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Abel MK, Wang A, Letourneau JM, Melisko ME, Cedars MI, Rosen MP. Changing the Perspective on Fertility Preservation for Women with Metastatic or Advanced Stage Cancer. Curr Oncol Rep 2024:10.1007/s11912-024-01530-9. [PMID: 38639793 DOI: 10.1007/s11912-024-01530-9] [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] [Accepted: 04/03/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE OF REVIEW In this Perspective we share the personal story of a 33-year-old patient diagnosed with metastatic breast cancer and her journey through fertility preservation, surrogacy, and eventually motherhood, highlighting misconceptions about fertility preservation in this population. RECENT FINDINGS There are nearly 1 million women under the age of 50 diagnosed and living with cancer in the USA. These patients are met with life-altering decisions, including those that may limit their reproductive ability. While there have been tremendous advances and advocacy in the field of oncofertility, there has been limited focus on patients with advanced stage or metastatic cancer. We describe five key misconceptions surrounding fertility preservation in patients with advanced stage cancer, offering a review of the literature and our approach to challenging topics like desiring fertility preservation in the face of Stage 4 disease, the safety and timing of ovarian stimulation during cancer treatment, and passing away following fertility preservation. We review the importance of assessing perceptions of fertility preservation in patients with metastatic cancer and highlight the lack of research in this area as a call to action.
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Affiliation(s)
- Mary Kathryn Abel
- San Francisco School of Medicine, University of California San Francisco, San Francisco, CA, USA.
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
- Deparment of Obstetrics and Gynecology, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, 75 Francis Street, 3rd Floor, Boston, MA, 02115, USA.
| | - Ange Wang
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Joseph M Letourneau
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Michelle E Melisko
- Division of Hematology and Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Marcelle I Cedars
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Mitchell P Rosen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
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Huang D, Magaoay B, Rosen MP, Cedars MI. Presence of Fibroids on Transvaginal Ultrasonography in a Community-Based, Diverse Cohort of 996 Reproductive-Age Female Participants. JAMA Netw Open 2023; 6:e2312701. [PMID: 37163265 PMCID: PMC10173016 DOI: 10.1001/jamanetworkopen.2023.12701] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
Importance Fibroids are benign uterine tumors that can cause significant morbidity. Knowledge on fibroid prevalence, especially in the asymptomatic population and in Asian and Hispanic or Latina individuals, is limited, and a better understanding of affected groups will improve timely diagnosis and motivate appropriate recruitment in clinical trials to reduce health disparities. Objective To estimate the prevalence of fibroids in a diverse cohort of female individuals. Design, Setting, and Participants This cross-sectional study included female individuals not seeking treatment for fertility or other conditions who were prospectively recruited in an academic medical center in San Francisco, California. Effort was made to recruit an equal proportion of participants from 4 large racial and ethnic groups in the United States (Asian-Chinese, Black or African American, Hispanic or Latina, and White) and across 4 equal age groups between 25 and 45 years. All participants reported regular menses (21-35 days), had not used estrogen- or progestin-containing medications in the 3 months prior to enrollment, and denied history of pelvic surgery. The assessment of ultrasonography results was part of an ongoing longitudinal cohort, with initial recruitment from October 2006 to September 2012. Data analysis was performed in April to September 2022. Main Outcomes and Measures Fibroid presence and burden as assessed by transvaginal ultrasonography. Results A total of 996 female participants were included in the analysis, including 229 (23.0%) Asian-Chinese, 249 (25.0%) Black or African American, 237 (23.8%) Hispanic or Latina, and 281 (28.2%) White individuals. Mean (SD) age was 34.8 (5.7) years in Asian-Chinese participants, 35.4 (6.1) years in Black or African American participants, 34.8 (5.3) years in Hispanic or Latina participants, and 35.3 (5.0) years in White participants. Fibroids were present in 21.8% (95% CI, 16.7%-27.8%) of Asian-Chinese participants, 35.7% (95% CI, 29.8%-42.0%) of Black or African American participants, 12.7% (95% CI, 8.7%-17.6%) of Hispanic or Latina participants, and 10.7% (95% CI, 7.3%-14.9%) of White participants. Black or African American and Asian-Chinese participants were more likely to have fibroids than White participants (Black or African American: adjusted odds ratio [OR], 4.72 [95% CI, 2.72-8.18]; P < .001; Asian-Chinese: adjusted OR, 3.35 [95% CI, 1.95-5.76]; P < .001). In those with fibroids, the proportion with multiple fibroids were 48.3% in Black or African American participants, 33.3% in White participants, 33.3% in Hispanic or Latina participants, and 26.0% in Asian-Chinese participants (P = .06). The largest mean (SD) fibroid diameter was 3.9 (1.9) cm in Black or African American participants, 3.2 (1.6) cm in Asian-Chinese participants, 3.2 (1.6) cm in White participants, and 3.0 (1.4) cm in Hispanic or Latina participants (P = .03). Conclusions and Relevance In this study of female participants in a nonclinical setting, Black or African American and Asian-Chinese participants were disproportionately affected by uterine fibroids. Hispanic or Latina participants had similar fibroid burden to White participants.
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Affiliation(s)
- David Huang
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
| | - Brady Magaoay
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
| | - Mitchell P Rosen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
| | - Marcelle I Cedars
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
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Wang A, Letourneau JM, Juarez-Hernandez F, Abel MK, Mok-Lin E, Rosen MP. Hormone concentrations of dominant follicles in the TALES randomized controlled trial comparing letrozole with tamoxifen. J Assist Reprod Genet 2022; 39:2617-2624. [PMID: 36192617 PMCID: PMC9723077 DOI: 10.1007/s10815-022-02626-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/21/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In this secondary analysis of the TAmoxifen or Letrozole in Estrogen Sensitive tumors (TALES) trial, we aimed to investigate if concurrent administration of letrozole vs. tamoxifen vs. no added treatment affects hormonal composition and size of stimulated ovarian follicles. METHODS TALES is a randomized controlled trial of IVF stimulation for estrogen receptor (ER)-positive breast cancer patients stimulated with gonadotropins and administered concurrent tamoxifen 20 mg or letrozole 5 mg. We analyzed estradiol (E2), testosterone (T), progesterone (P4), follicle stimulating hormone (FSH), luteinizing hormone (LH), and anti-Mullerian hormone (AMH). We used ANOVA/Kruskal-Wallis, logistic, and linear regression models to examine differences in follicular hormone levels, size, and mature oocyte yield between trial arm. RESULTS We included data from total 246 follicles (94 letrozole, 82 tamoxifen, and 70 control) from 123 unique participants. E2 was lower (letrozole 187.4, tamoxifen 1026.0, control 821.5 ng/mL, p < 0.01) and T was higher (letrozole 2489, tamoxifen 571, and control 504 ng/mL, p < 0.03) in the letrozole group compared to tamoxifen and control groups, while other hormone levels and follicle size were similar across groups. There were no significant differences in hormone concentrations within the follicle between tamoxifen and control arms. On multivariate logistic regression, there was no significant association of mature oocyte yield by follicle size, hormone levels, or trial arm. CONCLUSIONS Concurrent administration of letrozole with gonadotropins affects follicular E2 and T concentrations compared to tamoxifen/control. Tamoxifen was not associated with any differences in hormone concentrations within the follicle. Mature oocyte yield was similar across groups.
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Affiliation(s)
- Ange Wang
- Division of Reproductive Endocrinology and Infertility, University of California, San Francisco, 499 Illinois Street 6th Floor, San Francisco, CA, 94158, USA.
| | | | - Flor Juarez-Hernandez
- Division of Reproductive Endocrinology and Infertility, University of California, San Francisco, 499 Illinois Street 6th Floor, San Francisco, CA, 94158, USA
| | - Mary Kathryn Abel
- Division of Reproductive Endocrinology and Infertility, University of California, San Francisco, 499 Illinois Street 6th Floor, San Francisco, CA, 94158, USA
| | - Evelyn Mok-Lin
- Division of Reproductive Endocrinology and Infertility, University of California, San Francisco, 499 Illinois Street 6th Floor, San Francisco, CA, 94158, USA
| | - Mitchell P Rosen
- Division of Reproductive Endocrinology and Infertility, University of California, San Francisco, 499 Illinois Street 6th Floor, San Francisco, CA, 94158, USA
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Wang A, Juarez-Hernandez F, Gutierrez G, Kathryn Abel MK, Letourneau JM, Mok-Lin E, Rosen MP. ANXIETY AND DISTRESS IN YOUNG NEWLY DIAGNOSED CANCER PATIENTS DECREASE AFTER A FERTILITY PRESERVATION CONSULT. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.667] [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: 11/04/2022]
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Huang D, Magaoay B, Rosen MP, Cedars MI. FIBROID PREVALENCE AND BURDEN BY RACE IN AN ASYMPTOMATIC, DIVERSE COHORT OF REPRODUCTIVE-AGE WOMEN. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.125] [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: 11/04/2022]
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Quinn MM, Marsh P, Ribeiro S, Simbulan RK, Rosen MP. A deep dive into the morphokinetics and ploidy of low-quality blastocysts. F S Rep 2022; 3:231-236. [PMID: 36212568 PMCID: PMC9532888 DOI: 10.1016/j.xfre.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 10/28/2022] Open
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Ataman LM, Laronda MM, Gowett M, Trotter K, Anvari H, Fei F, Ingram A, Minette M, Suebthawinkul C, Taghvaei Z, Torres-Vélez M, Velez K, Adiga SK, Anazodo A, Appiah L, Bourlon MT, Daniels N, Dolmans MM, Finlayson C, Gilchrist RB, Gomez-Lobo V, Greenblatt E, Halpern JA, Hutt K, Johnson EK, Kawamura K, Khrouf M, Kimelman D, Kristensen S, Mitchell RT, Moravek MB, Nahata L, Orwig KE, Pavone ME, Pépin D, Pesce R, Quinn GP, Rosen MP, Rowell E, Smith K, Venter C, Whiteside S, Xiao S, Zelinski M, Goldman KN, Woodruff TK, Duncan FE. A synopsis of global frontiers in fertility preservation. J Assist Reprod Genet 2022; 39:1693-1712. [PMID: 35870095 PMCID: PMC9307970 DOI: 10.1007/s10815-022-02570-5] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/08/2022] [Indexed: 11/28/2022] Open
Abstract
Since 2007, the Oncofertility Consortium Annual Conference has brought together a diverse network of individuals from a wide range of backgrounds and professional levels to disseminate emerging basic and clinical research findings in fertility preservation. This network also developed enduring educational materials to accelerate the pace and quality of field-wide scientific communication. Between 2007 and 2019, the Oncofertility Consortium Annual Conference was held as an in-person event in Chicago, IL. The conference attracted approximately 250 attendees each year representing 20 countries around the world. In 2020, however, the COVID-19 pandemic disrupted this paradigm and precluded an in-person meeting. Nevertheless, there remained an undeniable demand for the oncofertility community to convene. To maintain the momentum of the field, the Oncofertility Consortium hosted a day-long virtual meeting on March 5, 2021, with the theme of "Oncofertility Around the Globe" to highlight the diversity of clinical care and translational research that is ongoing around the world in this discipline. This virtual meeting was hosted using the vFairs ® conference platform and allowed over 700 people to participate, many of whom were first-time conference attendees. The agenda featured concurrent sessions from presenters in six continents which provided attendees a complete overview of the field and furthered our mission to create a global community of oncofertility practice. This paper provides a synopsis of talks delivered at this event and highlights the new advances and frontiers in the fields of oncofertility and fertility preservation around the globe from clinical practice and patient-centered efforts to translational research.
