with controlled ovarian hyperstimulation and gestational surrogacy. CONCLUSION Controlled ovarian hyperstimulation and gestational surrogacy is a safe option for patients with lung transplant to have a genetic child.
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Affiliation(s)
- Jian Qun Huang
- Stanford Fertility and Reproductive Medicine Center, Stanford University Medical Center, Palo Alto, California 94304, USA
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27
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McElroy SL, Byrne JA, Chavez SL, Behr B, Hsueh AJ, Westphal LM, Reijo Pera RA. Parthenogenic blastocysts derived from cumulus-free in vitro matured human oocytes. PLoS One 2010; 5:e10979. [PMID: 20539753 PMCID: PMC2881862 DOI: 10.1371/journal.pone.0010979] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Accepted: 05/11/2010] [Indexed: 01/25/2023] Open
Abstract
Background Approximately 20% of oocytes are classified as immature and discarded following intracytoplasmic sperm injection (ICSI) procedures. These oocytes are obtained from gonadotropin-stimulated patients, and are routinely removed from the cumulus cells which normally would mature the oocytes. Given the ready access to these human oocytes, they represent a potential resource for both clinical and basic science application. However culture conditions for the maturation of cumulus-free oocytes have not been optimized. We aimed to improve maturation conditions for cumulus-free oocytes via culture with ovarian paracrine/autocrine factors identified by single cell analysis. Methodology/Principal Finding Immature human oocytes were matured in vitro via supplementation with ovarian paracrine/autocrine factors that were selected based on expression of ligands in the cumulus cells and their corresponding receptors in oocytes. Matured oocytes were artificially activated to assess developmental competence. Gene expression profiles of parthenotes were compared to IVF/ICSI embryos at morula and blastocyst stages. Following incubation in medium supplemented with ovarian factors (BDNF, IGF-I, estradiol, GDNF, FGF2 and leptin), a greater percentage of oocytes demonstrated nuclear maturation and subsequently, underwent parthenogenesis relative to control. Similarly, cytoplasmic maturation was also improved as indicated by development to blastocyst stage. Parthenogenic blastocysts exhibited mRNA expression profiles similar to those of blastocysts obtained after IVF/ICSI with the exception for MKLP2 and PEG1. Conclusions/Significance Human cumulus-free oocytes from hormone-stimulated cycles are capable of developing to blastocysts when cultured with ovarian factor supplementation. Our improved IVM culture conditions may be used for obtaining mature oocytes for clinical purposes and/or for derivation of embryonic stem cells following parthenogenesis or nuclear transfer.
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Affiliation(s)
- Sohyun L. McElroy
- Center for Human Embryonic Stem Cell Research and Education, Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Palo Alto, California, United States of America
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, United States of America
| | - James A. Byrne
- Center for Human Embryonic Stem Cell Research and Education, Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Palo Alto, California, United States of America
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, United States of America
| | - Shawn L. Chavez
- Center for Human Embryonic Stem Cell Research and Education, Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Palo Alto, California, United States of America
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, United States of America
| | - Barry Behr
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, United States of America
- Division of Reproductive Endocrinology and Infertility, Stanford Hospital and Clinics, Palo Alto, California, United States of America
| | - Aaron J. Hsueh
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, United States of America
| | - Lynn M. Westphal
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, United States of America
- Division of Reproductive Endocrinology and Infertility, Stanford Hospital and Clinics, Palo Alto, California, United States of America
| | - Renee A. Reijo Pera
- Center for Human Embryonic Stem Cell Research and Education, Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Palo Alto, California, United States of America
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, United States of America
- * E-mail:
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28
