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Horowitz E, Mizrachi Y, Barber E, Shimshy M, Levitas-Djerbi T, Finkelstein M, Shalev A, Farhi J, Raziel A, Esteves SC, Weissman A. High prevalence of low prognosis by the POSEIDON criteria in women undergoing planned oocyte cryopreservation. Eur J Obstet Gynecol Reprod Biol 2024; 295:42-47. [PMID: 38335583 DOI: 10.1016/j.ejogrb.2024.01.025] [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: 10/28/2023] [Revised: 01/13/2024] [Accepted: 01/18/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Planned oocyte cryopreservation (OC) is being increasingly utilized worldwide. However, some women cannot accumulate sufficient oocytes because of poor response to stimulation. The POSEIDON classification is a novel system to classify patients with 'expected' or 'unexpected' inappropriate ovarian response to exogenous gonadotropins. Our study aimed to examine the prevalence of POSEIDON patients among women undergoing planned OC. STUDY DESIGN We retrospectively reviewed the first cycles of 160 consecutive patients undergoing planned OC. Patients were classified into the four POSEIDON groups or as 'non-POSEIDON' based on age, AMH level and the number of oocytes retrieved. The primary outcome measure was the prevalence of POSEIDON patients. RESULTS Overall, 63 patients (39.4 %) were classified as POSEIDON patients, 12 in group 1, 12 in group 2, 8 in group 3, and 31 in group 4. Compared to non-POSEIDON patients, POSEIDON patients had increased basal FSH levels and reduced serum AMH levels and antral follicle counts, required higher FSH starting doses and increased gonadotropin requirements and reached lower peak serum estradiol levels. Additionally, POSEIDON patients had a lower number of oocytes retrieved (7.6 ± 3.1 vs.20.2 ± 9.9, p < 0.001) and vitrified (5.8 ± 2.9 vs.14.7 ± 6.8, p < 0.001) than non-POSEIDON counterparts, respectively. CONCLUSION We found a high prevalence of patients being classified as low prognosis according to the POSEIDON criteria among patients seeking planned OC. POSEIDON patients had increased gonadotropin requirements and a significantly lower number of oocytes retrieved and vitrified. This novel, unexpected finding adds clinically relevant information for counselling and management of patients undergoing planned OC.
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Affiliation(s)
- Eran Horowitz
- In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yossi Mizrachi
- In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Elad Barber
- In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Miriam Shimshy
- In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Talia Levitas-Djerbi
- In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Maya Finkelstein
- In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amir Shalev
- In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jacob Farhi
- In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arieh Raziel
- In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil.
| | - Ariel Weissman
- In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Sad K, Jones CY, Adams M, Lustenberger S, Lee RS, Elayavalli SR, Farhi J, Lemon LD, Fasken MB, Corbett AH, Spangle JM. Histone H3 E50K mutation confers oncogenic activity and supports an EMT phenotype. bioRxiv 2023:2023.10.11.561775. [PMID: 37873162 PMCID: PMC10592736 DOI: 10.1101/2023.10.11.561775] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Sequencing of human patient tumors has identified recurrent missense mutations in genes encoding core histones. We report that mutations that convert histone H3 amino acid 50 from a glutamate to a lysine (H3E50K) support an oncogenic phenotype in human cells. Expression of H3E50K is sufficient to transform human cells as evidenced by a dramatic increase in cell migration and invasion, and a statistically significant increase in proliferation and clonogenicity. H3E50K also increases the invasive phenotype in the context of co-occurring BRAF mutations, which are present in patient tumors characterized by H3E50K. H3E50 lies on the globular domain surface in a region that contacts H4 within the nucleosome. We find that H3E50K perturbs proximal H3 post-translational modifications globally and dysregulates gene expression, activating the epithelial to mesenchymal transition. Functional studies using S. cerevisiae reveal that, while yeast cells that express H3E50K as the sole copy of histone H3 show sensitivity to cellular stressors, including caffeine, H3E50K cells display some genetic interactions that are distinct from the characterized H3K36M oncohistone yeast model. Taken together, these data suggest that additional histone H3 mutations have the potential to be oncogenic drivers and function through distinct mechanisms that dysregulate gene expression.
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Affiliation(s)
- K Sad
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322
| | - CY Jones
- Department of Biology; Emory College of Arts and Sciences, Atlanta GA 30322
| | - M Adams
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322
| | - S Lustenberger
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA
| | - RS Lee
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322
| | - SR Elayavalli
- Department of Biology; Emory College of Arts and Sciences, Atlanta GA 30322
| | - J Farhi
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322
| | - LD Lemon
- Department of Biology; Emory College of Arts and Sciences, Atlanta GA 30322
| | - MB Fasken
- Department of Biology; Emory College of Arts and Sciences, Atlanta GA 30322
| | - AH Corbett
- Department of Biology; Emory College of Arts and Sciences, Atlanta GA 30322
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322
| | - JM Spangle
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322
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Ganer Herman H, Mizrachi Y, Marom O, Weissman A, Farhi J, Kovo M, Raziel A, Horowitz E. Obstetric and perinatal outcomes following ovulation induction and unassisted pregnancies in the same mother. Am J Perinatol 2023. [PMID: 37230475 DOI: 10.1055/a-2099-8399] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/27/2023]
Abstract
OBJECTIVE We aimed to assess whether ovulation induction treatments affect obstetric and neonatal outcomes. STUDY DESIGN This was a historic cohort study of deliveries in a single university-affiliated medical center between November 2008 and January 2020. We included women who had one pregnancy following ovulation induction, and one unassisted pregnancy. The obstetric and perinatal outcomes were compared between pregnancies following ovulation induction and unassisted pregnancies, so that each woman served as her own control. The primary outcome measure was birthweight. RESULTS A total of 193 deliveries following ovulation induction and 193 deliveries after unassisted conception by the same women were compared. Ovulation induction pregnancies were characterized by a significantly younger maternal age and a higher rate of nulliparity (62.7% vs. 8.3%, p<0.001). In pregnancies achieved by ovulation induction we found a higher rate of preterm birth (8.3% vs. 4.1%, p=0.02) and instrumental deliveries (8.8% vs. 2.1%, p=0.005), while cesarean delivery rates were higher following unassisted pregnancies. Birthweight was significantly lower in ovulation induction pregnancies (3167 ± 436 vs. 3251 ± 460 grams, p=0.009), although the rate of small for gestational age neonates was similar between the groups. On multivariate analysis, birthweight remained significantly associated with ovulation induction after adjustment for confounders, while preterm birth did not. CONCLUSION Pregnancies following ovulation induction treatments are associated with lower birthweight. This may be related to an altered placentation process following uterine exposure to supraphysiological hormonal levels.
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Affiliation(s)
- Hadas Ganer Herman
- Edith Wolfson Medical Center, Holon, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Yossi Mizrachi
- Edith Wolfson Medical Center, Holon, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Or Marom
- Edith Wolfson Medical Center, Holon, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Ariel Weissman
- Edith Wolfson Medical Center, Holon, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Jacob Farhi
- Edith Wolfson Medical Center, Holon, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Michal Kovo
- Meir Medical Center, Kfar Saba, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Arieh Raziel
- Edith Wolfson Medical Center, Holon, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Eran Horowitz
- Edith Wolfson Medical Center, Holon, Israel
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
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Horowitz E, Mizrachi Y, Ganer Herman H, Oz Marcuschamer E, Shalev A, Farhi J, Barber E, Orna SH, Raziel A, Weissman A. The effect of SARS-CoV-2 mRNA vaccination on AMH concentrations in infertile women. Reprod Biomed Online 2022; 45:779-784. [PMID: 35985956 PMCID: PMC9217631 DOI: 10.1016/j.rbmo.2022.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/17/2022] [Accepted: 06/15/2022] [Indexed: 01/31/2023]
Abstract
RESEARCH QUESTION Does SARS-CoV-2 mRNA vaccination affect the ovarian reserve of infertile women undergoing IVF? DESIGN This was a prospective observational study at a single university-affiliated IVF unit that included infertile women aged 18-44 years who were undergoing IVF/intracytoplasmic sperm injection between November 2020 and September 2021, had received two doses of SARS-CoV-2 mRNA vaccination and had undergone measurement of baseline anti-Müllerian hormone (AMH) concentration within the 12 months preceding their recruitment. AMH concentrations before and after vaccination were evaluated and compared. RESULTS Overall, 31 women were included in the study. The median AMH concentrations before and after COVID-19 vaccine were comparable (1.7 versus 1.6 g/ml, respectively, P = 0.96). No correlation was found between the participant's anti-COVID-19 antibody titre and the change in AMH concentration. CONCLUSIONS SARS-CoV-2 mRNA vaccination does not adversely affect ovarian reserve, as shown by comparing serum AMH concentrations before and after vaccination. These findings may serve as a counselling tool for clinicians to reassure women undergoing fertility treatment that SARS-CoV-2 mRNA vaccination is safe.