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Affiliation(s)
- L M Ataman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7-117, Chicago, IL, 60611, USA
| | - M 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
| | - M Gowett
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7-117, Chicago, IL, 60611, USA
| | - K Trotter
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7-117, Chicago, IL, 60611, USA
| | - H Anvari
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7-117, Chicago, IL, 60611, USA
| | - F Fei
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7-117, Chicago, IL, 60611, USA
| | - A Ingram
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7-117, Chicago, IL, 60611, USA
| | - M Minette
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7-117, Chicago, IL, 60611, USA
| | - C Suebthawinkul
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7-117, Chicago, IL, 60611, USA
| | - Z Taghvaei
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7-117, Chicago, IL, 60611, USA
| | - M Torres-Vélez
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7-117, Chicago, IL, 60611, USA
| | - K Velez
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7-117, Chicago, IL, 60611, USA
| | - S K Adiga
- Department of Clinical Embryology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
| | - A Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Nelune Comprehensive Cancer Centre, Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - L Appiah
- Department of Obstetrics and Gynecology, The University of Colorado School of Medicine, Aurora, CO, USA
| | - M T Bourlon
- Hemato-Oncology Department, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - N Daniels
- The Oncology and Fertility Centres of Ekocorp, Eko Hospitals, Lagos, Nigeria
| | - M M Dolmans
- Gynecology Research Unit, Institut de Recherche Expérimentale Et Clinique, Université Catholique de Louvain, Av. Mounier 52, 1200, Brussels, Belgium
- Department of Gynecology, Cliniques Universitaires Saint-Luc, Av. Hippocrate 10, 1200, Brussels, Belgium
| | - C Finlayson
- Department of Pediatrics (Endocrinology), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - R B Gilchrist
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - V Gomez-Lobo
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | | | - J A Halpern
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - K Hutt
- Anatomy & Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Australia
| | - E K Johnson
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - K Kawamura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - M Khrouf
- FERTILLIA, Clinique la Rose, Tunis, Tunisia
| | - D Kimelman
- Centro de Esterilidad Montevideo, Montevideo, Uruguay
| | - S Kristensen
- Department of Fertility, Copenhagen University Hospital, Copenhagen, Denmark
| | - R T Mitchell
- Department of Developmental Endocrinology, University of Edinburgh, Edinburgh, UK
| | - M B Moravek
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Michigan, Ann Arbor, MI, USA
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - L Nahata
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Endocrinology and Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - K E Orwig
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - M E Pavone
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - D Pépin
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - R Pesce
- Reproductive Medicine Unit, Obstetrics and Gynecology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - G P Quinn
- Departments of Obstetrics and Gynecology, Center for Medical Ethics, Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | - M P Rosen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Reproductive Endocrinology and Infertility, University of California, San Francisco, CA, USA
| | - E Rowell
- Department of Surgery (Pediatric Surgery), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - K Smith
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - C Venter
- Vitalab, Johannesburg, South Africa
| | - S Whiteside
- Fertility & Reproductive Health Program, Department of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH, USA
| | - S Xiao
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Environmental Health Sciences Institute, Rutgers University, New Brunswick, NJ, USA
| | - M Zelinski
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - K N Goldman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7-117, Chicago, IL, 60611, USA
| | - T K Woodruff
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - F E Duncan
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7-117, Chicago, IL, 60611, USA.
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Ataman LM, Laronda MM, Gowett M, Trotter K, Anvari H, Fei F, Ingram A, Minette M, Suebthawinkul C, Taghvaei Z, Torres-Vélez M, Velez K, Adiga SK, Anazodo A, Appiah L, Bourlon MT, Daniels N, Dolmans MM, Finlayson C, Gilchrist RB, Gomez-Lobo V, Greenblatt E, Halpern JA, Hutt K, Johnson EK, Kawamura K, Khrouf M, Kimelman D, Kristensen S, Mitchell RT, Moravek MB, Nahata L, Orwig KE, Pavone ME, Pépin D, Pesce R, Quinn GP, Rosen MP, Rowell E, Smith K, Venter C, Whiteside S, Xiao S, Zelinski M, Goldman KN, Woodruff TK, Duncan FE. Correction to: A synopsis of global frontiers in fertility preservation. J Assist Reprod Genet 2022; 39:1713-1714. [PMID: 35920992 PMCID: PMC9428069 DOI: 10.1007/s10815-022-02586-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/08/2022] [Indexed: 10/16/2022] Open
Affiliation(s)
- L M Ataman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7‑117, Chicago, IL, 60611, USA
| | - M 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
| | - M Gowett
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7‑117, Chicago, IL, 60611, USA
| | - K Trotter
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7‑117, Chicago, IL, 60611, USA
| | - H Anvari
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7‑117, Chicago, IL, 60611, USA
| | - F Fei
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7‑117, Chicago, IL, 60611, USA
| | - A Ingram
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7‑117, Chicago, IL, 60611, USA
| | - M Minette
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7‑117, Chicago, IL, 60611, USA
| | - C Suebthawinkul
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7‑117, Chicago, IL, 60611, USA
| | - Z Taghvaei
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7‑117, Chicago, IL, 60611, USA
| | - M Torres-Vélez
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7‑117, Chicago, IL, 60611, USA
| | - K Velez
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7‑117, Chicago, IL, 60611, USA
| | - S K Adiga
- Department of Clinical Embryology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
| | - A Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Nelune Comprehensive Cancer Centre, Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - L Appiah
- Department of Obstetrics and Gynecology, The University of Colorado School of Medicine, Aurora, CO, USA
| | - M T Bourlon
- Hemato‑Oncology Department, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - N Daniels
- The Oncology and Fertility Centres of Ekocorp, Eko Hospitals, Lagos, Nigeria
| | - M M Dolmans
- Gynecology Research Unit, Institut de Recherche Expérimentale Et Clinique, Université Catholique de Louvain, Av. Mounier 52, 1200, Brussels, Belgium
- Department of Gynecology, Cliniques Universitaires Saint-Luc, Av. Hippocrate 10, 1200, Brussels, Belgium
| | - C Finlayson
- Department of Pediatrics (Endocrinology), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - R B Gilchrist
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - V Gomez-Lobo
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | | | - J A Halpern
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - K Hutt
- Anatomy & Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Australia
| | - E K Johnson
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - K Kawamura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - M Khrouf
- FERTILLIA, Clinique la Rose, Tunis, Tunisia
| | - D Kimelman
- Centro de Esterilidad Montevideo, Montevideo, Uruguay
| | - S Kristensen
- Department of Fertility, Copenhagen University Hospital, Copenhagen, Denmark
| | - R T Mitchell
- Department of Developmental Endocrinology, University of Edinburgh, Edinburgh, UK
| | - M B Moravek
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Michigan, Ann Arbor, MI, USA
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - L Nahata
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Endocrinology and Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - K E Orwig
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - M E Pavone
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - D Pépin
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - R Pesce
- Reproductive Medicine Unit, Obstetrics and Gynecology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - G P Quinn
- Departments of Obstetrics and Gynecology, Center for Medical Ethics, Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | - M P Rosen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Reproductive Endocrinology and Infertility, University of California, San Francisco, CA, USA
| | - E Rowell
- Department of Surgery (Pediatric Surgery), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - K Smith
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - C Venter
- Vitalab, Johannesburg, South Africa
| | - S Whiteside
- Fertility & Reproductive Health Program, Department of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH, USA
| | - S Xiao
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Environmental Health Sciences Institute, Rutgers University, New Brunswick, NJ, USA
| | - M Zelinski
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - K N Goldman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7‑117, Chicago, IL, 60611, USA
| | - T K Woodruff
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - F E Duncan
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 303 E. Superior Street, Lurie 7‑117, Chicago, IL, 60611, USA.
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Cooper LJ, Emery BR, Aston K, Fair D, Rosen MP, Johnstone E, Letourneau JM. Fertility preservation practices for female oncofertility differ significantly across the USA: results of a survey of SREI members. J Assist Reprod Genet 2022; 39:1749-1757. [PMID: 35870098 PMCID: PMC9428095 DOI: 10.1007/s10815-022-02567-0] [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] [Received: 05/05/2022] [Accepted: 07/04/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE The field of oncofertility has maintained an important focus on improving access, yet standardized practices are lacking. To assess how female cancer patients are provided oncofertility care, we sought to determine provider-level differences and whether there are physician or practice characteristics that predict these variations. METHODS A cross-sectional survey was sent to SREI members. The survey included fifteen questions about physician practice characteristics and oncofertility cryopreservation protocols. Topics included ovarian stimulation protocols, fertilization techniques, stage of embryo cryopreservation, routine use of pre-implantation genetic testing for aneuploidy (PGT-A), and ovarian tissue cryopreservation (OTC). Statistical analyses assessed whether practice setting, geographic region, time in practice, and mandatory state insurance coverage had effects on cryopreservation protocols. RESULTS A total of 141 (17%) from diverse REI practice backgrounds completed the survey. The median number of new female oncofertility consults per year was 30 (range 1 to 300). Providers in academic settings treated more patients (median 40 vs. 15, p < 0.001). Providers in academic settings more often use gonadotropin-releasing hormone agonists (85% vs. 52%, p < 0.001) and perform OTC (41% vs. 4%, p < 0.001). Providers in academic practices were less likely to perform intracytoplasmic sperm injection in every cycle (37% vs. 55%, p = 0.032) and less likely to usually advise PGT-A (21% vs. 36%, p = 0.001). Mandated state insurance coverage had no effect on oncofertility practices. CONCLUSION Oncofertility practices vary among providers. Factors such as practice setting and region may affect the services provided. We do not yet know the best practices in oncofertility patients, and future research is needed.
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Affiliation(s)
- Leah J. Cooper
- grid.223827.e0000 0001 2193 0096Department of Obstetrics and Gynecology, University of Utah Health, 675 Arapeen Drive, Suite 205, Salt Lake City, UT 84105 USA
| | - Benjamin R. Emery
- grid.223827.e0000 0001 2193 0096Department of Surgery, University of Utah School of Medicine, Salt Lake City, USA
| | - Kenneth Aston
- grid.223827.e0000 0001 2193 0096Department of Surgery, University of Utah School of Medicine, Salt Lake City, USA
| | - Douglas Fair
- grid.223827.e0000 0001 2193 0096Department of Obstetrics and Gynecology, University of Utah Health, 675 Arapeen Drive, Suite 205, Salt Lake City, UT 84105 USA
| | - Mitchell P. Rosen
- grid.266102.10000 0001 2297 6811Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, USA
| | - Erica Johnstone
- grid.223827.e0000 0001 2193 0096Department of Obstetrics and Gynecology, University of Utah Health, 675 Arapeen Drive, Suite 205, Salt Lake City, UT 84105 USA
| | - Joseph M. Letourneau
- grid.223827.e0000 0001 2193 0096Department of Obstetrics and Gynecology, University of Utah Health, 675 Arapeen Drive, Suite 205, Salt Lake City, UT 84105 USA
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Quinn MM, Marsh P, Ribeiro S, Simbulan RK, Hickman C, Berntsen J, Rosen MP. Aneuploidy rates and morphokinetic parameters of embryos cultured in distinct culture media: a sibling oocyte study. Hum Reprod 2021; 37:226-234. [PMID: 34791277 DOI: 10.1093/humrep/deab253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/02/2021] [Revised: 09/01/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Do embryos from sibling oocytes assigned to distinct single-step media culture systems demonstrate differences in early embryo development, morphokinectics or aneuploidy rates? SUMMARY ANSWER Embryo quality, morphokinetic parameters and aneuploidy rates from trophectoderm biopsy were similar between sibling embryos cultured in distinct media systems from the time of gamete isolation. WHAT IS KNOWN ALREADY Studies on the effect of commercially available embryo culture media systems have demonstrated inconsistent impact on human embryonic development, morphokinetics, aneuploidy rates and clinical outcomes. In addition, these studies have been primarily randomized at the level of the embryo or the patient to culture media. STUDY DESIGN, SIZE, DURATION Prospective sibling oocyte cohort derived from 200 subjects undergoing IVF at a tertiary academic medical center between February 2018 and November 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS Sibling oocytes were allocated to Global® or SAGE® media system based upon laterality of ovary from which they were retrieved. All embryos were cultured in a time-lapse incubator. Blastocysts underwent trophectoderm biopsy for preimplantation genetic testing for aneuploidy using next-generation sequencing. MAIN RESULTS AND THE ROLE OF CHANCE One hundred twenty-seven subjects (n = 127) had paired blastocysts for biopsy in each culture media system. There was no difference in top quality blastocyst formation (47.1 ± 31.0 vs 48.1 ± 27.2%; P = 0.87) nor aneuploidy rate (62.3 ± 34.0 vs 56.1 ± 34.4%; P = 0.07) for sibling embryos cultured in Global versus SAGE media system. Embryo morphokinetic parameters including time to each cell division from two cells (t2) to eight cells (t8), time to morula stage (tM), time to blastocele formation (tSB), time to fully formed blastocyst (tB) and time to expansion of the blastocyst (tEB) were similar between paired blastocysts from each culture media system. LIMITATIONS, REASONS FOR CAUTION Pregnancy outcomes and offspring health data were not available for analysis. WIDER IMPLICATIONS OF THE FINDINGS Commercially available culture media may not have a differential impact on embryo development and blastocyst aneuploidy rate when patient and stimulation-related factors are held constant. STUDY FUNDING/COMPETING INTEREST(S) There was no external funding for this study. C.H. is owner of a consultancy company, IVF Professionals, Chief Scientific Officer at Apricity, Executive Director at TMRW and co-owner and shareholder of Aria Fertility. She has received speaker fees, consulting fees and travel support from Cooper Surgical and Vitrolife. J.B. is an employee and shareholder of vitrolife. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Molly M Quinn
- Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, CA, USA
| | - Philip Marsh
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Salustiano Ribeiro
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Rhodel K Simbulan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Mitchell P Rosen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
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Liu F, Zhou P, Baccei SJ, Masciocchi MJ, Amornsiripanitch N, Kiefe CI, Rosen MP. Qualifying Certainty in Radiology Reports through Deep Learning-Based Natural Language Processing. AJNR Am J Neuroradiol 2021; 42:1755-1761. [PMID: 34413062 DOI: 10.3174/ajnr.a7241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/25/2020] [Accepted: 05/19/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Communication gaps exist between radiologists and referring physicians in conveying diagnostic certainty. We aimed to explore deep learning-based bidirectional contextual language models for automatically assessing diagnostic certainty expressed in the radiology reports to facilitate the precision of communication. MATERIALS AND METHODS We randomly sampled 594 head MR imaging reports from an academic medical center. We asked 3 board-certified radiologists to read sentences from the Impression section and assign each sentence 1 of the 4 certainty categories: "Non-Definitive," "Definitive-Mild," "Definitive-Strong," "Other." Using the annotated 2352 sentences, we developed and validated a natural language-processing system based on the start-of-the-art bidirectional encoder representations from transformers (BERT), which can capture contextual uncertainty semantics beyond the lexicon level. Finally, we evaluated 3 BERT variant models and reported standard metrics including sensitivity, specificity, and area under the curve. RESULTS A κ score of 0.74 was achieved for interannotator agreement on uncertainty interpretations among 3 radiologists. For the 3 BERT variant models, the biomedical variant (BioBERT) achieved the best macro-average area under the curve of 0.931 (compared with 0.928 for the BERT-base and 0.925 for the clinical variant [ClinicalBERT]) on the validation data. All 3 models yielded high macro-average specificity (93.13%-93.65%), while the BERT-base obtained the highest macro-average sensitivity of 79.46% (compared with 79.08% for BioBERT and 78.52% for ClinicalBERT). The BioBERT model showed great generalizability on the heldout test data with a macro-average sensitivity of 77.29%, specificity of 92.89%, and area under the curve of 0.93. CONCLUSIONS A deep transfer learning model can be developed to reliably assess the level of uncertainty communicated in a radiology report.