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Moayeri SE, Lee HC, Lathi RB, Westphal LM, Milki AA, Garber AM. Laparoscopy in Women With Unexplained Infertility: ACost-Effectiveness Analysis. Obstet Gynecol Surv 2009. [DOI: 10.1097/01.ogx.0000363239.95266.2b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Shahine LK, Lamb JD, Lathi RB, Milki AA, Langen E, Westphal LM. Poor prognosis with in vitro fertilization in Indian women compared to Caucasian women despite similar embryo quality. PLoS One 2009; 4:e7599. [PMID: 19855835 PMCID: PMC2762076 DOI: 10.1371/journal.pone.0007599] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 09/28/2009] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Disease prevalence and response to medical therapy may differ among patients of diverse ethnicities. Poor outcomes with in vitro fertilization (IVF) treatment have been previously shown in Indian women compared to Caucasian women, and some evidence suggests that poor embryo quality may be a cause for the discrepancy. In our center, only patients with the highest quality cleavage stage embryos are considered eligible for extending embryo culture to the blastocyst stage. We compared live birth rates (LBR) between Indian and Caucasian women after blastocyst transfer to investigate whether differences in IVF outcomes between these ethnicities would persist in patients who transferred similar quality embryos. METHODOLOGY/PRINCIPAL FINDINGS In this retrospective cohort analysis, we compared IVF outcome between 145 Caucasians and 80 Indians who had a blastocyst transfer between January 1, 2005 and June 31, 2007 in our university center. Indians were younger than Caucasians by 2.7 years (34.03 vs. 36.71, P = 0.03), were more likely to have an agonist down regulation protocol (68% vs. 43%, P<0.01), and were more likely to have polycystic ovarian syndrome (PCOS), although not significant, (24% vs. 14%, P = 0.06). Sixty eight percent of Indian patients had the highest quality embryos (4AB blastocyst or better) transferred compared to 71% of the Caucasians (P = 0.2). LBR was significantly lower in the Indians compared to the Caucasians (24% vs. 41%, P<0.01) with an odds ratio of 0.63, (95%CI 0.46-0.86). Controlling for age, stimulation protocol and PCOS showed persistently lower LBR with an adjusted odds ratio of 0.56, (95%CI 0.40-0.79) in the multivariate analysis. CONCLUSIONS/SIGNIFICANCE Despite younger age and similar embryo quality, Indians had a significantly lower LBR than Caucasians. In this preliminary study, poor prognosis after IVF for Indian ethnicity persisted despite limiting analysis to patients with high quality embryos transferred. Further investigation into explanations for ethnic differences in reproduction is needed.
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Affiliation(s)
- Lora K Shahine
- Department of Obstetrics and Gynecology, Division of Reproductive Medicine, Stanford University, Stanford, California, United States of America.
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30
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Friedman BE, Rogers JL, Shahine LK, Westphal LM, Lathi RB. Effect of selective serotonin reuptake inhibitors on in vitro fertilization outcome. Fertil Steril 2009; 92:1312-1314. [DOI: 10.1016/j.fertnstert.2009.03.060] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2008] [Revised: 02/27/2009] [Accepted: 03/15/2009] [Indexed: 11/28/2022]
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31
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Moayeri SE, Lee HC, Lathi RB, Westphal LM, Milki AA, Garber AM. Laparoscopy in women with unexplained infertility: a cost-effectiveness analysis. Fertil Steril 2009; 92:471-80. [DOI: 10.1016/j.fertnstert.2008.05.074] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2007] [Revised: 05/20/2008] [Accepted: 05/21/2008] [Indexed: 11/30/2022]
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McLaren JF, Burney RO, Milki AA, Westphal LM, Dahan MH, Lathi RB. Effect of methotrexate exposure on subsequent fertility in women undergoing controlled ovarian stimulation. Fertil Steril 2009; 92:515-9. [DOI: 10.1016/j.fertnstert.2008.07.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Revised: 05/20/2008] [Accepted: 07/09/2008] [Indexed: 02/08/2023]
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33
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Krieg SA, Lathi RB, Behr B, Westphal LM. Normal pregnancy after tetraploid karyotype on trophectoderm biopsy. Fertil Steril 2009; 92:1169.e9-1169.e10. [PMID: 19608167 DOI: 10.1016/j.fertnstert.2009.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 05/22/2009] [Accepted: 06/02/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report a case of successful pregnancy after trophectoderm biopsy and fluorescence in situ hybridization (FISH) revealed a tetraploid karyotype. DESIGN Case report. SETTING A university medical center. PATIENT(S) An infertility patient desiring trophectoderm biopsy on frozen blastocysts to facilitate preimplantation genetic screening. INTERVENTION(S) Frozen blastocysts were thawed on the evening before transfer. Trophectoderm biopsy was performed the following morning. FISH results were available the same day, and two embryos with tetraploid results were transferred. MAIN OUTCOME MEASURE(S) Chorionic villus sample (CVS) and newborn exam. RESULT(S) Normal diploid CVS result and a healthy male infant. CONCLUSION(S) Although multiple cells can be analyzed using trophectoderm biopsy, abnormalities in the trophectoderm may not be present in the inner cell mass.