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Affiliation(s)
- Eran Horowitz
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Corresponding author
| | - Yossi Mizrachi
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadas Ganer Herman
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Einat Oz Marcuschamer
- Department of Obstetrics and Gynecology, Assuta Medical Center Ashdod, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Amir Shalev
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Farhi
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Barber
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Schwartz Harari Orna
- Microbiology and Immunology Laboratory, Edith Wolfson Medical Center, Holon, Israel
| | - Arieh Raziel
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Weissman
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Herman HG, Mizrachi Y, Marom O, Weissman A, Farhi J, Prof MK, Raziel A, Dr. EH. OBSTETRIC AND PERINATAL OUTCOMES FOLLOWING OVULATION INDUCTION AND UNASSISTED PREGNANCIES IN THE SAME MOTHER. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.729] [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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Ganer Herman H, Horowitz E, Mizrachi Y, Farhi J, Raziel A, Weissman A. Prediction, assessment, and management of suboptimal GnRH agonist trigger: a systematic review. J Assist Reprod Genet 2022; 39:291-303. [PMID: 35306603 PMCID: PMC8956771 DOI: 10.1007/s10815-021-02359-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 08/22/2021] [Accepted: 11/15/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE This systematic review aimed to identify baseline patient demographic and controlled ovarian stimulation characteristics associated with a suboptimal response to GnRHa triggering, and available options for prevention and management of suboptimal response. METHODS PubMed, Google Scholar, Medline, and the Cochrane Library were searched for keywords related to GnRHa triggering, and peer-reviewed articles from January 2000 to September 2021 included. RESULTS Thirty-seven studies were included in the review. A suboptimal response to GnRHa triggering was more likely following long-term or recent oral contraceptive use and with a low or high body mass index. Low basal serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol serum levels were correlated with suboptimal oocyte yield, as was a low serum LH level on the day of triggering. A prolonged stimulation period and increased gonadotropin requirements were correlated with suboptimal response to triggering. Post-trigger LH < 15 IU/L best correlated with an increased risk for empty follicle syndrome and a lower oocyte retrieval rate. Retriggering with hCG may be considered in patients with suboptimal response according to post-trigger LH, as in cases of failed aspiration. CONCLUSION Pre-treatment assessment of patient characteristics, with pre- and post-triggering assessment of clinical and endocrine cycle characteristics, may identify cases at risk for suboptimal response to GnRHa triggering and optimize its utilization.
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Affiliation(s)
- Hadas Ganer Herman
- grid.12136.370000 0004 1937 0546In Vitro Fertilization Unit, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Horowitz
- grid.12136.370000 0004 1937 0546In Vitro Fertilization Unit, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Mizrachi
- grid.12136.370000 0004 1937 0546In Vitro Fertilization Unit, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Farhi
- grid.12136.370000 0004 1937 0546In Vitro Fertilization Unit, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arieh Raziel
- grid.12136.370000 0004 1937 0546In Vitro Fertilization Unit, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Weissman
- grid.12136.370000 0004 1937 0546In Vitro Fertilization Unit, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Horowitz E, Mizrachi Y, Finkelstein M, Farhi J, Shalev A, Gold E, Raziel A, Weissman A. A randomized controlled trial of vaginal progesterone for luteal phase support in modified natural cycle - frozen embryo transfer. Gynecol Endocrinol 2021; 37:792-797. [PMID: 33307906 DOI: 10.1080/09513590.2020.1854717] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Our aim was to study whether luteal phase support (LPS) increases the live-birth rate (LBR) in women undergoing modified natural cycle (mNC) frozen-thawed embryo transfer (FET). METHODS In a randomized controlled trial, conducted at a university-affiliated tertiary medical center, a total of 59 patients aged 18-45 years, underwent mNC-FET. FET was performed in mNC following ovulation triggering by hCG. Patients were randomized into two groups; The No-LPS Group included 28 women who did not receive LPS, and the LPS Group included 31 women who received vaginal progesterone for LPS. The main outcome measure was LBR. RESULTS Baseline demographic and clinical characteristics were comparable between the study groups. The no-LPS group and the LPS group did not differ with regard to clinical pregnancy rate (21.4% vs. 32.3%; respectively, p = .35), LBR (17.9% vs. 19.4%; respectively, p = .88), or spontaneous miscarriage rate (3.6% vs. 12.9%; respectively, p = .35). On multivariate logistic regression analysis, LPS was not associated with LBR after controlling for confounders. CONCLUSION The results of our study suggest that LPS after mNC-FET does not improve the reproductive outcome, and therefore, might not be necessary.C linicaltrials.gov identifier: NCT01483365.
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Affiliation(s)
- Eran Horowitz
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Yossi Mizrachi
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Maya Finkelstein
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Jacob Farhi
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Amir Shalev
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Eran Gold
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Arieh Raziel
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ariel Weissman
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Mizrachi Y, Horowitz E, Gane. Herman H, Farhi J, Raziel A, Weissman A. P–649 Should women receive luteal support following natural cycle frozen embryo transfer? A systematic review and meta-analysis. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Should women receive luteal phase support (LPS) following natural cycle frozen embryo transfer (NC-FET)?
Summary answer
Progesterone LPS following NC-FET increases the live birth rate. There is no evidence to support the administration of hCG for LPS in these cases.
What is known already
Whether or not women should receive LPS following NC-FET is highly controversial. Previous studies have shown conflicting results.
Study design, size, duration
We conducted a systematic search of the literature published in Medline/PubMed, Embase and the Cochrane Library, from January 2000 until December 2020. We included all original English, peer-reviewed articles, irrespective of study-design. The search strategy included keywords related to natural cycle frozen embryo transfer and luteal phase support. Studies reporting the results of artificial or stimulated FET cycles were excluded.
Participants/materials, setting, methods
Our systematic search generated 395 records. After screening, eight studies were included in the review and seven studies were included in the meta-analysis. Two studies (n = 858) used hCG, and 6 studies (n = 1507) used progesterone for luteal support. Four studies were randomized controlled trials (RCTs), whereas the other four were historic cohort studies.
Main results and the role of chance
In a meta-analysis using random effects model, hCG administration for LPS did not increase the clinical pregnancy rate (two studies, OR 0.85, 95% CI 0.64–1.14). On the other hand, progesterone LPS was associated with a higher clinical pregnancy rate (five studies, OR 1.48, 95% CI 1.14–1.94), and a higher live birth rate (three studies, OR 1.67, 95% CI 1.19–2.36).
Limitations, reasons for caution
There was large heterogeneity in progesterone dose and route of administration, as well as the methods used for ovulation detection and triggering. Moreover, only four studies were randomized. Finally, both studies examining the use of hCG for LPS were performed by the same group of researchers in a single center.
Wider implications of the findings: The available evidence indicates that progesterone administration for LPS is beneficial following natural cycle frozen embryo transfer. There is no evidence to support the administration of hCG for LPS in these cases. Additional Large RCTs are necessary in order to improve the quality of evidence and validate our findings.
Trial registration number
PROSPERO ID: CRD42020199045
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Affiliation(s)
- Y Mizrachi
- IVF Unit, Obstetrics and Gynecology- the Edith Wolfson Medical Center, Holon, Israel
| | - E Horowitz
- IVF Unit, Obstetrics and Gynecology- the Edith Wolfson Medical Center, Holon, Israel
| | - H Gane. Herman
- IVF Unit, Obstetrics and Gynecology- the Edith Wolfson Medical Center, Holon, Israel
| | - J Farhi
- IVF Unit, Obstetrics and Gynecology- the Edith Wolfson Medical Center, Holon, Israel
| | - A Raziel
- IVF Unit, Obstetrics and Gynecology- the Edith Wolfson Medical Center, Holon, Israel
| | - A Weissman
- IVF Unit, Obstetrics and Gynecology- the Edith Wolfson Medical Center, Holon, Israel
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Mizrachi Y, Horowitz E, Ganer Herman H, Farhi J, Raziel A, Weissman A. Should women receive luteal support following natural cycle frozen embryo transfer? A systematic review and meta-analysis. Hum Reprod Update 2021; 27:643-650. [PMID: 33829269 DOI: 10.1093/humupd/dmab011] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 02/01/2021] [Revised: 03/08/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Spontaneous ovulation during a natural menstrual cycle is frequently used for timing frozen embryo transfer (FET). Nevertheless, it remains unclear whether or not women should receive luteal phase support (LPS) following natural cycle frozen embryo transfer (NC-FET). OBJECTIVE AND RATIONALE The aim of this systematic review and meta-analysis was to study whether the administration of LPS improves the reproductive outcome following NC-FET. SEARCH METHODS We conducted a systematic search of the literature published in Medline/PubMed, Embase and the Cochrane Library, from January 2000 until December 2020. We included all original English, peer-reviewed articles, irrespective of the study design. The search strategy included keywords related to NC-FET and luteal phase support. Studies reporting the results of artificial or stimulated FET cycles were excluded. OUTCOMES Our systematic search generated 416 records. After screening, eight studies were included in the review and seven studies were included in the meta-analysis. Two studies (n = 858) used hCG and six studies (n = 1507) used progesterone for luteal support. Four studies were randomised controlled trials (RCTs), whereas the other four were historic cohort studies. In a meta-analysis using a random effects model, hCG administration for LPS did not increase the clinical pregnancy rate (CPR) (two studies, odds ratio (OR) 0.85, 95% CI 0.64-1.14). On the other hand, progesterone LPS was associated with a higher CPR (five studies, OR 1.48, 95% CI 1.14-1.94), and a higher live birth rate (LBR) (three studies, OR 1.67, 95% CI 1.19-2.36). The association between progesterone LPS and the LBR remained significant after excluding non-randomised studies. WIDER IMPLICATIONS The available evidence indicates that progesterone administration for LPS is beneficial following NC-FET. There is no evidence to support the administration of hCG for LPS in these cases. Additional large RCTs are necessary to improve the quality of evidence and validate our findings.