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Affiliation(s)
- F Liu
- From the Department of Population and Quantitative Health Sciences (F.L., C.I.K.), University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Radiology (F.L., P.Z., S.J.B., M.J.M., N.A., M.P.R.), University of Massachusetts Medical School, Worcester, Massachusetts
| | - P Zhou
- Department of Radiology (F.L., P.Z., S.J.B., M.J.M., N.A., M.P.R.), University of Massachusetts Medical School, Worcester, Massachusetts
| | - S J Baccei
- Department of Radiology (F.L., P.Z., S.J.B., M.J.M., N.A., M.P.R.), University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Radiology (S.J.B., M.J.M., N.A., M.P.R.), UMass Memorial Medical Center, Worcester, Massachusetts
| | - M J Masciocchi
- Department of Radiology (F.L., P.Z., S.J.B., M.J.M., N.A., M.P.R.), University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Radiology (S.J.B., M.J.M., N.A., M.P.R.), UMass Memorial Medical Center, Worcester, Massachusetts
| | - N Amornsiripanitch
- Department of Radiology (F.L., P.Z., S.J.B., M.J.M., N.A., M.P.R.), University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Radiology (S.J.B., M.J.M., N.A., M.P.R.), UMass Memorial Medical Center, Worcester, Massachusetts
| | - C I Kiefe
- From the Department of Population and Quantitative Health Sciences (F.L., C.I.K.), University of Massachusetts Medical School, Worcester, Massachusetts
| | - M P Rosen
- Department of Radiology (F.L., P.Z., S.J.B., M.J.M., N.A., M.P.R.), University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Radiology (S.J.B., M.J.M., N.A., M.P.R.), UMass Memorial Medical Center, Worcester, Massachusetts
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Schermerhorn SMV, Rosen MP, Blevins EM, Byrd KA, Rabban JT, Marsh P, Lucas DJ. Regional air transportation of ovarian tissue for cryopreservation in a prepubertal female with cancer. Pediatr Blood Cancer 2021; 68:e29107. [PMID: 34105898 DOI: 10.1002/pbc.29107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/11/2022]
Abstract
Ovarian tissue cryopreservation is the only fertility preservation (FP) option available to prepubescent females receiving gonadotoxic therapy, but it has limited availability. A 6-year-old female was diagnosed with high-risk rhabdomyosarcoma, and the planned treatment carried an 80% risk of ovarian failure. Her parents desired FP, but the nearest center was 500 miles away. The patient underwent oophorectomy at the cancer center with air transport of the tissue to the oncofertility center, where it was successfully cryopreserved. Formation of networks between full-service and limited oncofertility centers in a hub-and-spoke model would increase access to FP services, particularly in children.
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Affiliation(s)
- Sophia M V Schermerhorn
- Division of Pediatric Surgery, Department of General Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - Mitchell P Rosen
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Erin M Blevins
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Naval Medical Center San Diego, San Diego, California, USA.,School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Kevin A Byrd
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Naval Medical Center San Diego, San Diego, California, USA
| | - Joseph T Rabban
- Department of Pathology, University of California, San Francisco, California, USA
| | - Philip Marsh
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Donald J Lucas
- Division of Pediatric Surgery, Department of General Surgery, Naval Medical Center San Diego, San Diego, California, USA.,School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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13
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Kaing A, Rosen MP, Quinn MM. Perceptions, motivations and decision regret surrounding preimplantation genetic testing for aneuploidy. Hum Reprod 2021; 35:2047-2057. [PMID: 32756971 DOI: 10.1093/humrep/deaa154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/04/2020] [Revised: 05/29/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Is there a difference in level of decision regret following IVF treatment between those who choose to complete or not complete preimplantation genetic testing for aneuploidy [PGT-A]? SUMMARY ANSWER Approximately one-third of the participants expressed moderate to severe regret (MSR) following their decision to either complete or not complete PGT-A; notably, decision regret was higher in those who chose not to complete PGT-A, primarily driven by significantly higher regret scores in those that experienced a miscarriage after not testing. WHAT IS KNOWN ALREADY Previous research has found that 39% of participants who completed PGT-A expressed some degree of decision regret and that negative clinical outcomes, such as lack of euploid embryos, negative pregnancy test or miscarriage, were associated with a higher level of decision regret. To date, there are no published studies assessing the possible disparity in decision regret surrounding PGT-A in a population of IVF patients that either chose to pursue PGT-A or not. STUDY DESIGN, SIZE, DURATION An anonymous online survey was distributed to 1583 patients who underwent IVF with or without PGT-A at a single university institution between January 2016 and December 2017. In total, 335 women accessed the survey, 220 met eligibility criteria and 130 completed the full study survey. Six participants were excluded due to refusal of medical record review, and nine participants were excluded after record review due to not meeting eligibility based on cycle start date or completing only embryo banking without attempting transfer. One hundred and fifteen participants were included in the final analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS Of the 115 participants included, 55 (48%) completed PGT-A and 60 (52%) did not complete PGT-A. The online survey included four sections: Demographics; Perceptions about PGT-A risks and benefits [scale from 0 (absolutely not true) to 100 (absolutely true)]; Decision-making factors [scale from 0 (not important) to 100 (very important)]; and Brehaut Decision Regret Scale [DRS] [range 0-100, with >25 indicating MSR]. A retrospective chart review was conducted to confirm study eligibility and collect cumulative clinical outcomes of consenting participants who completed the survey. MAIN RESULTS AND THE ROLE OF CHANCE Demographics of the PGT-A and no PGT-A cohorts were similar, with the majority of respondents being Caucasian or Asian, unaffiliated with any religion and with a graduate or professional degree. The two groups differed significantly in mean age, with the PGT-A group being slightly older (mean ± SD: 37 ± 3.7 versus 36 ± 3.4; P = 0.048), and in rate of miscarriages, with fewer participants in the PGT-A cohort experiencing a miscarriage (5% versus 22%; P = 0.012). The majority of participants in both PGT-A and no PGT-A cohorts strongly believed in the purported benefits of PGT-A, including that it decreases the risk of birth defects (median 82 versus 77; P = 0.046), improves the chances of having a healthy baby (median 89 versus 74; P = 0.002) and selects the best embryo for transfer (median 85 versus 80; P = 0.049). When asked to report their motivating factors for decision-making, both groups cited physician counseling as important (median 70 versus 71; P = 0.671); however, the PGT-A cohort was more strongly motivated by a desire to not transfer abnormal embryos (median 84 versus 53; P = 0.0001). Comparison of DRS score between those who did or did not undergo PGT-A showed significantly higher median DRS score after not completing PGT-A (median 15 versus 0; P = 0.013). There was a significantly higher proportion of participants who did not complete PGT-A that expressed mild (36% versus 16%) and MSR (32% versus 24%) compared to those who completed PGT-A (χ2 = 9.03, df = 2; P = 0.011). Sub-group analyses of DRS scores by outcomes of clinical pregnancy, miscarriage and live birth revealed that the higher DRS score in those not completing PGT-A was driven by a large increase in regret noted by those with history of a miscarriage (median 45 versus 0; P = 0.018). Multivariate logistic regression modeling found no evidence that any specific demographic factor, clinical outcome or perception/motivation surrounding PGT-A was independently predictive of increased risk for MSR. LIMITATIONS, REASONS FOR CAUTION The retrospective nature of data collection incurs the possibility of sampling and recall bias. As only 59% of eligible respondents completed the full survey, it is possible that mainly those with very positive or negative sentiments following treatment felt compelled to complete their response. This bias, however, would apply to the whole of the population, and not simply to those who did or did not complete PGT-A. WIDER IMPLICATIONS OF THE FINDINGS The proportion of participants expressing any degree of decision regret in this PGT-A cohort was 40%, which is comparable to that shown in prior research. This study adds to prior data by also assessing decision regret experienced by those who went through IVF without PGT-A, and showed that 68% expressed some level of regret with their decision-making. These results should not be interpreted to mean that all patients should opt for PGT-A to pre-emptively mitigate their risk of regret. Instead, it suggests that drivers of decision regret are likely multifactorial and unique to the experience of one's personal expectations regarding PGT-A, motivations for pursuing or not pursuing it and resultant clinical outcome. Highlighting the complex nature of regret, these data should encourage physicians to more carefully consider individual patient values toward risk-taking or risk-averse behavior, as well as their own positions regarding PGT-A. Until there are clear recommendations regarding utilization of PGT-A, a strong collaboration between physicians and genetic counselors is recommended to educate patients on the risks and potential benefits of PGT-A in a balanced and individualized manner. STUDY FUNDING/COMPETING INTEREST(S) No funding was utilized for study completion and the authors have no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Amy Kaing
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California-San Francisco, San Francisco, CA, USA
| | - Mitchell P Rosen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California-San Francisco, San Francisco, CA, USA
| | - Molly M Quinn
- Department of Obstetrics and Gynecology, University of California-Los Angeles, Los Angeles, CA, USA
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Jaswa EG, McCulloch CE, Simbulan R, Cedars MI, Rosen MP. Diminished ovarian reserve is associated with reduced euploid rates via preimplantation genetic testing for aneuploidy independently from age: evidence for concomitant reduction in oocyte quality with quantity. Fertil Steril 2021; 115:966-973. [PMID: 33583594 DOI: 10.1016/j.fertnstert.2020.10.051] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/09/2020] [Accepted: 10/18/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE(S) To determine whether women with diminished ovarian reserve (DOR) (quantitatively) had lower rates of euploid blastocysts, as a proxy for oocyte quality. DESIGN Retrospective cohort study. SETTING University reproductive health clinic. PATIENT(S) A total of 1,152 women aged 19-42 years underwent 1,675 IVF cycles yielding 8,073 blastocysts for biopsy from 2010 to 2019. INTERVENTIONS(S) Preimplantation genetic testing for aneuploidy. MAIN OUTCOME MEASURE(S) Euploid rates, defined as the number of euploid blastocysts divided by the number of biopsied blastocysts per cycle. RESULT(S) A total of 225 women (20%) had DOR as infertility diagnosis per the Bologna criteria. Age was higher among the women with DOR (39.5 y vs. 37.0 y). Euploid rates were lower among women with vs. without DOR (29.0% vs. 44.9%). In generalized linear models controlling for age, women with DOR had 24% reduced odds of a biopsied blastocyst being euploid versus women without DOR. In a secondary analysis assigning DOR status to women producing the lowest quartile of age-adjusted mature oocyte yield, this relationship remained. No differences were identified in live birth rates between women with and without DOR after euploid single-embryo transfer independently from age (n = 944 transfers; 56.8% vs. 54.8%, respectively). CONCLUSION(S) Blastocysts from women with DOR are less likely to be euploid than those from women without DOR after adjustment for age. Given the concomitant reduction in euploid rates with quantity of oocytes observed in this study, quantitative ovarian reserve assessments (i.e., follicular machinery) may yield insight into relative ovarian aging.