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Affiliation(s)
- Sacha A Krieg
- Division of Reproductive Endocrinology and Infertility, Stanford Hospital and Clinics, Palo Alto, California
| | - Ruth B Lathi
- Division of Reproductive Endocrinology and Infertility, Stanford Hospital and Clinics, Palo Alto, California
| | - Barry Behr
- Division of Reproductive Endocrinology and Infertility, Stanford Hospital and Clinics, Palo Alto, California
| | - Lynn M Westphal
- Division of Reproductive Endocrinology and Infertility, Stanford Hospital and Clinics, Palo Alto, California.
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Shahine LK, Burney RO, Behr B, Milki AA, Westphal LM, Lathi RB. Embryo quality before and after surgical treatment of endometriosis in infertile patients. J Assist Reprod Genet 2009; 26:69-73. [PMID: 19214735 DOI: 10.1007/s10815-008-9287-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Accepted: 12/12/2008] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To investigate the hypothesis that surgical treatment of endometriosis in infertile patients may improve pregnancy rates by improving embryo quality. METHODS We conducted a retrospective evaluation of 30 infertile patients treated with in vitro fertilization (IVF) before and after surgery for endometriosis. Patients served as their own controls and only cycles with similar stimulation protocols were compared. RESULTS Using standard visual evaluation, embryo quality on day 3 was similar before and after surgical treatment of endometriosis. Fifty seven percent of patients had stage I-II endometriosis and 43% had stage III-IV disease. No patients had a live birth after the first IVF cycle and 43% of patients had a live birth with the IVF cycle after surgery. CONCLUSIONS Surgical treatment of endometriosis does not alter embryo quality in patients with infertility treated with IVF.
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Affiliation(s)
- Lora K Shahine
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University, 900 Welch Road, Suite 350, Stanford, CA 94304, USA.
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Quintero RB, Helmer A, Huang JQ, Westphal LM. Ovarian stimulation for fertility preservation in patients with cancer. Fertil Steril 2008; 93:865-8. [PMID: 19013563 DOI: 10.1016/j.fertnstert.2008.10.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 09/30/2008] [Accepted: 10/03/2008] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate controlled ovarian hyperstimulation (COH) in women with cancer compared with healthy women. DESIGN A retrospective cohort study. SETTING Academic assisted reproductive technology (ART) program. PATIENT(S) Fifty women undergoing oocyte retrieval before cancer treatment and 50 age-matched controls. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Number of oocytes and matured oocytes retrieved, number of fertilized oocytes, days of stimulation, dose of gonadotropins. RESULT(S) There were no significant differences in the number of oocytes retrieved (13 vs. 11.5), the number of matured oocytes retrieved (9.7 vs. 9.6), and the number of oocytes fertilized (7.4 vs. 6.8). However, the patients with cancer had a longer duration of stimulation (10.5 vs. 9.0 days) and higher total dose of gonadotropins (4,174 IU vs. 3,416 IU). CONCLUSION(S) In our study, reasonable ovarian response was achieved by women with cancer with increased doses of gonadotropins and a longer duration of stimulation.