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Affiliation(s)
- Yossi Mizrachi
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson's Medical Center, Holon, Affiliated with the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eran Horowitz
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson's Medical Center, Holon, Affiliated with the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hadas Ganer Herman
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson's Medical Center, Holon, Affiliated with the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jacob Farhi
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson's Medical Center, Holon, Affiliated with the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arieh Raziel
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson's Medical Center, Holon, Affiliated with the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ariel Weissman
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson's Medical Center, Holon, Affiliated with the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Orvieto R, Farhi J, Nahum R, Basch S, Haas J, Aizer A. Future fertility of patients with zero oocytes yield in their first IVF cycle attempt. PLoS One 2021; 16:e0246889. [PMID: 33592057 PMCID: PMC7886146 DOI: 10.1371/journal.pone.0246889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/28/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We aim to estimate the future fertility of patient undergoing their first IVF cycle attempt with no oocyte retrieved, and to identify factors that might predict those who will conceive in subsequent IVF cycle attempt. METHODS A cohort retrospective study of all consecutive women attending our IVF unit, for their first IVF cycle attempt, between January 2013 to December 2019, who reached the ovum pick-up (OPU) stage with zero oocyte retrieved. Patients' characteristics and infertility-treatment-related variables in the first IVF cycle attempt were compared between those who conceived in a subsequent cycle and those who did not. Moreover, infertility-treatment-related variables during successful cycles resulting in pregnancy were compared to those without. RESULTS 59 met the study inclusion criteria, yielding zero oocytes. During the follow-up period, 12 (20.3%) women conceived (one conceived twice), and 8 (14%) gave birth to a live infant. Cumulative live-birth rate per OPU and per patients were 4% and 14%, respectively. Clinical pregnancies were achieved after 3.61+1.4 cycle attempts (range: 1-6), with no live-births following the fifth IVF cycle attempt. No in-between group differences were observed in ovarian stimulation variables of their first IVF cycle attempt. Moreover, in those cycles resulting in pregnancy, patients achieved a significantly higher number of fertilized oocytes (2.15+1.5 vs 0.94+1.5, respectively; p<0.01) and a higher mean top-quality embryos (TQE) (1.76+0.9 vs 0.73+1.2, respectively; p<0.003). CONCLUSION Women yielding zero oocytes at their first IVF cycle attempt, may achieve 14% cumulative live-birth rate after 5 IVF cycle attempts. Moreover, those who conceived in subsequent IVF cycle attempts were those achieving 2 or more fertilized oocytes/TQE.
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Affiliation(s)
- Raoul Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, at the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- * E-mail:
| | - Jacob Farhi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- IVF Unit, Wolfson Medical Center, Holon, Israel
| | - Ravit Nahum
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shani Basch
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
| | - Jigal Haas
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adva Aizer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Horowitz E, Mizrachi Y, Farhi J, Raziel A, Weissman A. Does the interval between the last GnRH antagonist dose and the GnRH agonist trigger affect oocyte recovery and maturation rates? Reprod Biomed Online 2020; 41:917-924. [DOI: 10.1016/j.rbmo.2020.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 11/15/2022]
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Mizrachi Y, Horowitz E, Farhi J, Raziel A, Weissman A. Ovarian stimulation for freeze-all IVF cycles: a systematic review. Hum Reprod Update 2019; 26:118-135. [DOI: 10.1093/humupd/dmz037] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/07/2019] [Accepted: 09/23/2019] [Indexed: 12/30/2022] Open
Abstract
Abstract
BACKGROUND
Freeze-all IVF cycles are becoming increasingly prevalent for a variety of clinical indications. However, the actual treatment objectives and preferred treatment regimens for freeze-all cycles have not been clearly established.
OBJECTIVE AND RATIONALE
We aimed to conduct a systematic review of all aspects of ovarian stimulation for freeze-all cycles.
SEARCH METHODS
A comprehensive search in Medline, Embase and The Cochrane Library was performed. The search strategy included keywords related to freeze-all, cycle segmentation, cumulative live birth rate, preimplantation genetic diagnosis, preimplantation genetic testing for aneuploidy, fertility preservation, oocyte donation and frozen-thawed embryo transfer. We included relevant studies published in English from 2000 to 2018.
OUTCOMES
Our search generated 3292 records. Overall, 69 articles were included in the final review. Good-quality evidence indicates that in freeze-all cycles the cumulative live birth rate increases as the number of oocytes retrieved increases. Although the risk of severe ovarian hyperstimulation syndrome (OHSS) is virtually eliminated in freeze-all cycles, there are certain risks associated with retrieval of large oocyte cohorts. Therefore, ovarian stimulation should be planned to yield between 15 and 20 oocytes. The early follicular phase is currently the preferred starting point for ovarian stimulation, although luteal phase stimulation can be used if necessary. The improved safety associated with the GnRH antagonist regimen makes it the regimen of choice for ovarian stimulation in freeze-all cycles. Ovulation triggering with a GnRH agonist almost completely eliminates the risk of OHSS without affecting oocyte and embryo quality and is therefore the trigger of choice. The addition of low-dose hCG in a dual trigger has been suggested to improve oocyte and embryo quality, but further research in freeze-all cycles is required. Moderate-quality evidence indicates that in freeze-all cycles, a moderate delay of 2–3 days in ovulation triggering may result in the retrieval of an increased number of mature oocytes without impairing the pregnancy rate. There are no high-quality studies evaluating the effects of sustained supraphysiological estradiol (E2) levels on the safety and efficacy of freeze-all cycles. However, no significant adverse effects have been described. There is conflicting evidence regarding the effect of late follicular progesterone elevation in freeze-all cycles.
WIDER IMPLICATIONS
Ovarian stimulation for freeze-all cycles is different in many aspects from conventional stimulation for fresh IVF cycles. Optimisation of ovarian stimulation for freeze-all cycles should result in enhanced treatment safety along with improved cumulative live birth rates and should become the focus of future studies.
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Affiliation(s)
- Yossi Mizrachi
- IVF Unit, Department of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eran Horowitz
- IVF Unit, Department of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jacob Farhi
- IVF Unit, Department of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arieh Raziel
- IVF Unit, Department of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ariel Weissman
- IVF Unit, Department of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Horowitz E, Mizrachi Y, Farhi J, Shalev A, Raziel A, Weissman A. Modified natural-cycle cryopreserved embryo transfer: is a washout period needed after a failed fresh cycle? Reprod Biomed Online 2019; 39:439-445. [PMID: 31307924 DOI: 10.1016/j.rbmo.2019.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 12/11/2018] [Revised: 05/02/2019] [Accepted: 05/08/2019] [Indexed: 11/25/2022]
Abstract
RESEARCH QUESTION Are the characteristics of the natural cycle or modified natural cycle (mNC), or live birth rates (LBR), affected by delaying frozen embryo transfer (FET) after a failed fresh IVF cycle? DESIGN In a retrospective study, conducted at a university-affiliated tertiary centre, 198 women aged 18-45 years undergoing their first FET cycle after a failed fresh embryo transfer attempt using an mNC were evaluated. Cycles were divided according to the time interval between oocyte retrieval and the start of the FET cycle into the immediate FET group (<22 days) and the delayed FET group (≥22 days). The main outcome measures were ovulation day and LBR. RESULTS The mean interval between oocyte retrieval and the start of the FET cycle was 15.6 ± 3.2 days in the immediate FET group and 84.8 ± 73.7 days in the delayed FET group (P < 0.001). Ovulation day was significantly delayed in the immediate FET group (day 17.1 ± 4.4 versus day 15.4 ± 3.7; P = 0.004). There was no difference between the immediate and delayed FET groups in terms of clinical pregnancy rate (CPR) (25.4% and 25.0%, respectively) or LBR (21.2% and 20.0%, respectively). CONCLUSIONS Natural-cycle characteristics are similar in immediate and delayed cycles, except for a slight delay in ovulation day. Deferring mNC-FET after a failed fresh IVF cycle does not improve the reproductive outcome. These results should encourage patients and clinicians who want to proceed with FET immediately after failure of fresh IVF.