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Affiliation(s)
- Eleni Greenwood Jaswa
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California.
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Rhodel Simbulan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
| | - Marcelle I Cedars
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
| | - Mitchell P Rosen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
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Letourneau JM, Wald K, Sinha N, Juarez‐Hernandez F, Harris E, Cedars MI, McCulloch CE, Dolezal M, Chien AJ, Rosen MP. Fertility preservation before breast cancer treatment appears unlikely to affect disease‐free survival at a median follow‐up of 43 months after fertility‐preservation consultation. Cancer 2019; 126:487-495. [DOI: 10.1002/cncr.32546] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 08/19/2019] [Accepted: 08/26/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Joseph M. Letourneau
- Department of Obstetrics, Gynecology, and Reproductive Sciences University of California San Francisco School of Medicine San Francisco California
- Department of Obstetrics and Gynecology University of Utah School of Medicine Salt Lake City Utah
| | - Kaitlyn Wald
- Department of Obstetrics, Gynecology, and Reproductive Sciences University of California San Francisco School of Medicine San Francisco California
| | - Nikita Sinha
- Department of Obstetrics, Gynecology, and Reproductive Sciences University of California San Francisco School of Medicine San Francisco California
- Department of Obstetrics and Gynecology Northwestern University School of Medicine Chicago Illinois
| | - Flor Juarez‐Hernandez
- Department of Obstetrics, Gynecology, and Reproductive Sciences University of California San Francisco School of Medicine San Francisco California
| | - Eve Harris
- Department of Obstetrics, Gynecology, and Reproductive Sciences University of California San Francisco School of Medicine San Francisco California
| | - Marcelle I. Cedars
- Department of Obstetrics, Gynecology, and Reproductive Sciences University of California San Francisco School of Medicine San Francisco California
| | - Charles E. McCulloch
- Department of Obstetrics, Gynecology, and Reproductive Sciences University of California San Francisco School of Medicine San Francisco California
| | - Milana Dolezal
- Hematology and Oncology California Pacific Medical Center Research Institute San Francisco California
| | - A. Jo Chien
- Department of Medicine University of California San Francisco School of Medicine San Francisco California
| | - Mitchell P. Rosen
- Department of Obstetrics, Gynecology, and Reproductive Sciences University of California San Francisco School of Medicine San Francisco California
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Greenwood EA, McCulloch CE, Olivera G, Lin W, Xie F, Cedars MI, Rosen MP. Blastocyst morphology correlates with preimplantation genetic testing for aneuploidy (PGT-A) results and may further predict pregnancy potential after euploid single embryo transfer (SET). Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.516] [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: 10/25/2022]
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Greenwood EA, Simbulan R, McCulloch CE, Cedars MI, Rosen MP. Survival behavior of embryo cohort in culture is associated with pregnancy performance of a surviving euploid blastocyst after single embryo transfer (SET): the canaries in the coal mine? Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.514] [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: 11/28/2022]
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Greenwood EA, McCulloch CE, Cedars MI, Rosen MP. Diminished ovarian reserve (DOR) is associated with reduced euploid rates via preimplantation genetic testing for aneuploidy (PGT-A) independent of age: evidence for concomitant reduction in oocyte quality with quantity. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.275] [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: 10/26/2022]
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Huang D, Greenwood EA, Marsh P, Runge A, Cedars MI, Rosen MP. Comparison of euploid rates via preimplantation genetic testing for aneuploidy (PGT-A) and subsequent pregnancy outcomes between asian and white patients. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.182] [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: 11/29/2022]
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Greenwood EA, McCulloch CE, Wald K, Ribeiro S, Marsh P, Cedars MI, Rosen MP. Preimplantation genetic testing for aneuploidy (PGT-A) and technology platform: does platform influence euploid call rates and/or subsequent pregnancy outcomes? Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.1364] [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: 10/25/2022]
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Zhou XP, McCulloch CE, Rosen MP, Cedars MI. The rate of antral follicle count decline decreases with older age and lower antral follicle count. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.1102] [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: 10/25/2022]
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Wald K, Greenwood EA, Cedars MI, Rosen MP. Physicians should avoid changing a patient’s ovarian stimulation protocol for the purpose of improving laboratory outcomes. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.682] [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: 10/26/2022]
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Wijekoon A, Rosen MP, Quinn MM. Lessons learned from evaluating decisional regret surrounding preimplantation genetic testing for aneuploidy. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.176] [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: 11/16/2022]
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Turan V, Quinn MM, Dayioglu N, Rosen MP, Oktay K. The impact of malignancy on response to ovarian stimulation for fertility preservation: a meta-analysis. Fertil Steril 2019; 110:1347-1355. [PMID: 30503134 DOI: 10.1016/j.fertnstert.2018.08.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 06/11/2018] [Revised: 07/13/2018] [Accepted: 08/02/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the impact of cancer diagnosis on response to ovarian stimulation for fertility preservation. DESIGN Meta-analysis. SETTING Not applicable. PATIENT(S) An electronic-based search was performed with the use of PubMed until May 2018 limited to English-language articles. In the final analysis, 10 case-controlled retrospective cohort studies were included, comparing ovarian response to stimulation between women with cancer and age-matched healthy women (control group). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Number of total oocytes retrieved, number of mature oocytes, fertilization rate and two pronuclei embryos obtained. RESULT(S) Ten studies that included a total of 713 women with cancer were analyzed in the cancer group (722 cycles), and 1,830 healthy women (1,835 cycles) qualified as controls for the meta-analysis. The pooled results showed no impact of cancer diagnosis on the mean number of total oocytes (P=.517; 95% CI -0.23 to 0.12), mature oocytes (P=.104; 95% CI -0.23 to 0.01), and two pronuclei embryos (P=.136; 95% CI -0.32 to 0.04) and fertilization rates (P=.273; 95% CI -0.29 to 0.183). When the analysis was limited to women with breast cancer diagnosis, there was also no difference in the mean number of total oocytes (P=.812; 95% CI -0.28 to 0.36) and mature oocytes (P=.993; 95% CI -0.16 to 0.16) between the two groups. CONCLUSION(S) This meta-analysis indicates that cancer diagnosis is not associated with reduced response to ovarian stimulation.
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Affiliation(s)
- Volkan Turan
- Yeni Yuzyil University School of Medicine, Department of Obstetrics and Gynecology, Division Reproductive Endocrinology and Infertility, Istanbul, Turkey
| | - Molly M Quinn
- University of California San Francisco School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, California
| | - Nurten Dayioglu
- Yeni Yuzyil University School of Medicine, Department of Biostatistics, Istanbul, Turkey
| | - Mitchell P Rosen
- University of California San Francisco School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, California
| | - Kutluk Oktay
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut; Innovation Fertility Preservation and IVF, New York, New York.
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Quinn MM, Rosen MP, Allen IE, Huddleston HG, Cedars MI, Fujimoto VY. Interpregnancy interval and singleton pregnancy outcomes after frozen embryo transfer. Fertil Steril 2019; 111:1145-1150. [PMID: 30955846 DOI: 10.1016/j.fertnstert.2019.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 11/06/2018] [Revised: 01/28/2019] [Accepted: 02/12/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To describe the relationship between interpregnancy interval (IPI) and perinatal outcomes in singleton live births after frozen embryo transfer (FET). DESIGN Retrospective analysis of the Society for Assisted Reproductive Technology Clinical Outcome Reporting System cohort including patients with a history of live birth from ART who returned for an FET cycle between 2004 and 2013. SETTING Not applicable. PATIENT(S) A total of 19,270 singleton live births from FET subsequent to a live birth. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Odds for preterm delivery (<37, <34, <28 weeks) and low birth weight (<2,500, <1,500 g) adjusted for age, body mass index, and history of prior preterm delivery. RESULT(S) Of 74,456 autologous FET cycles following an index live birth, 24,091 resulted in a repeat live birth, with 19,270 singleton live births. An IPI of <12 months occurred in 19% of cycles. Adjusted odds (aORs) for preterm delivery at <37 weeks were significantly increased for an IPI of <6 months (aOR 2.05, 95% confidence interval [CI] 1.48-2.84), 6 to <12 months (aOR 1.26, 95% CI 1.06-1.49), and 18 to <24 months (aOR 1.23, 95% CI 1.06-1.43) when compared with the reference interval of 12 to <18 months. Additionally, an IPI of <6 months was associated with increased odds for low birth weight (aOR 3.06, 95% CI 2.07-4.52) and very low birth weight (aOR 5.65, 95% CI 2.96-10.84) compared with an IPI of 12 to <18 months. CONCLUSION(S) In this nationally representative population, an interval from delivery to start of an FET cycle of <12 months is associated with increased odds for preterm delivery among singleton live births. Consistent with data for patients undergoing fresh IVF, the data support delaying FET 12 months from a live birth.
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Affiliation(s)
- Molly M Quinn
- Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, California.
| | - Mitchell P Rosen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Isabel Elaine Allen
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Heather G Huddleston
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Marcelle I Cedars
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Victor Y Fujimoto
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California
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Quinn MM, Rosen MP, Allen IE, Huddleston HG, Cedars MI, Fujimoto VY. Decreased clinical pregnancy and live birth rates after short interval from delivery to subsequent assisted reproductive treatment cycle. Hum Reprod 2019; 33:1316-1321. [PMID: 29912323 DOI: 10.1093/humrep/dey108] [Citation(s) in RCA: 2] [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] [Received: 02/20/2018] [Accepted: 04/20/2018] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Does the interval from delivery to initiation of a subsequent ART treatment cycle impact clinical pregnancy or live birth rates? SUMMARY ANSWER An interval from delivery to treatment start of <6 months or ≥24 months is associated with decreased likelihood of clinical pregnancy and live birth. WHAT IS KNOWN ALREADY Short interpregnancy intervals are associated with poor obstetric outcomes in the naturally conceiving population prompting birth spacing recommendations of 18-24 months from international organizations. Deferring a subsequent pregnancy attempt means a woman will age in the interval with an attendant decline in her fertility. STUDY DESIGN, SIZE, DURATION Retrospective analysis of the Society for Assisted Reproductive Technology Clinical Outcome Reporting System (SARTCORS) cohort containing 61 686 ART cycles from 2004 to 2013. PARTICIPANTS/MATERIALS, SETTING, METHODS The delivery-to-cycle interval (DCI) was calculated for patients from SARTCORS with a history of live birth from ART who returned to the same clinic for a first subsequent treatment cycle. Generalized linear models were fit to determine the risk of clinical pregnancy and live birth by DCI with subsequent adjustment for factors associated with outcomes of interest. Predicted probabilities of clinical pregnancy and live birth were generated from each model. MAIN RESULTS AND THE ROLE OF CHANCE A DCI of <6 months was associated with a 5.6% reduction in probability of clinical pregnancy (40.1 ± 1.9 versus 45.7 ± 0.6%, P = 0.009) and 6.8% reduction in live birth (31.6 ± 1.7 versus 38.4 ± 0.6%, P = 0.001) per cycle start compared to a DCI of 12 to <18 months. A DCI of ≥24 months was associated with a 5.1% reduction in probability of clinical pregnancy (40.6 ± 0.5 versus 45.7 ± 0.6%, P < 0.001) and 5.7% reduction in live birth (32.7 ± 0.5 versus 38.4 ± 0.6%, P < 0.001) compared to 12 to <18 months. LIMITATIONS, REASONS FOR CAUTION The SART database is reliant upon self-report of many variables of interest including live birth. It remains unclear whether poorer outcomes are a result of residual confounding from factors inherent to the population with a very short or long DCI or the interval itself. WIDER IMPLICATIONS OF THE FINDINGS Birth spacing recommendations for naturally conceiving populations may not be generally applicable to patients with a history of infertility. Patients planning ART treatment should wait a minimum of 6 months, but not more than 24 months, from a live birth for optimization of clinical pregnancy and live birth rates. STUDY FUNDING/COMPETING INTEREST(S) National Center for Advancing Translational Sciences, National Institutes of Health, UCSF-CTSI Grant number UL1TR001872. The authors have no competing interests.