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Affiliation(s)
- Rudolpho B Quintero
- Department of Obstetrics & Gynecology, Division of Reproductive Endocrinology & Infertility, Stanford University, Stanford, California 94304, USA
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Krieg SA, Henne MB, Westphal LM. Obstetric outcomes in donor oocyte pregnancies compared with advanced maternal age in in vitro fertilization pregnancies. Fertil Steril 2008; 90:65-70. [PMID: 17727845 DOI: 10.1016/j.fertnstert.2007.06.014] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Revised: 06/06/2007] [Accepted: 06/06/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate obstetric complications in women who conceived through donated oocytes compared with women who conceived through assisted reproduction using autologous oocytes. DESIGN Retrospective cohort analysis. SETTING Stanford Hospital and Clinics and Lucille Packard Children's hospital, both tertiary referral centers. PATIENT(S) A cohort of 71 oocyte recipients who underwent in vitro fertilization (IVF) were compared to all women over 38 years who conceived through IVF with autologous oocytes (n = 108) between January 1, 2001, and December 31, 2005, at Stanford University and subsequently delivered infants at Lucille Packard Children's Hospital. INTERVENTION(S) Assisted reproductive technology with donor oocytes. MAIN OUTCOME MEASURE(S) Obstetric charts of the donor-oocyte recipients were compared for all women over 38 years old who had conceived through IVF with autologous oocytes at the same center (n = 108) and delivered at the same hospital during the same time period. Perinatal complications including preeclampsia, diabetes, preterm labor, preterm premature rupture of membranes and placental abnormalities, mode of delivery, presentation, Apgar scores, gestational age at delivery, and weight were compared between the groups. RESULT(S) Oocyte recipients and autologous oocyte controls had similar rates of complications of prematurity, hypertensive disorders of pregnancy, gestational diabetes, and placental abnormalities. Infant birth weights and gestational age at time of delivery were similar between the two groups. CONCLUSION(S) This study suggests that women undergoing IVF with donor oocytes are not at increased risk for complications during pregnancy or at increased immediate neonatal complications compared with women of advanced maternal age undergoing IVF with autologous oocytes.
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Affiliation(s)
- Sacha A Krieg
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA.
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Massie JAM, Burney RO, Milki AA, Westphal LM, Lathi RB. Basal follicle-stimulating hormone as a predictor of fetal aneuploidy. Fertil Steril 2008; 90:2351-5. [PMID: 18178189 DOI: 10.1016/j.fertnstert.2007.10.041] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 10/10/2007] [Accepted: 10/22/2007] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether an elevated basal FSH concentration is an independent predictor of fetal aneuploidy, as measured in spontaneous abortions (SAB). DESIGN Retrospective study. SETTING Academic reproductive endocrinology and infertility center. PATIENT(S) All women with karyotypes of chorionic villi isolated from first trimester spontaneous miscarriages at the time of dilation and curettage from 1999 to 2006. The highest basal serum FSH level in the year preceding dilation and curettage was recorded. INTERVENTIONS(S) Monitoring of early pregnancy. MAIN OUTCOME MEASURE(S) Fetal karyotype. RESULTS(S) A total of 177 spontaneous miscarriages with karyotypes (70 euploid and 107 aneuploid) were identified, of which 53% were conceived by IVF. The aneuploid cohort consisted of trisomic (87%), teraploid (9.3%), and monosomic (3.7%) gestations. Using logistic regression analysis, basal FSH was not found to be independently predictive of an aneuploid gestation in our data set. CONCLUSION(S) Our data do not support the hypothesis that an elevated basal FSH concentration is associated with an increase in fetal aneuploidy. Our findings suggest that the association between diminished ovarian reserve and SAB may result from nonkaryotypic factors.