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Affiliation(s)
- Eran Horowitz
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Mizrachi
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Farhi
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Shalev
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arieh Raziel
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Weissman
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Farhi J, Cohen K, Mizrachi Y, Weissman A, Raziel A, Orvieto R. Should ICSI be implemented during IVF to all advanced-age patients with non-male factor subfertility? Reprod Biol Endocrinol 2019; 17:30. [PMID: 30845973 PMCID: PMC6407274 DOI: 10.1186/s12958-019-0474-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 02/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUD In order to maximize In vitro fertilization (IVF) success rates in advanced- age patients, it has been suggested to favor the use of intracytoplasmic sperm injection (ICSI) over conventional insemination (CI), with the notion that ICSI would serve as a tool to overcome interference in sperm oocyte interaction and sperm oocyte penetration issues that can be related to maternal age and are not due to sperm abnormalities. We therefore aim to evaluate the role of ICSI in the treatment of non-male factor infertile patients aged ≥35 in terms of fertilization and top-quality embryo rates. METHODS In this retrospective cohort study, data were collected and analyzed for all patients with non-male factor infertility, aged ≥35 treated, undergoing their first IVF cycle attempt with 6 or more oocytes yield, in whom a 50% ICSI-CI division was performed. RESULTS Five hundreds and four oocytes were collected from 52 eligible patients. Overall, 245 oocytes underwent ICSI and 259 oocytes underwent CI. The fertilization rate was 71.0% following ICSI, compared to 50.1% in the CI treated oocytes (P < 0.001). The top quality embryo rate was 62.8% following ICSI compared to 45.5% following CI (P < 0.001). Subdividing the study population to two age groups revealed that the above differences remained significant in patients aged 35-39 yrs., whereas in those aged 40-45 yrs., the differences were non-significant but still inclined in favor of ICSI. CONCLUSIONS This study favors the use of ICSI in the older IVF population in order to increase both the fertilization rate and the number of top quality embryos that result per IVF cycle. Further studies are needed to establish our observations and use ICSI as the preferred approach to overcome egg sperm abnormal interactions related to advanced maternal age.
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Affiliation(s)
- Jacob Farhi
- 0000 0004 0621 3939grid.414317.4IVF Unit, Wolfson Medical Center, Holon, Israel
- 0000 0004 1937 0546grid.12136.37Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kfir Cohen
- 0000 0004 1937 0546grid.12136.37Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Mizrachi
- 0000 0004 0621 3939grid.414317.4IVF Unit, Wolfson Medical Center, Holon, Israel
| | - Ariel Weissman
- 0000 0004 0621 3939grid.414317.4IVF Unit, Wolfson Medical Center, Holon, Israel
- 0000 0004 1937 0546grid.12136.37Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arieh Raziel
- 0000 0004 0621 3939grid.414317.4IVF Unit, Wolfson Medical Center, Holon, Israel
- 0000 0004 1937 0546grid.12136.37Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raoul Orvieto
- 0000 0004 1937 0546grid.12136.37Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- 0000 0001 2107 2845grid.413795.dInfertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- 0000 0004 1937 0546grid.12136.37Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Farhi J, Elizur S, Yonish M, Seidman DS, Shulman A, Schiff E, Orvieto R. Assessment of a double freezing approach in the management of surplus embryos in IVF. Reprod Biomed Online 2019; 38:517-519. [PMID: 30777667 DOI: 10.1016/j.rbmo.2018.11.010] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/23/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
Abstract
RESEARCH QUESTION What pregnancy rates are achieved after transfer of cryopreserved double slow-frozen embryos in IVF cycles? Patients in whom surplus thawed cleaved embryos (day 2 or 3) were grown to the blastocyst stage, re-frozen and then re-thawed for transfer (double freezing) were included. DESIGN Data were collected on all patients who had undergone the above procedure at the IVF unit of Assuta Ramat Hachayal Hospital, Tel Aviv, during a 7-year period. For each patient in the study group, the two-consecutive, matched-by-age patients treated with frozen-thawed single blastocyst transfer were selected to form a 2:1 ratio control group. All embryos were frozen using the slow freeze protocol. RESULTS A total of 54 patients had 70 embryos that were re-frozen at the blastocyst stage. Twenty-eight of these blastocysts were thawed and 27 underwent transfer to 25 patients. A single embryo was transferred to 23 patients and two embryos were transferred to two patients. The survival rate of the second thawing was 96.4% (27/28). Clinical pregnancy rate was 16% (4/25) and implantation rate was 14.8% (4/27). In the study group, pregnancies were achieved in 22 out of the 25 patients using IVF treatment, indicating good receptivity of the uterus. In the control group, the implantation/pregnancy rates were significantly higher (44.2% [23/52]; P < 0.01). CONCLUSION The transfer of twice slow-frozen and thawed embryos does not seem to be a beneficial approach in the planned management of cryopreserved surplus embryos owing to the low pregnancy rate achieved after transfer of the re-frozen blastocyst embryos.
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Affiliation(s)
- Jacob Farhi
- IVF Unit, Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Elizur
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; IVF Unit, Assuta Medical Center, Tel Aviv
| | | | - Daniel S Seidman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; IVF Unit, Assuta Medical Center, Tel Aviv
| | - Adrian Shulman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; IVF Unit, Assuta Medical Center, Tel Aviv
| | - Eyal Schiff
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; IVF Unit, Assuta Medical Center, Tel Aviv
| | - Raoul Orvieto
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan; Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
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Jackson J, Farhi J, Wheeler K, Rueb G, Thom C, Schenkman N. Retrospective Review of Acute Renal Colic Management in the Emergency Department and Review of Guidelines. Urology Practice 2018. [DOI: 10.1016/j.urpr.2017.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- J. Jackson
- Urology Department, University of Virginia, Charlottesville, Virginia
| | - J. Farhi
- Urology Department, University of Virginia, Charlottesville, Virginia
| | - K. Wheeler
- Urology Department, University of Virginia, Charlottesville, Virginia
| | - G. Rueb
- Department of Radiology & Medical Imaging, University of Virginia, Charlottesville, Virginia
| | - C. Thom
- Emergency Department, University of Virginia, Charlottesville, Virginia
| | - N. Schenkman
- Urology Department, University of Virginia, Charlottesville, Virginia
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Farhi J, Oron G, Orbach S, Levran D, Barkat J, Tzelnick S, Ben-Haroush A. A previous caesarean section is not a risk factor for tubal abnormalities in the infertile population. J OBSTET GYNAECOL 2018; 38:466-469. [PMID: 29405087 DOI: 10.1080/01443615.2017.1371680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In this retrospective cohort study of 1716 cases of women undergoing infertility treatment between the years 1999-2012, we aimed to identify whether parturients with a previous surgical history are at a higher risk for tubal abnormalities as determined by hysterosalpingography (HSG) in this infertile population. Amongst the study population, tubal obstruction was identified on HSG in 15.8% of patients with no past history of an abdominal surgery and 16.3% of patients with a previous caesarean section (CS) delivery. These rates were significantly lower than those for women with a previous gynaecological surgery (34.7%) or abdominal surgery (27%) (p < .001 for all comparisons). Our results suggest that past history of CS poses no additional risk for tubal abnormality within the infertile population, whereas a history of other abdominal or gynaecological surgical procedures doubles this risk. Impact Statement What is already known on this subject? While numerous risk factors for tubal factor infertility have been established, to date, the relation between previous abdominal surgeries and the risk for tubal factor infertility remains inconclusive. What the results of this study add? In this study, we aimed to evaluate the correlation between previous CS history and the risk for having tubal factor infertility. Our results demonstrated that previous caesarean section delivery does not increase the risk for tubal factor infertility in the infertile population, whereas history of other abdominal or gynaecological surgical procedures doubles this risk. What the implications are of these findings for clinical practice and/or further research? Further research is needed for further evaluation of this association and its clinical implications.