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Affiliation(s)
- Molly M Quinn
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 550 16th Street, 7th Floor, San Francisco, CA, USA
| | - Mitchell P Rosen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 550 16th Street, 7th Floor, San Francisco, CA, USA
| | - Isabel Elaine Allen
- Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, 550 16th Street, 7th Floor, San Francisco, CA, USA
| | - Heather G Huddleston
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 550 16th Street, 7th Floor, San Francisco, CA, USA
| | - Marcelle I Cedars
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 550 16th Street, 7th Floor, San Francisco, CA, USA
| | - Victor Y Fujimoto
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 550 16th Street, 7th Floor, San Francisco, CA, USA
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Quinn MM, Juarez-Hernandez F, Dunn M, Okamura RJ, Cedars MI, Rosen MP. Decision-making surrounding the use of preimplantation genetic testing for aneuploidy reveals misunderstanding regarding its benefit. J Assist Reprod Genet 2018; 35:2155-2159. [PMID: 30334131 PMCID: PMC6289916 DOI: 10.1007/s10815-018-1337-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/12/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE We aimed to explore how patients make decisions regarding use of preimplantation genetic testing for aneuploidy (PGT-A) for in vitro fertilization (IVF). METHODS This is a cross-sectional survey at an academic medical center. Three hundred subjects initiating an IVF cycle over 8 weeks were asked to complete a validated survey to determine how they decided whether or not to pursue PGT-A. All patients were previously counseled that the primary goal of PGT-A is to maximize pregnancy rates per embryo transfer. Survey responses were compared between those who elected PGT-A and those who did not with a chi-squared or t test. RESULTS Of 191 subjects who completed the survey, 117 (61%) planned PGT-A, while 74 (39%) did not. Among those who decided to undergo PGT-A, 56% stated their primary reason was to have a healthy baby, while 18% chose PGT-A to reduce the incidence of birth defects, and 16% aimed to decrease the risk of miscarriage. Patients who decided not to pursue PGT-A stated they prioritized avoiding the scenario in which they might have no embryos to transfer (36%) or reducing cost (31%). Both groups rated physicians as the single most important source of information in their decision-making (56% vs 68%, p = NS). CONCLUSIONS Patients who chose to undergo PGT-A have different priorities from those who do not. Many patients planning PGT-A do so for reasons that are not evidence-based. While patients cite physicians as their primary source of information in the decision-making process, rationales for selecting PGT-A are inconsistent with physician counseling.
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Affiliation(s)
- Molly M Quinn
- Department of Obstetrics, Gynecology and Reproductive Sciences Division of Reproductive Endocrinology and Infertility, University of California San Francisco School of Medicine, 550 16th Street, 7th Floor, San Francisco, CA, 94158-2519, USA.
| | - Flor Juarez-Hernandez
- Department of Obstetrics, Gynecology and Reproductive Sciences Division of Reproductive Endocrinology and Infertility, University of California San Francisco School of Medicine, 550 16th Street, 7th Floor, San Francisco, CA, 94158-2519, USA
| | - Molly Dunn
- Department of Obstetrics, Gynecology and Reproductive Sciences Division of Reproductive Endocrinology and Infertility, University of California San Francisco School of Medicine, 550 16th Street, 7th Floor, San Francisco, CA, 94158-2519, USA
| | - Richard Jason Okamura
- Department of Obstetrics, Gynecology and Reproductive Sciences Division of Reproductive Endocrinology and Infertility, University of California San Francisco School of Medicine, 550 16th Street, 7th Floor, San Francisco, CA, 94158-2519, USA
| | - Marcelle I Cedars
- Department of Obstetrics, Gynecology and Reproductive Sciences Division of Reproductive Endocrinology and Infertility, University of California San Francisco School of Medicine, 550 16th Street, 7th Floor, San Francisco, CA, 94158-2519, USA
| | - Mitchell P Rosen
- Department of Obstetrics, Gynecology and Reproductive Sciences Division of Reproductive Endocrinology and Infertility, University of California San Francisco School of Medicine, 550 16th Street, 7th Floor, San Francisco, CA, 94158-2519, USA
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Stiner RK, Clarke JL, Sinha N, Chan J, Letourneau JM, Niemasik EE, Rabbitt JE, Chang SM, Butowski NA, Prados MD, Rosen MP. Attitudes toward fertility and fertility preservation in women with glioma. Neurooncol Pract 2018; 6:218-225. [PMID: 31386027 DOI: 10.1093/nop/npy036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background No studies have examined the fertility priorities of women undergoing treatment for their glioma. Glioma patients frequently undergo chemotherapy as part of their treatment; however, it is unknown whether patients truly are aware of its possible effects on their fertility. Our objective was to assess the fertility priorities of glioma patients and ascertain whether female glioma patients are being effectively counseled on the effects of chemotherapy on their fertility prior to beginning treatment. Methods The sample was composed of female patients from the Neuro-oncology clinic of the University of California, San Francisco. Participants completed a cross-sectional survey between October 2010 and December 2013 exploring their attitudes toward fertility and their experience with fertility counseling prior to chemotherapy initiation. Results Seventy-two women completed the survey. Analysis of the survey results showed that 30% of women receiving chemotherapy reported having a discussion regarding fertility preservation prior to beginning treatment. Of those who reported having this discussion, 80% were aware that chemotherapy could negatively affect their fertility. Many women reported that while fertility preservation was not important to them at the time of diagnosis, it was a priority for them at the time of survey completion. Although interest in having children tended to decrease after cancer treatment, the majority of respondents reported wanting a child after treatment. Conclusions The data obtained in this study suggest a lack of understanding of reproductive priorities, which may be addressed with a more comprehensive fertility discussion prior to beginning treatment.
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Affiliation(s)
- Rachel K Stiner
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Jennifer L Clarke
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Nikita Sinha
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
| | - Jessica Chan
- Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Joseph M Letourneau
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
| | - Erin E Niemasik
- Department of Obstetrics and Gynecology, Kaiser Permanente, San Francisco, CA, USA
| | - Jane E Rabbitt
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Susan M Chang
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Nicholas A Butowski
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Michael D Prados
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Mitchell P Rosen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
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Quinn MM, Jalalian L, Ribeiro S, Ona K, Demirci U, Cedars MI, Rosen MP. Microfluidic sorting selects sperm for clinical use with reduced DNA damage compared to density gradient centrifugation with swim-up in split semen samples. Hum Reprod 2018; 33:1388-1393. [DOI: 10.1093/humrep/dey239] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/12/2018] [Accepted: 06/15/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Molly M Quinn
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 550 16th Street, 7th Floor, San Francisco, CA, USA
| | - Liza Jalalian
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 550 16th Street, 7th Floor, San Francisco, CA, USA
| | - Salustiano Ribeiro
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 550 16th Street, 7th Floor, San Francisco, CA, USA
| | - Katherine Ona
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 550 16th Street, 7th Floor, San Francisco, CA, USA
| | - Utkan Demirci
- Stanford Canary Center for Early Cancer Detection, Stanford University, 3155 Porter Dr, Palo Alto, CA, USA
| | - Marcelle I Cedars
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 550 16th Street, 7th Floor, San Francisco, CA, USA
| | - Mitchell P Rosen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 550 16th Street, 7th Floor, San Francisco, CA, USA
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Quinn MM, Rosen MP, Huddleston HG, Cedars MI, Fujimoto VY. Interpregnancy Interval and Singleton Live Birth Outcomes From In Vitro Fertilization. Obstet Gynecol 2018; 132:115-121. [DOI: 10.1097/aog.0000000000002644] [Citation(s) in RCA: 6] [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] [Indexed: 11/25/2022]
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Quinn MM, Cakmak H, Letourneau JM, Cedars MI, Rosen MP. Response to ovarian stimulation is not impacted by a breast cancer diagnosis. Hum Reprod 2018; 32:568-574. [PMID: 28122888 DOI: 10.1093/humrep/dew355] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 10/02/2016] [Accepted: 12/22/2016] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION Does a breast cancer diagnosis impact ovarian function in the setting of fertility preservation? SUMMARY ANSWER Ovarian reserve and ovarian stimulation outcomes are similar in patients with a new diagnosis of breast cancer and patients undergoing elective fertility preservation. WHAT IS KNOWN ALREADY Prior studies, with small study populations, lack of controlling for individual differences in ovarian reserve and infertile controls, have reported conflicting outcomes for cancer patients undergoing ovarian stimulation for fertility preservation. STUDY DESIGN, SIZE, DURATION This retrospective cohort analysis included 589 patients undergoing ovarian stimulation for fertility preservation between 2009 and 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS Women with a recent breast cancer diagnosis (n = 191) and women desiring elective fertility preservation (n = 398) underwent ovarian stimulation with an antagonist protocol at an academic medical center. The aromatase inhibitor letrozole was administered to breast cancer patients with estrogen-sensitive disease. MAIN RESULTS AND THE ROLE OF CHANCE Baseline antral follicle count (AFC) was not different between the breast cancer patients and controls (15.4 ± 10.4 [mean ± SD] vs 15.4 ± 10.0, P = NS), even after categorization by age. Total (19.4 ± 0.9 [mean ± SEM] vs 17.0 ± 0.5, P = NS) and mature (MII) oocytes retrieved (13.7 ± 0.7 vs 13.2 ± 0.4, P = NS), adjusted for age, BMI and total gonadotropin dose, were also similar between the two groups. Letrozole use was associated with a decreased maturity rate (MII/total oocytes retrieved) compared to elective cryopreservation (0.71 ± 0.01 vs 0.77 ± 0.01, P < 0.001), although the mature oocyte yield [MII/AFC] was comparable (1.01 ± 0.06 vs 0.93 ± 0.03, P = NS). LIMITATIONS, REASONS FOR CAUTION The single center design may impact generalizability. Additionally, the lack of subsequent embryo and pregnancy data is an inherent weakness. WIDER IMPLICATIONS OF THE FINDINGS In females, a breast cancer diagnosis does not impact gonadal function as measured by AFC or ovarian stimulation outcomes. Breast cancer patients should be counseled that their response to ovarian stimulation for fertility preservation is similar to that of patients undergoing elective oocyte cryopreservation. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Molly M Quinn
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA94143, USA
| | - Hakan Cakmak
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA94143, USA
| | - Joseph M Letourneau
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA94143, USA
| | - Marcelle I Cedars
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA94143, USA
| | - Mitchell P Rosen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA94143, USA
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Chinnasamy T, Kingsley JL, Inci F, Turek PJ, Rosen MP, Behr B, Tüzel E, Demirci U. Guidance and Self-Sorting of Active Swimmers: 3D Periodic Arrays Increase Persistence Length of Human Sperm Selecting for the Fittest. Adv Sci (Weinh) 2018; 5:1700531. [PMID: 29610725 PMCID: PMC5827459 DOI: 10.1002/advs.201700531] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/09/2017] [Indexed: 05/19/2023]
Abstract
Male infertility is a reproductive disease, and existing clinical solutions for this condition often involve long and cumbersome sperm sorting methods, including preprocessing and centrifugation-based steps. These methods also fall short when sorting for sperm free of reactive oxygen species, DNA damage, and epigenetic aberrations. Although several microfluidic platforms exist, they suffer from structural complexities, i.e., pumps or chemoattractants, setting insurmountable barriers to clinical adoption. Inspired by the natural filter-like capabilities of the female reproductive tract for sperm selection, a model-driven design, featuring pillar arrays that efficiently and noninvasively isolate highly motile and morphologically normal sperm, with lower epigenetic global methylation, from raw semen, is presented. The Simple Periodic ARray for Trapping And isolatioN (SPARTAN) created here modulates the directional persistence of sperm, increasing the spatial separation between progressive and nonprogressive motile sperm populations within an unprecedentedly short 10 min assay time. With over 99% motility of sorted sperm, a 5-fold improvement in morphology, 3-fold increase in nuclear maturity, and 2-4-fold enhancement in DNA integrity, SPARTAN offers to standardize sperm selection while eliminating operator-to-operator variations, centrifugation, and flow. SPARTAN can also be applied in other areas, including conservation ecology, breeding of farm animals, and design of flagellar microrobots for diagnostics.