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Affiliation(s)
- Jamie A M Massie
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Stanford University Medical Center, Stanford, California 94305, USA
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Burney RO, Gebhardt J, Shu Y, Behr B, Westphal LM. Normal pregnancy resulting from a non-pronuclear oocyte at the time of examination for fertilization. CLIN EXP OBSTET GYN 2008; 35:170-171. [PMID: 18754284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE To report the case of a patient undergoing in vitro fertilization (IVF) in which a non-pronuclear (0PN) oocyte resulted in a normal pregnancy. METHODS A 36-year-old woman underwent an IVF-embryo transfer treatment cycle. RESULTS Four oocytes were retrieved for insemination by IVF. Examination for fertilization revealed two polypronuclearpolygynic and two non-pronuclear oocytes. The non-pronuclear oocytes were observed further for development. One embryo developed from the non-pronuclear cohort and was transferred at the 8-cell stage on day 3. Subsequently, a pregnancy developed, and resulted in the delivery of a healthy term infant. CONCLUSIONS Non-pronuclear oocytes may represent a source of developmentally competent embryos, and further observation of this cohort should be considered, particularly in situations involving a low yield of oocytes at retrieval.
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Affiliation(s)
- R O Burney
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305-5317, USA
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Moayeri SE, Behr B, Lathi RB, Westphal LM, Milki AA. Reply: “Perspectives on oocyte research”. Fertil Steril 2007. [DOI: 10.1016/j.fertnstert.2007.07.1370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Quintero RB, Urban R, Lathi RB, Westphal LM, Dahan MH. A comparison of letrozole to gonadotropins for ovulation induction, in subjects who failed to conceive with clomiphene citrate. Fertil Steril 2007; 88:879-85. [DOI: 10.1016/j.fertnstert.2006.11.166] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Revised: 11/29/2006] [Accepted: 11/30/2006] [Indexed: 10/22/2022]
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Lathi RB, Mark SD, Westphal LM, Milki AA. Cytogenetic testing of anembryonic pregnancies compared to embryonic missed abortions. J Assist Reprod Genet 2007; 24:521-4. [PMID: 17899357 PMCID: PMC3455028 DOI: 10.1007/s10815-007-9166-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Accepted: 07/31/2007] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The objective of this study is to determine the rate of abnormalities detected by cytogenetic testing of first trimester miscarriages, in patients with and without an embryonic pole seen on ultrasound. MATERIALS AND METHODS A retrospective study of 272 D&Cs for missed abortions in an academic infertility practice from 1999 to 2006. Karyotype results were compared with transvaginal ultrasound findings. Chi-squared analysis was used with a P < 0.05 for significance. RESULTS There was a high rate of abnormal karyotypes in all miscarriages (65%). Rates of abnormal karyotypes were 58% and 68% in cases with anembryonic gestations and those with a fetal pole seen, respectively (P > 0.05). CONCLUSION The high rate of abnormalities detected in both groups suggests that useful results can be obtained from chromosomal testing of the POC regardless of ultrasound findings. Further studies on the prognostic value and cost effectiveness of chromosomal testing are needed.
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Affiliation(s)
- Ruth B Lathi
- Stanford University Medical Center, 300 Pasteur Drive HH333, Stanford, CA 94306, USA.
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Henne MB, Zhang M, Paroski S, Kelshikar B, Westphal LM. Comparison of obstetric outcomes in recipients of donor oocytes vs. women of advanced maternal age with autologous oocytes. J Reprod Med 2007; 52:585-90. [PMID: 17847755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To evaluate obstetric complications in women conceiving with donated oocytes as compared to controls of advanced maternal age. STUDY DESIGN We compared the obstetric outcomes of a cohort of 69 women who conceived through oocyte donation to all women over 38 years old (n = 681) who delivered at the same hospital in the same period. We first compared obstetric complications and outcomes in the entire cohort. Additional comparisons were made while controlling for multiple covariates: maternal and fetal complications, mode of delivery, estimated gestational age and infant weight at delivery. RESULTS Women who conceived with donor oocytes were older than controls. In the cohort, oocyte recipients were at increased risk for several obstetric complications. However, when controlling for age and multiple gestations, only preterm labor, preeclampsia and protracted labor were increased in oocyte recipients. CONCLUSION Women who conceive with donor oocytes might be at increased risk of complications during pregnancy. When age and multiple gestations are accounted for, these patients remain at risk for preterm labor, preeclampsia and protracted labor requiring cesarean delivery.