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Affiliation(s)
- Jacob Farhi
- a Fertility Clinics, Ashdod and Holon Women's Health Centers , Clalit Health Services , Ashdod and Holon , Israel.,b Department of Obstetrics and Gynecology, IVF Unit , Wolfson Medical Center , Holon , Israel.,c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Galia Oron
- c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,d Department of Obstetrics and Gynecology , Helen Schneider Hospital for Women, Rabin Medical Center , Petach Tikva , Israel
| | - Sharon Orbach
- c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,e Department of Anaesthesia , Rabin Medical Center , Petach Tikva , Israel
| | - David Levran
- b Department of Obstetrics and Gynecology, IVF Unit , Wolfson Medical Center , Holon , Israel.,c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Jonathan Barkat
- b Department of Obstetrics and Gynecology, IVF Unit , Wolfson Medical Center , Holon , Israel.,c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Sharon Tzelnick
- a Fertility Clinics, Ashdod and Holon Women's Health Centers , Clalit Health Services , Ashdod and Holon , Israel
| | - Avi Ben-Haroush
- c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,d Department of Obstetrics and Gynecology , Helen Schneider Hospital for Women, Rabin Medical Center , Petach Tikva , Israel
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Thom C, Warlaumont M, Farhi J, Jackson J, Schenkman N. 19 Collaborative Application of Guidelines Changes Imaging Utilization and Impacts Length of Stay in Acute Renal Colic. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.043] [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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Lande Y, Fisch B, Tsur A, Farhi J, Prag-Rosenberg R, Ben-Haroush A, Kessler-Icekson G, Zahalka MA, Ludeman SM, Abir R. Short-term exposure of human ovarian follicles to cyclophosphamide metabolites seems to promote follicular activation in vitro. Reprod Biomed Online 2016; 34:104-114. [PMID: 27815062 DOI: 10.1016/j.rbmo.2016.10.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [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: 05/16/2016] [Revised: 10/03/2016] [Accepted: 10/04/2016] [Indexed: 01/13/2023]
Abstract
How chemotherapy affects dormant ovarian primordial follicles is unclear. The 'burnout' theory, studied only in mice, suggests cyclophosphamide enhances primordial follicle activation. Using 4-hydroperoxycyclophosphamide (4hc) and phosphoramide mustard (PM), this study assessed how the active cyclophosphamide metabolites 4-hydroxycyclophosphamide (4-OHC) and PM, affect human primordial follicles. Frozen-thawed human ovarian samples were sliced and cultured with basic culture medium (cultured controls) or with 4hc/PM (3 µmol/l/10 µmol/l) (treated samples) for 24-48 h. Follicular counts and classification, Ki67 and anti-Müllerian hormone (AMH) immunohistochemistry and an apoptosis assay were used for evaluation, and 17β-oestradiol and AMH were measured in spent media samples. Generally, there was primordial follicle decrease and elevated developing follicle rates in treated samples compared with cultured (P = 0.04 to P < 0.0005) and uncultured controls (P < 0.05 to P < 0.0001). No traces of apoptosis were found. There were almost twicethe levels of AMH and 17β-oestradiol in treated compared with untreated samples (AMH with 4hc 3 µmol/l; P = 0.04). All follicles stained positively for AMHincluded treated samples. Ki67 positive staining was noted in all samples. Cyclophosphamide metabolites seem to enhance human primordial follicle activation to developing follicles, in vitro. Study findings support the 'burnout' theory as the mechanism of chemotherapy-induced ovarian toxicity.
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Affiliation(s)
- Yechezkel Lande
- Infertility and IVF Unit, Beilinson's Women Hospital, Rabin Medical Center Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Benjamin Fisch
- Infertility and IVF Unit, Beilinson's Women Hospital, Rabin Medical Center Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Abraham Tsur
- Infertility and IVF Unit, Beilinson's Women Hospital, Rabin Medical Center Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Obstetrics and Gynecology, The Chaim Sheba Medical, Ramat Gan, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Farhi
- Infertility and IVF Unit, Beilinson's Women Hospital, Rabin Medical Center Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Israel; IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roni Prag-Rosenberg
- Infertility and IVF Unit, Beilinson's Women Hospital, Rabin Medical Center Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Avi Ben-Haroush
- Infertility and IVF Unit, Beilinson's Women Hospital, Rabin Medical Center Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Gania Kessler-Icekson
- The Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Muayad A Zahalka
- The Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Susan M Ludeman
- Department of Basic and Social Sciences, Albany College of Pharmacy and Health Sciences, Albany, NY, USA
| | - Ronit Abir
- Infertility and IVF Unit, Beilinson's Women Hospital, Rabin Medical Center Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Israel.
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Ben-Haroush A, Farhi J, Zahalka Y, Sapir O, Meizner I, Fisch B. Correlations between antral follicle count and ultrasonographic ovarian parameters and clinical variables and outcomes in IVF cycles. Gynecol Endocrinol 2012; 28:432-5. [PMID: 22122694 DOI: 10.3109/09513590.2011.634935] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To assess the correlation between the antral follicle count (AFC) and other ultrasonographic parameters and clinical variables in in vitro fertilization (IVF) cycles. METHODS Pretreatment ultrasonographic evaluation included AFC (total), large (5-10 mm) and small (2-4 mm) antral follicles, ovarian volume, and ovarian Doppler indices. Data were prospectively uploaded and subsequently analysed in relation to IVF cycle results. RESULTS The study included 128 women (128 cycles). Analysis of body mass index (BMI) yielded a weak significant correlation with large (5-10 mm) AFC but not with other sonographic variables. AFC was significantly correlated with patient age, ovarian volume, number of retrieved oocytes, total dose of used gonadotropins, peak estradiol, number of top-quality embryos, and number of frozen embryos and marginally correlated with number of aspirated immature oocytes. Lower large (5-10 mm) AFC was the only ovarian parameter associated with oral contraception pretreatment compared to nontreatment, even after adjustment for age and BMI. There was no difference in any of the parameters between short and long IVF cycles. CONCLUSIONS BMI is only weakly correlated with AFC. Pretreatment with oral contraceptives may be associated with lower AFC. Pretreatment with gonadotropin-releasing hormone agonist (long protocol) does not alter the ultrasonographic ovarian parameters.
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Affiliation(s)
- Avi Ben-Haroush
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Campus, Petach Tikva, 49100, Israel.
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Farhi J, Sapir O, Maman M, Fisch B, Ben-Haroush A. Novel protocol for scheduling oocyte retrieval in IVM cycles in PCOS patients: a case series. Reprod Biomed Online 2011; 23:765-8. [DOI: 10.1016/j.rbmo.2011.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 08/01/2011] [Accepted: 08/02/2011] [Indexed: 10/17/2022]
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Ben-Haroush A, Farhi J, Ben-Aharon I, Sapir O, Pinkas H, Fisch B. High yield of oocytes without an increase in circulating estradiol levels in breast cancer patients treated with follicle-stimulating hormone and aromatase inhibitor in standard gonadotropin-releasing hormone analogue protocols. Isr Med Assoc J 2011; 13:753-756. [PMID: 22332446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Adjuvant/neoadjuvant chemotherapy in breast cancer patients may be associated with amenorrhea and a marked reduction in ovarian reserve. OBJECTIVES To assess the use of letrozole with follicle-stimulating hormone (FSH) in gonadotropin-releasing hormone (GnRH) analogue protocols, based on reported attempts to avoid the estradiol (E2) increase during controlled ovarian hyperstimulation for embryo cryopreservation in breast cancer patients using a combination of low dose FSH and aromatase inhibitor (letrozole) in a GnRH-antagonist protocol. METHODS Twenty-four breast cancer patients were treated with recombinant FSH (150-450 U/day) and letrozole (5 mg/day) in a long GnRH-agonist (n=7) or GnRH-antagonist (n=17) protocol. After oocyte retrieval, insemination and/ or intracytoplasmic sperm injection was performed. The embryos were frozen. RESULTS The average interval from surgery to oocyte retrieval was 40 days. Average duration of treatment was 9.6 days and mean peak E2 level 1342 +/- 1091 pmol/L, yielding 16.0 +/- 16.3 oocytes (range 0-82). Mean fertilization rate was 69.5 +/- 20.4% and mean number of embryos cryopreserved 10.3 +/- 9.3. More oocytes were retrieved with the long GnRH protocol, but the difference was not statistically significant (24.8 +/- 24.6 vs. 12.0 +/- 8.8 pmol/L, P = 0.07). CONCLUSIONS As previously reported, ovarian stimulation with letrozole and FSH, in both the long GnRH-agonist and GnRH-antagonist protocols, is apparently effective in breast cancer patients and spares them exposure to high E2 levels.
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Affiliation(s)
- Avi Ben-Haroush
- Infertility and IVF Unit, Department of Obstetrics & Gynecology, Schneider Hospital for Women, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
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Ben-Haroush A, Farhi J, Zahalka Y, Sapir O, Meizner I, Fisch B. Small antral follicle count (2-5 mm) and ovarian volume for prediction of pregnancy in in vitro fertilization cycles. Gynecol Endocrinol 2011; 27:748-52. [PMID: 21879794 DOI: 10.3109/09513590.2010.526668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To assess the value of antral follicle count (AFC) and other parameters as predictors of pregnancy in in vitro fertilization (IVF). METHODS In a cohort study, unselected consecutive women in IVF treatment were evaluated. Pretreatment parameters included AFC (subpopulations of small (2-5 mm) and large (5-10 mm) AFC), ovarian volume, and ovarian stroma Doppler indices. RESULTS The study included 115 women of whom 38 (33%) were pregnant. Total AFC was significantly higher in the pregnant than in the non-pregnant group (13.7 ± 5.8 vs. 11.3 ± 5.3, p = 0.034). On receiver operator characteristic (ROC) curve analysis, the pretreatment variables that were significantly associated with pregnancy were small AFC (2-5 mm), total AFC, and ovarian volume/AFC ratio. Women with a positive score (total AFC >15; small AFC (2-5 mm) >10; ovarian volume in mm(3)/AFC, <1400), had a significantly higher number of retrieved oocytes and a higher pregnancy rate than women with a negative score (12.1 ± 5.1 vs. 8.7 ± 5.0, p = 0.027 and 58.3% vs. 30.1%, p = 0.049, respectively). On multivariate logistic regression analysis, total AFC was the only significant and independent predictor of pregnancy (p = 0.034). CONCLUSION Pretreatment small AFC and ovarian volume may identify women with a higher probability to achieve pregnancy in IVF.