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Affiliation(s)
- Thiruppathiraja Chinnasamy
- Bio‐Acoustic MEMS in Medicine (BAMM) LaboratoryCanary Center at Stanford for Cancer Early DetectionDepartment of RadiologyStanford School of MedicineStanford UniversityPalo AltoCA94304USA
| | - James L. Kingsley
- Department of PhysicsWorcester Polytechnic InstituteWorcesterMA01609USA
| | - Fatih Inci
- Bio‐Acoustic MEMS in Medicine (BAMM) LaboratoryCanary Center at Stanford for Cancer Early DetectionDepartment of RadiologyStanford School of MedicineStanford UniversityPalo AltoCA94304USA
| | | | - Mitchell P. Rosen
- Department of OBGYNUniversity of California San Francisco School of MedicineSan FranciscoCA94158USA
| | - Barry Behr
- Department of Obstetrics and GynecologySchool of MedicineStanford UniversityStanfordCA94305USA
| | - Erkan Tüzel
- Department of PhysicsWorcester Polytechnic InstituteWorcesterMA01609USA
| | - Utkan Demirci
- Bio‐Acoustic MEMS in Medicine (BAMM) LaboratoryCanary Center at Stanford for Cancer Early DetectionDepartment of RadiologyStanford School of MedicineStanford UniversityPalo AltoCA94304USA
- Department of Electrical Engineering (by courtesy)Stanford UniversityStanfordCA94305USA
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Huddleston HG, Quinn MM, Kao CN, Lenhart N, Rosen MP, Cedars MI. Women with polycystic ovary syndrome demonstrate worsening markers of cardiovascular risk over the short-term despite declining hyperandrogenaemia: Results of a longitudinal study with community controls. Clin Endocrinol (Oxf) 2017; 87:775-782. [PMID: 29044581 DOI: 10.1111/cen.13497] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 07/20/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To compare age-associated changes in cardiovascular risk markers in lean and obese reproductive-aged women with polycystic ovary syndrome (PCOS) with community controls. DESIGN Longitudinal study at an academic medical centre PATIENTS: Patients diagnosed with PCOS by 2004 Rotterdam criteria in a multidisciplinary clinic were systematically enrolled from 2006-2014 in a PCOS cohort study and subsequently agreed to participate in a longitudinal study. The comparison controls were from the prospective, longitudinal Ovarian Aging (OVA) study, which consists of healthy women with regular menstrual cycles recruited from 2006 to 2011. MEASUREMENTS Cardiovascular risk markers and hormone parameters at baseline and follow-up. RESULTS Obese and lean PCOS (n = 38) and control women (n = 296) completed two study visits. The follow-up time (3.5 ± 1.5 vs 4.0 ± 0.8 years, P = .06) and magnitude of BMI gain (+0.1 kg/m2 /y [-0.11, 0.36] vs +0.26 [-0.18, 0.87] P = .19) did not differ between obese and lean PCOS and controls. In PCOS subjects, total testosterone decreased in both obese and lean, but the decrease was greater in obese subjects (-0.09 nmol/L per year; 95% CI: -0.16, -0.02 vs -0.04 nmol/L per year; 95%CI: -0.11, 0.03). Compared to their respective controls, obese and lean PCOS saw worsening triglyceride (TG) levels (P < .05) and HOMA-IR (P < .05) over time, but there was no difference in change in LDL, HDL, fasting glucose, C-reactive protein or ALT. CONCLUSIONS In a longitudinal study, reproductive-aged women with PCOS demonstrated declines in biochemical hyperandrogenaemia over time. Despite this, PCOS subjects experienced steeper increases in cardiovascular risk factors associated with insulin resistance, including triglycerides and HOMA-IR.
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Affiliation(s)
- Heather G Huddleston
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco School of Medicine, San Francisco, CA, USA
| | - Molly M Quinn
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco School of Medicine, San Francisco, CA, USA
| | - Chia-Ning Kao
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco School of Medicine, San Francisco, CA, USA
| | - Nikolaus Lenhart
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco School of Medicine, San Francisco, CA, USA
| | - Mitchell P Rosen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco School of Medicine, San Francisco, CA, USA
| | - Marcelle I Cedars
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco School of Medicine, San Francisco, CA, USA
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Anaya Y, Mata DA, Letourneau J, Cakmak H, Cedars MI, Rosen MP. Author Correction: A novel oocyte maturation trigger using 1500 IU of human chorionic gonadotropin plus 450 IU of follicle-stimulating hormone may decrease ovarian hyperstimulation syndrome across all in vitro fertilization stimulation protocols. J Assist Reprod Genet 2017; 35:309. [PMID: 29178020 DOI: 10.1007/s10815-017-1093-1] [Citation(s) in RCA: 1] [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] [Indexed: 11/24/2022] Open
Abstract
The original version of this article unfortunately contained a mistake. The middle initial of Douglas A. Mata was omitted. The original article has been corrected.
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Affiliation(s)
- Yanett Anaya
- Center for Reproductive Health and Division of Reproductive Endocrinology and Infertility, University of California, San Francisco, 499 Illinois Street, San Francisco, CA, 94143, USA.
| | - Douglas A Mata
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Joseph Letourneau
- Center for Reproductive Health and Division of Reproductive Endocrinology and Infertility, University of California, San Francisco, 499 Illinois Street, San Francisco, CA, 94143, USA
| | - Hakan Cakmak
- Center for Reproductive Health and Division of Reproductive Endocrinology and Infertility, University of California, San Francisco, 499 Illinois Street, San Francisco, CA, 94143, USA
| | - Marcelle I Cedars
- Center for Reproductive Health and Division of Reproductive Endocrinology and Infertility, University of California, San Francisco, 499 Illinois Street, San Francisco, CA, 94143, USA
| | - Mitchell P Rosen
- Center for Reproductive Health and Division of Reproductive Endocrinology and Infertility, University of California, San Francisco, 499 Illinois Street, San Francisco, CA, 94143, USA
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Anaya Y, Mata DA, Letourneau J, Cakmak H, Cedars MI, Rosen MP. A novel oocyte maturation trigger using 1500 IU of human chorionic gonadotropin plus 450 IU of follicle-stimulating hormone may decrease ovarian hyperstimulation syndrome across all in vitro fertilization stimulation protocols. J Assist Reprod Genet 2017; 35:297-307. [PMID: 29086322 DOI: 10.1007/s10815-017-1074-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 07/09/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Modification of the trigger used to induce final oocyte maturation in in vitro fertilization (IVF) is a major strategy used to reduce the risk of ovarian hyperstimulation syndrome (OHSS). A novel trigger composed of 1500 IU of human chorionic gonadotropin (hCG) plus 450 IU of follicle-stimulating hormone (FSH) has been developed to reduce OHSS risk. This study compares outcomes of the novel trigger to conventional triggers used in high-risk OHSS patients undergoing IVF. METHODS In this retrospective cohort study, IVF cycles at high risk for OHSS based on a serum estradiol > 5000 pg/ml on trigger day conducted between January 2008 and February 2016 were evaluated. Oocyte maturation was induced with the novel trigger (1500 IU hCG plus 450 IU FSH) or a conventional trigger [3300 IU hCG, gonadotropin-releasing hormone agonist (GnRHa) alone, or GnRHa plus 1500 IU hCG]. IVF cycle outcomes were compared. Trigger strategies were examined for associations with OHSS development using logistic regression. RESULTS Among 298 eligible IVF cycles identified, there were no differences in oocyte maturation, fertilization, embryo quality, or pregnancy outcomes among all triggers. After adjusting for serum estradiol level and number of follicles, the novel trigger was associated with lower odds of OHSS symptom development compared to the 3300 IU hCG and GnRHa plus hCG 1500 IU triggers (p = 0.007 and 0.04, respectively). CONCLUSIONS This study suggests that 1500 IU hCG plus 450 IU FSH may be associated with decreased OHSS symptoms compared to conventional triggers, while producing similar IVF and pregnancy outcomes. More important, this novel trigger may provide a superior alternative in down-regulated cycles and in patients with hypothalamic dysfunction where GnRHa triggers cannot be utilized.
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Affiliation(s)
- Yanett Anaya
- Center for Reproductive Health and Division of Reproductive Endocrinology and Infertility, University of California, San Francisco, 499 Illinois Street, San Francisco, CA, 94143, USA.
| | - Douglas A Mata
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Joseph Letourneau
- Center for Reproductive Health and Division of Reproductive Endocrinology and Infertility, University of California, San Francisco, 499 Illinois Street, San Francisco, CA, 94143, USA
| | - Hakan Cakmak
- Center for Reproductive Health and Division of Reproductive Endocrinology and Infertility, University of California, San Francisco, 499 Illinois Street, San Francisco, CA, 94143, USA
| | - Marcelle I Cedars
- Center for Reproductive Health and Division of Reproductive Endocrinology and Infertility, University of California, San Francisco, 499 Illinois Street, San Francisco, CA, 94143, USA
| | - Mitchell P Rosen
- Center for Reproductive Health and Division of Reproductive Endocrinology and Infertility, University of California, San Francisco, 499 Illinois Street, San Francisco, CA, 94143, USA
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Letourneau JM, Cakmak H, Quinn M, Sinha N, I Cedars M, Rosen MP. Long-term hormonal contraceptive use is associated with a reversible suppression of antral follicle count and a break from hormonal contraception may improve oocyte yield. J Assist Reprod Genet 2017; 34:1137-1144. [PMID: 28669055 PMCID: PMC5581794 DOI: 10.1007/s10815-017-0981-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/13/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Unlike infertility, patients presenting for fertility preservation (FP) are often using combined hormonal contraceptives (CHC). We studied whether long-term (≥6 months) CHC use is associated with reversible suppression of antral follicle count (AFC). METHODS This is a longitudinal study of FP cycles from 2012 to 2016. We studied three groups: those without CHC exposure (NO CHC), those with CHC usage with a CHC break (BREAK), and without a break (NO BREAK) prior to ovarian stimulation. We assessed ovarian reserve by AFC at initial consultation and discussed the possibility of CHC suppression of AFC. Patients chose between ovarian stimulation with no CHC break versus ovarian stimulation after a CHC break. AFC was measured serially in the BREAK group. We assessed whether AFC suppression was reversed in the BREAK group. Total oocyte yield was compared among the NO CHC, BREAK, and NO BREAK groups. T tests, ANOVA, and linear/logistic regressions were used. RESULTS Seven hundred forty-three women underwent FP. Twenty-one percent (n = 154) were taking long-term CHC (≥6 months). AFC suppression was more likely with CHC use (OR 1.6, 95% CI 1.1-2.4, P = 0.011). The BREAK group (n = 79) stopped CHC for an average of 4 months. AFC improvement started at 1 month and plateaued at approximately 6- to 7-month break. The BREAK group had approximately twice as many oocytes per initial AFC as NO BREAK (2.8 ± 3.8 vs. 1.4 ± 0.9, P < 0.001). CONCLUSIONS When women present for FP on CHC, AFC may be suppressed. A CHC break of several months is associated with an increase in AFC and a potential improvement in overall egg yield.
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Affiliation(s)
- Joseph M Letourneau
- Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA.
| | - Hakan Cakmak
- Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
| | - Molly Quinn
- Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
| | - Nikita Sinha
- Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
| | - Marcelle I Cedars
- Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
| | - Mitchell P Rosen
- Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
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Chien AJ, Chambers J, Mcauley F, Kaplan T, Letourneau J, Hwang J, Kim MO, Melisko ME, Rugo HS, Esserman LJ, Rosen MP. Erratum to: Fertility preservation with ovarian stimulation and time to treatment in women with stage II-III breast cancer receiving neoadjuvant therapy. Breast Cancer Res Treat 2017; 165:161. [PMID: 28660429 DOI: 10.1007/s10549-017-4350-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- A Jo Chien
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St., Box 1710, San Francisco, CA, 94115, USA.
| | - Julia Chambers
- University of California San Francisco School of Medicine, Francisco, CA, USA
| | - Fiona Mcauley
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St., Box 1710, San Francisco, CA, 94115, USA
| | - Tessa Kaplan
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Joseph Letourneau
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Jimmy Hwang
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St., Box 1710, San Francisco, CA, 94115, USA
| | - Mi-Ok Kim
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St., Box 1710, San Francisco, CA, 94115, USA
| | - Michelle E Melisko
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St., Box 1710, San Francisco, CA, 94115, USA
| | - Hope S Rugo
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St., Box 1710, San Francisco, CA, 94115, USA
| | - Laura J Esserman
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St., Box 1710, San Francisco, CA, 94115, USA
| | - Mitchell P Rosen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
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Chien AJ, Chambers J, Mcauley F, Kaplan T, Letourneau J, Hwang J, Kim MO, Melisko ME, Rugo HS, Esserman LJ, Rosen MP. Fertility preservation with ovarian stimulation and time to treatment in women with stage II-III breast cancer receiving neoadjuvant therapy. Breast Cancer Res Treat 2017; 165:151-159. [PMID: 28503722 DOI: 10.1007/s10549-017-4288-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [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: 05/04/2017] [Accepted: 05/08/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine whether fertility preservation with ovarian stimulation (OS) results in treatment delay in breast cancer (BC) patients receiving neoadjuvant therapy (NAT). METHODS This is a retrospective study of women screened for the prospective neoadjuvant ISPY2 trial at the University of California San Francisco. All patients were <43, had stage II-III BC, and received neoadjuvant therapy. Time to initiation of NAT was compared between women who underwent OS (STIM) and women who did not (control). Patient and tumor characteristics, as well as oncologic outcomes, were compared between STIM and control groups. RESULTS 82 patients were included (34 STIM and 48 control). STIM patients were overall younger (mean = 35 vs. 36.9 years old, p = 0.06), and more likely to be childless (79.4 vs 31.2%, p < 0.0001) than controls. Mean time from diagnosis to initiation of NAT was 40 days, with no significant difference between STIM and control groups (mean 39.8 days vs 40.9 days, p = 0.75). Mean time from diagnosis to fertility consultation was 16.3 days. With median follow-up of 79 months, 16 (19.5%) patients have recurred or died from BC. Rates of pCR, recurrence, and death were similar in both groups. Six of 34 STIM patients have undergone embryo transfer, resulting in one patient with two live births. CONCLUSION Fertility preservation with OS can be performed in the neoadjuvant setting without delay in initiation of systemic therapy and should be discussed with all early-stage BC patients of reproductive age.