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Affiliation(s)
- Melinda B Henne
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
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Davis LB, Lathi RB, Westphal LM, Milki AA. Elective single blastocyst transfer in women older than 35. Fertil Steril 2007; 89:230-1. [PMID: 17509586 DOI: 10.1016/j.fertnstert.2007.02.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Revised: 02/10/2007] [Accepted: 02/21/2007] [Indexed: 11/23/2022]
Abstract
A retrospective review of all patients older than 35 who underwent elective single blastocyst transfer was performed. Twenty-three of the 45 patients (51.1%) have an ongoing pregnancy or liveborn delivery, with a mean age of 37.3 years, demonstrating a clear role for elective single transfer in this relatively older IVF population.
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Affiliation(s)
- Lynn B Davis
- Stanford University Medical Center, Palo Alto, California 94304, USA
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Lathi RB, Westphal LM, Milki AA. Aneuploidy in the miscarriages of infertile women and the potential benefit of preimplanation genetic diagnosis. Fertil Steril 2007; 89:353-7. [PMID: 17509575 DOI: 10.1016/j.fertnstert.2007.02.040] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 02/21/2007] [Accepted: 02/21/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the frequency of specific aneuploidies in miscarriages in an infertility practice and calculate the potential sensitivities of the different aneuploidy screening options for preimplantation genetic diagnosis (PGD) in this setting. DESIGN Retrospective analysis. SETTING Academic reproductive endocrinology and infertility practice. PATIENT(S) Women with miscarriages that had karyotype analysis on products of conception. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Karyotype of spontaneous abortions compared with commercially available PGD options. RESULT(S) Of the 273 karyotypes analyzed, 177 (64.8%) were abnormal. The average age of the patients was 37 +/- 4.5 years. Using a limited five-probe panel, 54 of the 177 (31%) abnormal karyotypes would have been detected. In contrast, an extended PGD panel (using 9, 10, or 12 chromosome probes) would have detected 127, 131, and 140 of 177 abnormalities, 72%, 74%, and 79% respectively. The difference between the limited (5-probe) and extended (9-, 10-, and 12-probe) panels was statistically significant. There was not a statistically significant difference among the extended panels. CONCLUSION(S) Most of the abnormalities seen in miscarriages are detectable by PGD with extended panels. A significantly higher percentage of these abnormalities could be detected by screening for 9, 10, or 12 chromosomes compared with only 5.
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Affiliation(s)
- Ruth B Lathi
- Division of Reproductive Endocrinology and Infertility, Stanford University Medical Center, Stanford, California 94305, USA.
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Moayeri SE, Behr B, Lathi RB, Westphal LM, Milki AA. Risk of monozygotic twinning with blastocyst transfer decreases over time: an 8-year experience. Fertil Steril 2007; 87:1028-32. [PMID: 17343858 DOI: 10.1016/j.fertnstert.2006.09.013] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2006] [Revised: 09/01/2006] [Accepted: 09/01/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of our study is to compare the occurrence of monozygotic twinning (MZT) from blastocyst transfer (BT) in our program between an earlier and more recent time period. DESIGN Retrospective. SETTING Academic IVF practice. PATIENT(S) All pregnancies conceived between March 2002 and December 2005 (N = 932) in our program were compared to pregnancies conceived before March 2002 (N = 554), which were the subject of a previous study. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The incidence of MZT with day 3 embryo transfer and BT were compared between the study and control groups. RESULT(S) During the study period, the rate of MZT was not significantly different for BT at 2.3% (9/385) compared to day 3 embryo transfer at 1.8% (10/547). This rate of 2.3% for BT was significantly lower than the rate of 5.6% (11/197) reported at our institution for BT before March 2002. CONCLUSION(S) Our study suggests that the risk of MZT with BT is significantly lower in the more recent time period and is in the range of what is seen with cleavage stage transfer. It is likely that improvements in culture systems as experience is gained with BT played a role.