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Affiliation(s)
- Avi Ben-Haroush
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Oron G, Fisch B, Ao A, Zhang XY, Farhi J, Ben-Haroush A, Kesseler-Icekson G, Abir R. Erratum to “Expression of growth-differentiating factor 9 and its type 1 receptor in human ovaries” [Reprod. BioMed. Online 21 (2010) 109–117]. Reprod Biomed Online 2011. [DOI: 10.1016/j.rbmo.2010.09.005] [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: 11/30/2022]
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Farhi J, Ben-Haroush A. Distribution of causes of infertility in patients attending primary fertility clinics in Israel. Isr Med Assoc J 2011; 13:51-54. [PMID: 21446238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Infertility is one of the most prevalent health disorders in young adults. OBJECTIVES To study the distribution of causes of infertility in couples referred to primary infertility clinics in Israel. METHODS Data for a 9 year period were derived from two clinics of major women's hospitals run by the country's largest health insurance fund. All patients were treated by one physician. Laparoscopy was not performed to rule out endometriosis. RESULTS Of the 2515 couples identified, 1991 (79.2%) had a definitive diagnosis following complete workup (including hysterosalpingography). Mean age was 29.6 +/- 6.0 years; mean duration of infertility was 1.7 +/- 1.8 years. Primary infertility accounted for 65% of cases. Causes of infertility were male factor (45%), oligo-ovulation disorders (37%), and tubal damage (18%). Infertility factors were identified in the woman alone in 30.6% of cases and the man alone in 29.2%. Two combined infertility factors were found in 18% of patients, and three combined factors in 0.5%. The rate of unexplained infertility (which probably includes non-tubal endometriosis) was 20.7%. CONCLUSIONS As male factor accounts for almost half of all cases of infertility in couples, sperm analysis is mandatory before any treatment.
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Affiliation(s)
- Jacob Farhi
- Fertility Clinics, Women's Health Centers, Clalit Medical Services, Ashdod and Holon, Israel
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Farhi J, Ben-Haroush A, Andrawus N, Pinkas H, Sapir O, Fisch B, Ashkenazi J. Erratum to “High serum oestradiol concentrations in IVF cycles increase the risk of pregnancy complications related to abnormal placentation” [Reprod. BioMed. Online 21 (2010) 331–337]. Reprod Biomed Online 2011. [DOI: 10.1016/j.rbmo.2010.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Farhi J, Ben-Haroush A, Sapir O, Fisch B, Ashkenazi J. High-quality embryos retain their implantation capability in overweight women. Reprod Biomed Online 2010; 21:706-11. [PMID: 20880747 DOI: 10.1016/j.rbmo.2010.06.040] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 06/23/2010] [Accepted: 06/30/2010] [Indexed: 11/30/2022]
Abstract
To assess the effect of obesity on implantation rate, pregnancy rate and course of pregnancy in young women undergoing IVF in whom only high-quality embryos were transferred, a cohort study included women attending the IVF unit in 2006-2007 with favourable parameters to achieve pregnancy (<38years, fewer than three IVF cycles, transfer of two high-quality embryos), grouped by body mass index (BMI). Of 230 women, 160 had a BMI ⩽25kg/m(2) (mean 21.6±2.2) and 73 had BMI >25kg/m(2) (mean 29.5±3.7). The overweight group had a higher consumption of gonadotrophins during stimulation. There were no between-group differences in treatment protocols, duration of gonadotrophin stimulation, maximal oestradiol concentrations, endometrial thickness and number of oocytes retrieved/fertilized, or in rates of pregnancy (51.3%, 52.1%), implantation (34.5%, 37.5%), multiple pregnancy, and abortion. Rate of gestational diabetes or pregnancy-induced hypertension was higher in the overweight group (23.3%, 8.2%; P=0.045). Within the overweight group, those with multiple pregnancies were at highest risk (31.3%, 6.9%; P=0.031). In conclusion, implantation and pregnancy rates are not compromised in overweight women when high-quality embryos are transferred. However, in overweight women, pregnancy complications remain high, mainly in those with multiple pregnancies.
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Affiliation(s)
- Jacob Farhi
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100, Israel.
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Farhi J, Orvieto R, Gavish O, Homburg R. The association between follicular size on human chorionic gonadotropin day and pregnancy rate in clomiphene citrate treated polycystic ovary syndrome patients. Gynecol Endocrinol 2010; 26:546-8. [PMID: 20218821 DOI: 10.3109/09513591003686312] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine leading follicle size on human chorionic gonadotropin (hCG) day and pregnancy rate in anovulatory polycystic ovary syndrome (PCOS) patients treated with clomiphene citrate (CC). DESIGN Retrospective cohort study. SETTING Fertility clinics in women's health centers. PATIENTS Data on 291 infertile women with PCOS and irregular cycles who underwent 685 CC treatment cycles were used. Only cycles with one or two follicles >14 mm were included. hCG was administered once the leading follicle reached the size of 17-24 mm. MAIN OUTCOME MEASURE(S) Pregnancy rates in relation to leading follicle size. RESULTS Mono/bi-follicular response was observed in 418 cycles. Pregnancy rates were highest (13.6-18.6%) when hCG was administered in the presence of an 18-22 mm follicle, lowest with 17 mm, 23 mm and 24 mm (8.8%, 8.8% and 5.7%, respectively). No differences were observed in pregnancy rates between mono and bi-follicular cycles. CONCLUSIONS In CC treatment, hCG should be administered when follicular size is at the range of 18-22 mm.
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Affiliation(s)
- Jacob Farhi
- Fertility Clinics, Ashdod and Holon Women's Health Centers, Clalit Medical Services, Rabin Medical Center, Petach Tikva, Israel.
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Abstract
To evaluate the influence of female age and cause of infertility on the outcome of controlled ovarian hyperstimulation (COH) and intrauterine insemination (IUI), we studied 2717 COH cycles in 1035 subfertile couples. The cumulative clinical pregnancy rates were 39% and 58% after three and six COH cycles, respectively. The cumulative pregnancy rate significantly decreased with maternal age and differed by cause of infertility. The cumulative pregnancy rate continued to increase with an increase in COH cycle number up to the third, or forth cycle, in patients with mechanical and combined infertility, respectively, and in up to the second cycle in patients aged 40 years or more. These findings provide treatment guidelines for clinicians in determining the likelihood of treatment success and the point at which to proceed to the next treatment strategy.
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Affiliation(s)
- Jacob Farhi
- Fertility Clinics, Ashdod and Holon Women's Health Centers, Clalit Medical Services, Israel.
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Farhi J, Fisch B, Garor R, Peled Y, Pinkas H, Abir R. Neurotrophin 4 enhances in vitro follicular assembly in human fetal ovaries. Fertil Steril 2010; 95:1267-71. [PMID: 20447632 DOI: 10.1016/j.fertnstert.2010.03.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2009] [Revised: 03/08/2010] [Accepted: 03/16/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the in vitro effect of neurotrophin 4 (NT-4) on follicular assembly in human fetal ovaries. DESIGN Human ovarian tissue from fetuses at 19-20 gestational weeks was placed in organ culture for two weeks with NT-4. Control groups were cultured with a neutralizing antibody against NT-4. SETTING Infertility unit at an university-affiliated tertiary medical center. PATIENT(S) Four patients who underwent pregnancy terminations at 19-20 gestational weeks. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Histologic findings of follicular assembly. RESULT(S) Follicular assembly was significantly increased in the specimens cultured with NT-4 than in the uncultured specimens, the samples cultured without NT-4, and samples cultured with the neutralizing antibody. In the second week of culture, additional follicular assembly was promoted in the presence of 100 ng/mL NT-4 but not with 10 ng/mL NT-4. CONCLUSION(S) This is the first report showing that NT-4 seems to promote human follicular assembly in fetal ovaries, probably in a dose-dependent manner. Follicular assembly is regulated by multiple signals, and additional studies on the effects of other growth factors in combination with NT-4 are warranted.