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Affiliation(s)
- A Jo Chien
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St., Box 1710, San Francisco, CA, 94115, USA.
| | - Julia Chambers
- University of California San Francisco School of Medicine, Francisco, CA, USA
| | - Fiona Mcauley
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St., Box 1710, San Francisco, CA, 94115, USA
| | - Tessa Kaplan
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Joseph Letourneau
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Jimmy Hwang
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St., Box 1710, San Francisco, CA, 94115, USA
| | - Mi-Ok Kim
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St., Box 1710, San Francisco, CA, 94115, USA
| | - Michelle E Melisko
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St., Box 1710, San Francisco, CA, 94115, USA
| | - Hope S Rugo
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St., Box 1710, San Francisco, CA, 94115, USA
| | - Laura J Esserman
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St., Box 1710, San Francisco, CA, 94115, USA
| | - Mitchell P Rosen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
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Salem WH, Letourneau JM, Chan J, Chan SW, Cedars M, Rosen MP. Cancer survivors of gynecologic malignancies are at risk for decreased opportunity for fertility preservation. Contracept Reprod Med 2017; 2:12. [PMID: 29201417 PMCID: PMC5683589 DOI: 10.1186/s40834-017-0039-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 11/04/2016] [Accepted: 01/24/2017] [Indexed: 11/10/2022] Open
Abstract
Background Cancer survivors rate fertility as one of the most important determinants of their quality of life in the years after cancer treatment. We seek to describe the reproductive goals of women affected by gynecologic cancers and investigate their specific challenges during fertility preservation (FP) counseling. Methods Univariate & multivariate logistic regression were used for quantitative analysis of objective FP counseling measures between women with gynecologic (GYN) and non-gynecologic (non-GYN) cancers from a cross sectional survey. Framework analysis was conducted on patient perception of physician-patient interactions. Results Of the 2537 women contacted, 1892 responded and 1686 reported treatment with potential to impact fertility. Among women with GYN cancers 52% wanted future children. Women <35 years were interested in FP (74%). Women with Gyn cancers received less FP counseling than women with non Gyn cancer (OR 0.5 95% CI 0.4-0.6). Three hundred twenty-four patients gave qualitative answers. Patient identified barriers included incomplete FP information (59%), nondisclosure (29%), a disinterest in FP (5%), and a perceived urgency to start treatment (7%). Conclusions Women with gynecologic cancers are less likely to be counseled about FP in comparison to women not affected by gynecologic cancers despite having similar fertility goals. We have identified patient perceived barriers to optimal FP counseling which may be improved upon to increase the value of FP and optimize quality of life for cancer survivors of gynecologic malignancies.
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Affiliation(s)
- Wael H Salem
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA USA
| | - Joe M Letourneau
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA USA
| | - Jessica Chan
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA USA
| | - Sai-Wing Chan
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA USA
| | - Marcelle Cedars
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA USA
| | - Mitchell P Rosen
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA USA
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Chan JL, Letourneau J, Salem W, Cil AP, Chan SW, Chen LM, Rosen MP. Regret around fertility choices is decreased with pre-treatment counseling in gynecologic cancer patients. J Cancer Surviv 2016; 11:58-63. [PMID: 27480882 DOI: 10.1007/s11764-016-0563-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 06/09/2016] [Accepted: 07/24/2016] [Indexed: 01/06/2023]
Abstract
PURPOSE Data have demonstrated an association between regret and lack of fertility counseling among patients undergoing treatment for non-gynecologic cancers. We sought to determine if fertility-related regret is reduced with pre-treatment counseling or fertility-sparing surgery (FSS) in patients with gynecologic cancers. METHODS A cross-sectional survey was administered to 593 reproductive-age survivors (18-40 years old at diagnosis) of localized cervix, ovarian, or endometrial cancers that were eligible for FSS. A validated decision regret score was used to evaluate regret in patients. RESULTS Four hundred seventy women completed the survey. Forty-six percent received pre-treatment counseling about treatment's effects on fertility. Having received counseling (adjusted ß-coefficient of -1.24, 95 % CI = -2.29 to -0.18, p = 0.02), satisfactory counseling (adjusted ß-coefficient of -2.71, 95 % CI = -3.86 to -1.57, p < 0.001), and FSS (adjusted ß-coefficient of -1.26, 95 % CI = -2.39 to -0.14, p = 0.03) were associated with lower regret post-treatment, after adjusting for age. Time since diagnosis, prior parity, socioeconomic status and cancer type were not associated with regret (p > 0.05). While 50 % of women reported desiring more children after diagnosis, desire for children after treatment was associated with increased regret (adjusted ß-coefficient of 3.97, 95 % CI = 2.92-5.02, p < 0.001). CONCLUSIONS Though less than half of study participants received counseling about the effect of cancer treatment on future fertility, both fertility counseling and FSS were associated with decreased regret in reproductive-aged women with gynecologic cancers. The desire for more children after treatment was associated with increased regret. IMPLICATIONS FOR CANCER SURVIVORS Inquiring about fertility desires and providing counseling regarding reproductive outcomes following cancer treatment should be implemented as part of the treatment process.
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Affiliation(s)
- Jessica L Chan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, Sixth Floor, San Francisco, CA, 94158, USA. .,Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market Street, Suite 800, Philadelphia, PA, 19104, USA.
| | - Joseph Letourneau
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, Sixth Floor, San Francisco, CA, 94158, USA
| | - Wael Salem
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, Sixth Floor, San Francisco, CA, 94158, USA.,Department of Obstetrics and Gynecology, University of Southern California, 1240 North Mission Road, Los Angeles, CA, 90033, USA
| | - Aylin Pelin Cil
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, Sixth Floor, San Francisco, CA, 94158, USA.,Istanbul Memorial Hospital ART and Reproductive Genetics Center, Piyale Pasa Bulvari, 34385, Okmeydani Sisli, Istanbul, Turkey
| | - Sai-Wing Chan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, Sixth Floor, San Francisco, CA, 94158, USA
| | - Lee-May Chen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, Sixth Floor, San Francisco, CA, 94158, USA
| | - Mitchell P Rosen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, Sixth Floor, San Francisco, CA, 94158, USA
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Shah MS, Letourneau JM, Niemasik EE, Bleil M, McCulloch CE, Rosen MP. The role of in-depth reproductive health counseling in addressing reproductive health concerns in female survivors of nongynecologic cancers. J Psychosoc Oncol 2016; 34:305-17. [PMID: 27144587 DOI: 10.1080/07347332.2016.1182958] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 10/21/2022]
Abstract
The purpose of this study was to characterize reproductive concerns among female cancer survivors and determine the role of targeted counseling in improving overall reproductive quality of life (QOL). A survey was administered to women from the California Cancer Registry, ages 18-40, with nongynecologic cancers diagnosed from 1993 to 2007, who received fertility-compromising treatments. In total, 356 women completed the survey, which included questions regarding their reproductive health counseling history and the reproductive concerns scale (RCS), a validated reproductive QOL tool. Factors independently associated with higher RCS scores included a desire for children at the time of diagnosis, posttreatment infertility, treatment with chemoradiation or bone marrow transplant, and income less than $100,000 per year at diagnosis. Among the highest reported reproductive concerns were those related to loss of control over one's reproductive future and concerns about the effect of illness on one's future fertility. Across our population and independent of age, in-depth reproductive health counseling prior to cancer treatment was associated with significantly lower RCS scores. Our findings highlight the importance of early counseling and targeting high-risk groups for additional counseling after completion of cancer treatment. This approach may be an effective strategy for optimizing long-term reproductive QOL in this vulnerable population.
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Affiliation(s)
- M S Shah
- a Department of Obstetrics, Gynecology , and Reproductive Sciences, University of California San Francisco , San Francisco , CA , USA
| | - J M Letourneau
- a Department of Obstetrics, Gynecology , and Reproductive Sciences, University of California San Francisco , San Francisco , CA , USA.,b Department of Obstetrics and Gynecology , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - E E Niemasik
- a Department of Obstetrics, Gynecology , and Reproductive Sciences, University of California San Francisco , San Francisco , CA , USA.,c Department of Obstetrics and Gynecology , Cornell University , New York , NY , USA
| | - M Bleil
- d Department of Epidemiology and Biostatistics , University of California San Francisco , San Francisco , CA , USA
| | - Charles E McCulloch
- d Department of Epidemiology and Biostatistics , University of California San Francisco , San Francisco , CA , USA
| | - M P Rosen
- a Department of Obstetrics, Gynecology , and Reproductive Sciences, University of California San Francisco , San Francisco , CA , USA
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Usadi RS, Diamond MP, Legro RS, Schlaff WD, Hansen KR, Casson P, Christman G, Wright Bates G, Baker V, Seungdamrong A, Rosen MP, Lucidi S, Thomas T, Huang H, Santoro N, Eisenberg E, Zhang H, Alvero R. Recruitment strategies in two reproductive medicine network infertility trials. Contemp Clin Trials 2015; 45:196-200. [PMID: 26386293 DOI: 10.1016/j.cct.2015.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 07/08/2015] [Revised: 09/07/2015] [Accepted: 09/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Recruitment of individuals into clinical trials is a critical step in completing studies. Reports examining the effectiveness of different recruitment strategies, and specifically in infertile couples, are limited. METHODS We investigated recruitment methods used in two NIH sponsored trials, Pregnancy in Polycystic Ovary Syndrome (PPCOS II) and Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS), and examined which strategies yielded the greatest number of participants completing the trials. RESULTS 3683 couples were eligible for screening. 1650 participants were randomized and 1339 completed the trials. 750 women were randomized in PPCOS II; 212 of the participants who completed the trial were referred by physicians. Participants recruited from radio ads (84/750) and the internet (81/750) resulted in similar rates of trial completion in PPCOS II. 900 participants were randomized in AMIGOS. 440 participants who completed the trial were referred to the study by physicians. The next most successful method in AMIGOS was the use of the internet, achieving 78 completed participants. Radio ads proved the most successful strategy in both trials for participants who earned <$50,000 annually. Radio ads were most successful in enrolling white patients in PPCOS II and black patients in AMIGOS. Seven ancillary Clinical Research Scientist Training (CREST) sites enrolled 324 of the participants who completed the trials. CONCLUSIONS Physician referral was the most successful recruitment strategy. Radio ads and the internet were the next most successful strategies, particularly for women of limited income. Ancillary clinical sites were important for overall recruitment.
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Affiliation(s)
- Rebecca S Usadi
- Carolinas Healthcare System Reproductive Medicine and Infertility, 1025 Morehead Medical Dr., Charlotte, NC 28232, United States.