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Affiliation(s)
- Sharon E Moayeri
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Stanford University Medical Center, Stanford, California, USA
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Moayeri SE, Coutre SE, Ramirez EJ, Westphal LM. Von Willebrand disease presenting as recurrent hemorrhage after transvaginal oocyte retrieval. Am J Obstet Gynecol 2007; 196:e10-1. [PMID: 17403383 DOI: 10.1016/j.ajog.2007.01.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Revised: 01/05/2007] [Accepted: 01/16/2007] [Indexed: 11/30/2022]
Abstract
A 34-year-old nulligravid woman experienced hemorrhage after each of 2 oocyte retrievals. Initial coagulopathy screening was negative. Treatments used during in vitro fertilization likely interfered with assay performance. Reevaluation remote from medications confirmed the diagnosis of von Willebrand disease. Treatments used during in vitro fertilization may increase bleeding risk and confound coagulopathy evaluation.
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Affiliation(s)
- Sharon E Moayeri
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Stanford Hospital, Stanford, CA, USA
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Kea B, Gebhardt J, Watt J, Westphal LM, Lathi RB, Milki AA, Behr B. Effect of reduced oxygen concentrations on the outcome of in vitro fertilization. Fertil Steril 2007; 87:213-6. [PMID: 17081523 DOI: 10.1016/j.fertnstert.2006.05.066] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2005] [Revised: 05/26/2006] [Accepted: 05/26/2006] [Indexed: 10/24/2022]
Abstract
We compared the effects of two standard oxygen concentrations, physiological (5% O(2), 5% CO(2), and 90% N(2)) and atmospheric (5% CO(2) with the balance as air), on fertilization, embryo development, and pregnancy rate in 106 patients undergoing IVF, excluding donor oocyte cycles and preimplantation genetic diagnosis cycles. The differences in oxygen concentration did not significantly affect fertilization rate, blastocyst formation, or pregnancy rate, but there was a significant difference in mean embryo score between physiological and atmospheric groups on day 3.
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Affiliation(s)
- Bory Kea
- School of Medicine, Stanford University, Stanford, California 94305, USA
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Nezhat C, Littman ED, Lathi RB, Berker B, Westphal LM, Giudice LC, Milki AA. The dilemma of endometriosis: is consensus possible with an enigma? Fertil Steril 2006; 84:1587-8. [PMID: 16359950 DOI: 10.1016/j.fertnstert.2005.06.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Revised: 06/27/2005] [Accepted: 06/27/2005] [Indexed: 11/19/2022]
Abstract
Many will agree that the use of laparoscopy to diagnose and potientially treat endometriosis in patients who suffer from infertility has been superseded by IVF and sometimes oocyte donation, especially in older patients. The findings of our study add another dimension to management of endometriosis in the setting of infertility and emphasize the importance of keeping laparoscopy in the infertility management equation.
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Affiliation(s)
- Camran Nezhat
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, California, USA.
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Bendikson K, Milki AA, Speck-Zulak A, Westphal LM. Comparison of GnRH antagonist cycles with and without oral contraceptive pretreatment in potential poor prognosis patients. CLIN EXP OBSTET GYN 2006; 33:145-7. [PMID: 17089576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE To evaluate the effect of oral contraceptive pill (OCP) pretreatment in patients undergoing IVF cycles with an antagonist. METHODS In this retrospective study, 194 cycles of women with diminished ovarian reserve undergoing IVF with a protocol using GnRH antagonists were evaluated. Oral contraceptive pretreatment was used in 146 cycles. RESULTS Pregnancy rates were the same in both groups. Patients using OCPs required more gonadotropins (5,890 IU) compared to patients not undergoing OCP pretreatment (4,410 IU). CONCLUSIONS Pregnancy outcomes were the same whether or not OCP pretreatment was implemented in poor responders using an antagonist protocol. While OCP pretreatment may help with scheduling flexibility, the higher dose of gonadotropins needed for ovarian stimulation should be considered.
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Affiliation(s)
- K Bendikson
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, CA 94305, USA
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