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Affiliation(s)
- Jacob Farhi
- Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
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Farhi J, Ao A, Fisch B, Zhang XY, Garor R, Abir R. Glial cell line–derived neurotrophic factor (GDNF) and its receptors in human ovaries from fetuses, girls, and women. Fertil Steril 2010; 93:2565-71. [DOI: 10.1016/j.fertnstert.2009.09.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2009] [Revised: 09/23/2009] [Accepted: 09/23/2009] [Indexed: 10/20/2022]
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Farhi J, Ben-Haroush A, Haroush AB, Andrawus N, Pinkas H, Sapir O, Fisch B, Ashkenazi J. High serum oestradiol concentrations in IVF cycles increase the risk of pregnancy complications related to abnormal placentation. Reprod Biomed Online 2010; 21:331-7. [PMID: 20688571 DOI: 10.1016/j.rbmo.2010.04.022] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 04/09/2010] [Accepted: 04/13/2010] [Indexed: 10/19/2022]
Abstract
The study was designed to evaluate the isolated effect of high serum oestradiol concentration on human chorionic gonadotrophin (HCG) day in IVF cycles on endometrial receptivity and placentation. A retrospective cohort included all women attending the IVF unit in 2006 and 2007, with the best prognosis to achieve pregnancy: age (<38 years), less than three IVF cycles, transfer of two highest grade embryos and no evidence of factors known to impair implantation or that are associated with increased risk of pregnancy complications. The total included 280 patients were categorized into three groups according to their serum oestradiol concentration on HCG day: group 1, oestradiol <5000 pmol/l, group 2, oestradiol in the range 5000-10,000 pmol/l and group 3, oestradiol in the range of 10,000-15,000 pmol/l. No significant differences were found between the groups in implantation, pregnancy and abortion rates. The high oestradiol group was characterized by high rate (20.8%) of pregnancy complications related to abnormal placentation--fetal growth restriction, pregnancy-induced hypertension and abnormal implantation of the placenta. Hence, the decision to perform embryo transfer in high-responder patients should take into consideration both possible risks of ovarian hyperstimulation syndrome and pregnancy complications related to abnormal placentation.
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Affiliation(s)
- Jacob Farhi
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Beilinson Campus, Rabin Medical Center, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Oron G, Fisch B, Ao A, Zhang XY, Farhi J, Ben-Haroush A, Haroush AB, Kesseler-Icekson G, Abir R. Expression of growth-differentiating factor 9 and its type 1 receptor in human ovaries. Reprod Biomed Online 2010; 21:109-17. [PMID: 20427239 DOI: 10.1016/j.rbmo.2010.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 02/21/2010] [Accepted: 03/09/2010] [Indexed: 11/15/2022]
Abstract
The expression of growth-differentiating factor 9 (GDF9) has not been studied in ovaries from girls and human fetuses nor has its receptor transforming growth factor-beta1 receptor (TGFbetaR1) been investigated in ovaries of girls/women. The aim of this study was to fill these gaps. Ovarian samples were obtained from 16 human fetuses at 21-35 gestational weeks and from 34 girls/women aged 5-39years. These specimens were prepared for immunohistochemical staining of the GDF9 and TGFbetaR1 proteins. Reverse transcription polymerase chain reaction was used to detect GDF9 mRNA transcripts and in-situ hybridization to localize TGFbetaR1 mRNA transcripts. Positive staining for the GDF9 protein was identified in oocytes and granulosa cells in all samples tested. GDF9 mRNA transcripts were present in all samples. Protein expression of TGFbetaR1 was identified in granulosa cells in all samples. Oocyte staining was identified in samples from girls/women but in only one fetal sample. TGFbetaR1 mRNA transcripts were identified in granulosa cells and oocytes in 50% of the samples from fetuses aged over 22 gestational weeks and in samples from girls/women. The detection of GDF9 and TGFbetaR1 at both at the protein and mRNA levels suggests that GDF9 may have functions in human preantral follicles.
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Affiliation(s)
- Galia Oron
- Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva 49100, Israel
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Farhi J, Fisch B, Sapir O, Pinkas H, Ben-Haroush A. Effect of coasting on IVF cycle characteristics and outcome in short vs. long GnRH agonist protocols. Gynecol Endocrinol 2010; 26:187-92. [PMID: 20148740 DOI: 10.3109/09513590903015601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To compare the results of IVF cycles following coasting in patients treated with long versus short GnRH agonist protocols. METHODS A retrospective comparative study in which all women aged 35 years or less attending the IVF unit from 2000 to 2006 in whom coasting was used in GnRH agonist protocols were included. Data on coasting-related variables and outcome were collected from the files and compared between the short GnRH agonist (n = 78) and long GnRH agonist (n = 181) cycles. RESULTS The short GnRH agonist cycles were characterized by higher E2 levels during coasting and longer duration of coasting than the long GnRH agonist cycles. Although the number of retrieved oocytes was lower following coasting in the short protocol, there was no difference between the groups in fertilization rate, number of high-quality embryos available for transfer, and pregnancy rate. Pregnancy rate in both protocols was negatively correlated to E2 level at initiation of coasting. The overall moderate and severe OHSS rate after coasting was 5.1% in the short-protocol group and 6.0% in the long-protocol group (p = 0.76). CONCLUSIONS The ovarian response curve to coasting is longer in the short than in the long GnRH-agonist protocol, but there is no significant difference in pregnancy or OHSS rates.
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Affiliation(s)
- Jacob Farhi
- Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tiqwa, Israel
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Farhi J, Orvieto R, Homburg R. Administration of clomiphene citrate in patients with polycystic ovary syndrome, without inducing withdrawal bleeding, achieves comparable treatment characteristics and outcome. Fertil Steril 2009; 93:2077-9. [PMID: 19732872 DOI: 10.1016/j.fertnstert.2009.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 07/23/2009] [Accepted: 08/07/2009] [Indexed: 10/20/2022]
Abstract
In an attempt to evaluate the effect of random timing of the start of clomiphene citrate (CC) treatment in anovulatory patients with polycystic ovary syndrome on treatment characteristics and outcome, with no regard to time of menstruation, we studied 291 women in their first CC treatment cycle. Duration of treatment was shorter by 2 days and number of leading follicles was higher when treatment was started late (7-29 days from starting a bleed, as compared with day 5), but no effect of starting day was observed on response rate to CC, maximal E(2) level, endometrial thickness, and pregnancy rate.
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Affiliation(s)
- Jacob Farhi
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel.
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Farhi J, Ben-Haroush A, Lande Y, Sapir O, Pinkas H, Fisch B. In vitro fertilization cycle outcome after coasting in gonadotropin-releasing hormone (GnRH) agonist versus GnRH antagonist protocols. Fertil Steril 2009; 91:377-82. [DOI: 10.1016/j.fertnstert.2007.11.086] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Revised: 11/28/2007] [Accepted: 11/28/2007] [Indexed: 10/22/2022]
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Pinkas H, Sapir O, Avrech OM, Ben-Haroush A, Ashkenzi J, Fisch B, Farhi J. The effect of oral contraceptive pill for cycle scheduling prior to GnRH-antagonist protocol on IVF cycle parameters and pregnancy outcome. J Assist Reprod Genet 2008; 25:29-33. [PMID: 18205037 DOI: 10.1007/s10815-007-9189-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Accepted: 11/14/2007] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate the effect of oral contraceptive pills (OCP) pretreatment on IVF cycle outcome in GnRH-antagonist protocol. DESIGN Retrospective cohort study. SETTING Major tertiary university-affiliated center. PATIENTS All patients treated with GnRH antagonist in our IVF unit during the last 3 years were included in the study. Overall 1,799 IVF cycles were performed. Of these, in 604 cycles OCP pretreatment was used prior to GnRH-antagonist for cycle scheduling. Patients were divided into two age groups-young group aged < or = 35 years and older group aged > or = 36 years. INTERVENTIONS The young group underwent 927 cycles, 281 cycles with OCP pretreatment and 646 cycles without. The older group underwent 872 cycles, 323 cycles with OCP pretreatment and 549 cycles without. Data was analyzed within each age group. MAIN OUTCOME MEASURES Treatment duration and total dose of FSH IU used for stimulation, number of oocytes retrieved, implantation and pregnancy rates. RESULTS All OCP-pretreated cycles required significantly longer stimulation than non-pretreated cycles (young: 10.76 vs. 9.21 days; older: 10.48 vs. 8.73 days, respectively) and higher total dose of FSH IU (young: 3,210 IU vs. 2,565 IU; older: 4,973 IU vs. 3,983 IU, respectively). There were no other differences in cycle characteristics between groups. Implantation and pregnancy rates were not affected by OCP pretreatment. CONCLUSIONS OCP pretreatment can be offered as a mode for cycle scheduling prior to GnRH-antagonist protocol, though it may be associated with longer stimulation and higher gonadotropin consumption.