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, GA 30912, United States
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA 17033, United States
| | - William D Schlaff
- Department of Obstetrics and Gynecology, Jefferson University, Philadelphia PA 19107, United States
| | - Karl R Hansen
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, OK 73104, United States
| | - Peter Casson
- Northeastern Reproductive Medicine, Colchester VT 05446, United States
| | - Gregory Christman
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL 32606, United States
| | - G Wright Bates
- Department of Obstetrics and Gynecology, University of Alabama Birmingham, Birmingham, AL 35233, United States
| | - Valerie Baker
- Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, CA 94304, United States
| | - Aimee Seungdamrong
- University of Medicine and Dentistry of New Jersey, Newark, NJ 07101, United States
| | - Mitchell P Rosen
- Department of Reproductive Endocrinology and Infertility, University of California, San Francisco, CA 94115, United States
| | - Scott Lucidi
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA 23235, United States
| | - Tracey Thomas
- Collaborative Center for Statistics in Science, Yale School of Public Health, New Haven, CT 06511, United States
| | - Hao Huang
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT 06520, United States
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO 80045, United States
| | - Esther Eisenberg
- Fertility and Infertility Branch, Eunice Kennedy Shriver National Institutes of Child Health and Human Development, Rockville, MD 20847, United States
| | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT 06520, United States
| | - Ruben Alvero
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO 80045, United States
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Chan JL, Letourneau J, Salem W, Cil AP, Chan SW, Chen LM, Rosen MP. Sexual satisfaction and quality of life in survivors of localized cervical and ovarian cancers following fertility-sparing surgery. Gynecol Oncol 2015; 139:141-7. [PMID: 26232519 DOI: 10.1016/j.ygyno.2015.07.105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 06/18/2015] [Revised: 07/24/2015] [Accepted: 07/25/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine if sexual satisfaction and sexual quality of life (QOL) are different in survivors of localized cervical and ovarian cancers who undergo fertility-sparing surgery (FSS) as compared with standard surgery. METHODS 470 survivors of localized cervical and ovarian cancers diagnosed between the ages of 18-40 were recruited from the California Cancer Registry to complete a cross-sectional survey. Validated questionnaires were used to assess sexual satisfaction and sexual QOL. RESULTS 228 women with localized cervical cancer and 125 with localized ovarian cancer completed the survey. In the cervical cancer group, 92 underwent FSS. Compared with the 84 women who did not undergo FSS (had a hysterectomy, but retained at least one ovary), there was no significant difference in sexual satisfaction or sexual QOL mean scores in women who maintained their uterus (cold-knife cone or trachelectomy), after controlling for age and menopausal status. 82 women with ovarian cancer underwent FSS. Compared with the 39 women that had a bilateral salpingo-oophorectomy, we found no significant differences in sexual satisfaction or sexual QOL in women who maintained at least one ovary (USO or cystectomy), after controlling for age and menopausal status. CONCLUSIONS While FSS may allow for post-treatment fertility, it may not confer a significant benefit with regard to sexual satisfaction or sexual QOL. Thus, the decision to perform FSS should not be dictated based on preservation of sexual functioning.
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Affiliation(s)
- Jessica L Chan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 1635 Divisadero, Suite 601, San Francisco, CA 94115, USA; Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market Street, Suite 800, Philadelphia, PA 19104, USA.
| | - Joseph Letourneau
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 1635 Divisadero, Suite 601, San Francisco, CA 94115, USA; Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 101 Manning Drive Chapel Hill, NC 27514, USA.
| | - Wael Salem
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 1635 Divisadero, Suite 601, San Francisco, CA 94115, USA.
| | - Aylin Pelin Cil
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 1635 Divisadero, Suite 601, San Francisco, CA 94115, USA; Istanbul Memorial Hospital ART and Reproductive Genetics Center, Piyale Pasa Bulvari, 34385 Okmeydani Sisli, Istanbul, Turkey.
| | - Sai-Wing Chan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 1635 Divisadero, Suite 601, San Francisco, CA 94115, USA.
| | - Lee-May Chen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 1635 Divisadero, Suite 601, San Francisco, CA 94115, USA.
| | - Mitchell P Rosen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, 1635 Divisadero, Suite 601, San Francisco, CA 94115, USA.
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Cakmak H, Tran ND, Zamah AM, Cedars MI, Rosen MP. A novel "delayed start" protocol with gonadotropin-releasing hormone antagonist improves outcomes in poor responders. Fertil Steril 2014; 101:1308-14. [PMID: 24636401 DOI: 10.1016/j.fertnstert.2014.01.050] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [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: 10/27/2013] [Revised: 01/20/2014] [Accepted: 01/28/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate whether delaying the start of ovarian stimulation with GnRH antagonist improves ovarian response in poor responders. DESIGN Retrospective study. SETTING Academic medical center. PATIENT(S) Thirty patients, who responded poorly and did not get pregnant with conventional estrogen priming antagonist IVF protocol. INTERVENTION(S) Delayed-start antagonist protocol (estrogen priming followed by early follicular-phase GnRH antagonist treatment for 7 days before ovarian stimulation). MAIN OUTCOME MEASURE(S) Number of dominant follicles and mature oocytes retrieved, mature oocyte yield, and fertilization rate. RESULT(S) The number of patients who met the criteria to proceed to oocyte retrieval was significantly higher in the delayed-start protocol [21/30 (70%)] compared with the previous conventional estrogen priming antagonist cycle [11/30 (36.7%)]. The number of dominant follicles was significantly higher in the delayed-start (4.2 ± 2.7) compared with conventional (2.4 ± 1.3) protocol. In patients who had oocyte retrieval after both protocols (n = 9), the delayed start resulted in shorter ovarian stimulation (9.4 ± 1.4 days vs. 11.1 ± 2.0 days), higher number of mature oocytes retrieved (4.9 ± 2.0 vs. 2.2 ± 1.1), and a trend toward increased fertilization rates with intracytoplasmic sperm injection (ICSI; 86 ± 17% vs. 69 ± 21%) compared with conventional protocol. After delayed start, the average number of embryos transferred was 2.8 ± 1.4 with implantation rate of 9.8% and clinical pregnancy rate of 23.8%. CONCLUSION(S) The delayed-start protocol improves ovarian response in poor responders by promoting and synchronizing follicle development without impairing oocyte developmental competence.
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Affiliation(s)
- Hakan Cakmak
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
| | - Nam D Tran
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
| | - A Musa Zamah
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
| | - Marcelle I Cedars
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
| | - Mitchell P Rosen
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California.
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Bleil ME, Gregorich SE, Adler NE, Sternfeld B, Rosen MP, Cedars MI. Race/ethnic disparities in reproductive age: an examination of ovarian reserve estimates across four race/ethnic groups of healthy, regularly cycling women. Fertil Steril 2013; 101:199-207. [PMID: 24182412 DOI: 10.1016/j.fertnstert.2013.09.015] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 09/07/2013] [Accepted: 09/10/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine whether reproductive age, as indexed by a validated marker of ovarian reserve (antimüllerian hormone [AMH]), varies among women of different race/ethnic backgrounds. DESIGN Cross-sectional study. SETTING Community-based sample. PATIENT(S) Multiethnic sample of 947 (277 white, 237 African American, 220 Latina, and 213 Chinese) healthy and regularly cycling premenopausal women, ages 25-45. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) AMH level. RESULT(S) A multivariate model was fit examining race/ethnicity, covariates, nonlinear terms for age (age(2), age(3)), and body mass index (BMI(2), BMI(3)), and two-way interactions between race/ethnicity and each of the other predictor variables in relation to AMH. After backward elimination, significant effects included race/ethnicity (F = 8.45), age (F = 349.94), race/ethnicity-by-linear age interaction (F = 4.67), age(2) (F = 31.61), and BMI (F = 10.69). Inspection of the significant race/ethnicity-by-linear age interaction showed AMH levels were consistently lower among Latina women compared with white women across all ages, whereas AMH levels were lower among African American and Chinese women compared with the white women at younger and middle ages, respectively. The AMH levels were higher among African American compared with Latina and Chinese women at older ages. CONCLUSION(S) Although the results must be considered preliminary, the findings are twofold: African American women may have lower AMH levels at younger ages but experience less of a reduction in AMH with advancing age, and Latina and Chinese women compared with white women may have lower AMH levels, marking a lower ovarian reserve and a possibly increased risk for earlier menopause.
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Affiliation(s)
- Maria E Bleil
- Department of Psychiatry, University of California San Francisco, San Francisco, California.
| | - Steven E Gregorich
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Nancy E Adler
- Department of Psychiatry, University of California San Francisco, San Francisco, California
| | - Barbara Sternfeld
- Division of Research, Kaiser Permanente of Northern California, Oakland, California
| | - Mitchell P Rosen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
| | - Marcelle I Cedars
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
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Abstract
The reproductive sequelae of cancer treatments may provide an important model of accelerated ovarian aging. Tens of thousands of women treated for cancer each year experience infertility and early menopause as a result of treatment. A spectrum of reproductive compromise commonly ranges from immediate menopause at the time of cancer treatment to the less proximate outcome of early menopause in the years to decades after treatment. A woman's reproductive lifespan can be shortened after chemotherapy or radiation because such treatments likely decrease the number of viable eggs after treatment. This acceleration in the decline of the number of follicles leads to increased rates of not only infertility and miscarriage but also early menopause, which represents the most extreme form of accelerated ovarian aging. The degree of reproductive impairment is dependent on chronologic age and the diagnosis or treatment. The variation in outcomes that persist may be partially explained by pretreatment ovarian reserve. Establishing the use of clinical predictors such as ovarian reserve markers to effectively anticipate such outcomes is an obvious and important keystone in the foundation of cancer survivorship research. An improved understanding of cancer treatment's ability to accelerate follicle death, decrease fecundability, and initiate an earlier menopause could provide a clinically relevant, time-shortened, and reproducible snapshot into the basic biology of ovarian aging.
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Affiliation(s)
- Joseph Letourneau
- Division of Reproductive Endocrinology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
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Cakmak H, Katz A, Cedars MI, Rosen MP. Effective method for emergency fertility preservation: random-start controlled ovarian stimulation. Fertil Steril 2013; 100:1673-80. [PMID: 23987516 DOI: 10.1016/j.fertnstert.2013.07.1992] [Citation(s) in RCA: 208] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 07/08/2013] [Accepted: 07/23/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether random-start controlled ovarian stimulation (COS), in which a patient is stimulated on presentation regardless of her menstrual-cycle phase, has outcomes similar to conventional early follicular phase-start COS for fertility preservation in cancer patients. DESIGN Retrospective cohort study. SETTING Academic medical center. PATIENT(S) Women recently diagnosed with cancer and in preparation for gonadotoxic therapy. INTERVENTION(S) Random- versus conventional-start COS. MAIN OUTCOME MEASURE(S) PRIMARY OUTCOME number of mature oocytes retrieved; secondary outcomes: pattern of follicular development, oocyte yield, and fertilization rate. RESULT(S) The number of total and mature oocytes retrieved, oocyte maturity rate, mature oocyte yield, and fertilization rates were similar in random- (n = 35) and conventional-start (n = 93) COS cycles. No superiority was noted when comparing COS started in the late follicular (n = 13) or luteal phase (n = 22). The addition of letrozole, in the case of estrogen-sensitive cancers, did not adversely affect COS outcomes or oocyte maturity and competence in either random- or conventional-start protocols. CONCLUSION(S) Random-start COS is as effective as conventional-start COS in fertility preservation. This protocol would minimize delays and allow more patients to undergo fertility preservation and still proceed with cancer treatment within 2-3 weeks.
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Affiliation(s)
- Hakan Cakmak
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
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Abstract
The patients referred for fertility preservation owing to a malignant disease do not represent the typical population of subfertile patients treated in IVF units. Cancer may affect multiple tissues throughout the body and can result in a variety of complications during controlled ovarian stimulation. Determination of the controlled ovarian stimulation protocol and gonadotropin dose for oocyte/embryo cryopreservation requires an individualized assessment. This review highlights the new protocols that are emerging to reduce time constraints and emphasizes management considerations to decrease complications.
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Affiliation(s)
- Hakan Cakmak
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Reproductive Endocrinology and Infertility, University of California, San Francisco, California, USA
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Letourneau JM, Niemasik EE, McCulloch CE, Rugo HS, Katz PP, Cedars MI, Rosen MP. Temporary amenorrhea predicts future infertility in young women treated with chemotherapy. ACTA ACUST UNITED AC 2013. [DOI: 10.7243/2049-7962-2-16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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50
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Cakmak H, Fujimoto VY, Zamah AM, Rosen MP, Tran ND, Cedars MI, Rinaudo PF. Metaphase II (MII) oocytes obtained at different time points in the same in vitro fertilization cycle. J Assist Reprod Genet 2012; 29:1203-5. [PMID: 22941385 DOI: 10.1007/s10815-012-9852-5] [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: 05/24/2012] [Accepted: 08/12/2012] [Indexed: 01/27/2023] Open
Affiliation(s)
- Hakan Cakmak
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA 94115, USA
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