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Affiliation(s)
- Haim Pinkas
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Farhi J, Farhi J, Ben-Haroush A, Dresler H, Pinkas H, Sapir O, Fisch B. Male factor infertility, low fertilisation rate following ICSI and low number of high-quality embryos are associated with high order recurrent implantation failure in young IVF patientsa. Acta Obstet Gynecol Scand 2008; 87:76-80. [DOI: 10.1080/00016340701743074] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nitke S, Horowitz E, Farhi J, Krissi H, Shalev J. Combined intrauterine and twin cervical pregnancy managed by a new conservative modality. Fertil Steril 2007; 88:706.e1-3. [PMID: 17349638 DOI: 10.1016/j.fertnstert.2006.12.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 12/22/2006] [Accepted: 12/22/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe a rare case of a heterotopic pregnancy with two gestational sacs in the cervix and one in the uterine cavity. DESIGN Case report. SETTING Tertiary university hospital. PATIENT(S) A 45-year-old woman was diagnosed with a triplet gestation 7 weeks following IVF treatment for primary infertility of 5 years' duration. Transvaginal ultrasound scan revealed three gestational sacs: one sac inside the uterine cavity containing a live fetus, and two sacs in the uterine cervix, one containing a live fetus and a second empty sac. INTERVENTION(S) Pregnancy termination was performed by selective intraarterial catheterization of the uterine artery, intraarterial administration of methotrexate, and uterine artery embolization with Gelfoam. MAIN OUTCOME MEASURE(S) Intra- or postprocedural complications and fertility preservation. RESULT(S) The pregnancy termination was successfully performed without intra- or postprocedural complications, with preservation of the patient's fertility. CONCLUSION(S) Intraarterial methotrexate with uterine vessel embolization is an effective conservative approach to heterotopic cervical pregnancy.
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Affiliation(s)
- Shmuel Nitke
- The Helen Schneider Comprehensive Women's Health Center, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Farhi J, Fisch B. Risk of major congenital malformations associated with infertility and its treatment by extent of iatrogenic intervention. Pediatr Endocrinol Rev 2007; 4:352-7. [PMID: 17643083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Cumulative evidence from large cohort studies, multicenter studies, and meta-analyses suggests that assisted reproductive technologies are associated with an elevated risk of congenital malformations. Theoretically, there are several putative factors in infertility treatments which may be related to the development of congenital malformations. These include, in part, the exposure to gonadotrophin stimulation and the exposure to supra-physiological levels of E2; the altered physiological environment of implantation; the in-vitro culture conditions at early stages of embryonic development; the artificial selection of sperm for fertilization and the sperm injection process in ICSI and the process of embryo cryopreservation. However, it is also possible that the culprit is not the infertility treatment that leads to the increased risk of congenital malformations but a factor or factors inherent to infertile patients. OBJECTIVE The aim of this review is to present the current data, summarize it and define the association between major congenital malformation and different types of infertility treatments as well as to infertility per se. MATERIAL AND METHODS We conducted an extensive search of the medical literature (Pubmed, 1985-2006) to identify all data relating major congenital malformations to infertile couples, infertility treatments or to characteristics of the infertile population. The rates of congenital malformations associated with infertility were analyzed by the degree of iatrogenic intervention to better define the relative risks. RESULTS The findings confirmed the increased risk of congenital malformations in relation to in vitro fertilization even in singleton infants. There was no difference in the occurrence of major congenital malformations by either the laboratory maneuvers of sperm or embryos of varying complexity or by the specific medications used for ovarian stimulation or luteal support. Increased risk for congenital malformations was also found in infertile couples in relation to infertility treatment with ovulation induction with or without intrauterine insemination and even in spontaneous conception. CONCLUSIONS The data seems to indicate that infertile couples harbor an inherent, a priori risk for congenital malformations in their offspring. The risk increases in direct relation to the severity of infertility treatment in which the pregnancy was obtained. The question still remains if this direct relation reflects the severity of the infertility status of the couple or is related to an added value imposed by the infertility treatment.
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Affiliation(s)
- Jacob Farhi
- Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Abstract
With the gradual decline in the use of zygote intra-Fallopian transfer (ZIFT), current practice is to offer ZIFT almost exclusively to patients with repeated implantation failure (RIF). For practical reasons, the procedure is sometimes deferred by 1 day and embryo intra-Fallopian transfer (EIFT) is performed. The aim of the present study was to compare the reproductive outcome of ZIFT versus EIFT. In a retrospective analysis, 176 patients who failed in 7.65 +/- 3.7 previous IVF cycles underwent 200 ZIFT and 73 EIFT procedures. Implantation and live birth rates were compared for both groups. Patients in both groups were found comparable for demographic and clinical parameters. Similar numbers of oocytes were retrieved and fertilized in both groups, and 5.2 +/- 1.2 zygotes/embryos were transferred. Implantation and live birth rates (10.5 and 26.5% versus 10.9 and 24.7% for ZIFT and EIFT respectively) were comparable. It is concluded that tubal transfer of zygotes and day-2 cleavage stage embryos are equally effective.
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Affiliation(s)
- Ariel Weissman
- IVF Unit, Department of Obstetrics and Gynecology, Wolfson Medical Centre, Holon 58100.
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Farhi J, Ben-Haroush A, Dresler H, Sapir O, Fisch B. O-241. Fertil Steril 2006. [DOI: 10.1016/j.fertnstert.2006.07.275] [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: 11/30/2022]
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Farhi J, Ben-Haroush A, Weissman A, Nahum H, Levran D. P-750. Fertil Steril 2006. [DOI: 10.1016/j.fertnstert.2006.07.1136] [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: 10/24/2022]
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Weissman A, Eldar I, Farhi J, Ravhon A, Biran G, Levran D. Zygote Intrafallopian Transfer (ZIFT) in Patients With Repeated Implantation Failure: Ten Years Experience of a Single Center. Fertil Steril 2005. [DOI: 10.1016/j.fertnstert.2005.07.938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shalev J, Orvieto R, Farhi J, Bar-Hava I, Dekel A, Ben-Rafael Z. Diagnosis of ruptured fetal membranes in pregnancy with the use of urograffin. J OBSTET GYNAECOL 2004; 19:150-1. [PMID: 15512256 DOI: 10.1080/01443619965462] [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: 10/16/2022]
Abstract
The objective of our study was to assess the value of intraamniotic injection of urograffin in the diagnosis of premature rupture of membranes (PROM). Intra-amniotic injection of urograffin with the concomitant insertion of a vaginal tampon was performed in 30 consecutive patients who were admitted because of suspected PROM and the presence of a heavy bloody vaginal secretion. The vaginal tampons were X-rayed for the presence of radio-opacity. In 23 patients, traces of urograffin were found in the vaginal tampons by X-ray. No fetal or maternal complications were observed during delivery and puerperium. We suggest the use of intraamniotic injection of urograffin for the diagnosis of PROM in cases where heavy bloody vaginal discharge is present.
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Affiliation(s)
- J Shalev
- Department of Obstetrics and Gynaecology, Rabin Medical Centre, Petah Tiqva, Israel
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Farhi J, Weissman A, Nahum H, Steinfeld Z, Glezerman M, Levran D. Outcome of GnRH antagonist cycled in high responder patients undergoing IVF. Fertil Steril 2003. [DOI: 10.1016/s0015-0282(03)01413-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Levran D, Zahalka N, Malinger G, Farhi J, Glezerman M, Weissman A. Junctional zone contractions during zygote intrafallopian transfer. Fertil Steril 2003. [DOI: 10.1016/s0015-0282(03)01954-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Zahalka N, Weissman A, Farhi J, Malinger G, Glezerman M, Levran D. Adverse IVF outcome with increased junctional zone contractions frequency on the day of hCG administration. Fertil Steril 2003. [DOI: 10.1016/s0015-0282(03)01819-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Malinger G, Zahalka N, Weissman A, Farhi J, Glezerman M, Levran D. Junctional zone contractions in natural and stimulated cycles. Fertil Steril 2003. [DOI: 10.1016/s0015-0282(03)01523-1] [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: 11/30/2022]
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Weissman A, Farhi J, Royburt M, Nahum H, Glezerman M, Levran D. Prospective evaluation of two stimulation protocols for low responders who were undergoing in vitro fertilization-embryo transfer. Fertil Steril 2003; 79:886-92. [PMID: 12749425 DOI: 10.1016/s0015-0282(02)04928-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare two stimulation protocols designed for low responders undergoing IVF. DESIGN Randomized, prospective study. SETTING University hospital IVF unit. PATIENT(S) Sixty low responders who were recruited on the basis of results in previous cycles. INTERVENTION(S) Modified flare protocol in which a high dose of GnRH agonist was administered for the first 4 days, followed by a standard agonist dose, or a modified long protocol in which a standard agonist dose was used until pituitary down-regulation, after which the agonist dose was halved during stimulation. MAIN OUTCOME MEASURE(S) Number of oocytes retrieved. RESULT(S) Twenty-nine cycles were performed with the modified flare protocol and 31 were performed with the modified long protocol. Significantly more oocytes were obtained with the modified long protocol than the modified flare protocol (4.42 +/- 2.6 vs. 3.07 +/- 2.15). The number and quality of embryos available for transfer was similar in both groups. One clinical pregnancy (3.4%) was achieved with the modified flare protocol, and 7 pregnancies (22.5%) were achieved using the modified long protocol. CONCLUSION(S) These preliminary results substantiate the poor prognosis and outcome for low responders undergoing IVF. A modified long "mini-dose" protocol appears to be superior to a modified mega-dose flare protocol in terms of oocyte yield and cycle outcome.
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Affiliation(s)
- Ariel Weissman
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.
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