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Engmann L, Hallisey S, Bartolucci A. "Walking on eggshells": will PIEZO-intracytoplasmic sperm injection emerge as a new standard for penetrating the PIEZona pellucida? Fertil Steril 2024:S0015-0282(24)00243-7. [PMID: 38616034 DOI: 10.1016/j.fertnstert.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Affiliation(s)
- Lawrence Engmann
- The Center for Advanced Reproductive Services, Farmington, Connecticut; and Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut.
| | - Stephanie Hallisey
- The Center for Advanced Reproductive Services, Farmington, Connecticut; and Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Alison Bartolucci
- The Center for Advanced Reproductive Services, Farmington, Connecticut; and Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut
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Godiwala P, Kwieraga J, Almanza E, Neuber E, Grow D, Benadiva C, Makhijani R, DiLuigi A, Schmidt D, Bartolucci A, Engmann L. The impact of microfluidics sperm processing on blastocyst euploidy rates compared with density gradient centrifugation: a sibling oocyte double-blinded prospective randomized clinical trial. Fertil Steril 2024:S0015-0282(24)00109-2. [PMID: 38367686 DOI: 10.1016/j.fertnstert.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE To compare the euploidy rates among blastocysts created from sibling oocytes injected with sperm and processed using microfluidics or density gradient centrifugation. DESIGN Sibling oocyte randomized controlled trial. SETTING Single university-affiliated infertility practice. PATIENTS A total of 106 patients aged 18-42 years undergoing fresh in vitro fertilization treatment cycles with preimplantation genetic testing between January 2021 and April 2022 contributed 1,442 mature oocytes, which were injected with sperm and processed using microfluidics or density gradient centrifugation. INTERVENTION(S) The sperm sample is divided and processed using a microfluidics device and density gradient centrifugation for injection into sibling oocytes. MAIN OUTCOME MEASURE(S) The primary outcome was the embryo euploidy rate. Secondary outcomes included fertilization, high-quality blastulation, and ongoing pregnancy rates. RESULT(S) The blastocyst euploidy rate per mature oocyte was not significantly different in the study group compared with the control group (22.9% vs. 20.5%). The blastocyst euploidy rate per biopsied embryo was also similar between the 2 groups (53.0% vs. 45.7%). However, the fertilization rate per mature oocyte injected was found to be significantly higher in the study group compared with the control group (76.0% vs. 69.9%). The high-quality blastulation rate per mature oocyte injected was similar between the 2 groups, as was the total number of embryos frozen. There were no differences in the number of participants with no blastocysts for biopsy or the number of participants with no euploid embryos between the 2 groups. Among the male factor infertility and recurrent pregnancy loss subgroups, there were no differences in euploidy rates, fertilization rates, blastulation rates, or total numbers of blastocysts frozen, although the study was underpowered to detect these differences. Seventy-seven patients underwent frozen embryo transfer; there were no significant differences in pregnancy outcomes between the 2 groups. CONCLUSION(S) Microfluidics processing did not improve embryo euploidy rates compared with density gradient centrifugation in this sibling oocyte study, although fertilization rates were significantly higher. CLINICAL TRIAL REGISTRATION NUMBER NCT04744025.
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Affiliation(s)
- Prachi Godiwala
- The Center for Advanced Reproductive Services, Farmington, Connecticut; Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Jane Kwieraga
- The Center for Advanced Reproductive Services, Farmington, Connecticut
| | - Emilse Almanza
- Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Evelyn Neuber
- The Center for Advanced Reproductive Services, Farmington, Connecticut
| | - Daniel Grow
- The Center for Advanced Reproductive Services, Farmington, Connecticut; Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Claudio Benadiva
- The Center for Advanced Reproductive Services, Farmington, Connecticut; Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Reeva Makhijani
- The Center for Advanced Reproductive Services, Farmington, Connecticut; Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Andrea DiLuigi
- The Center for Advanced Reproductive Services, Farmington, Connecticut; Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut
| | - David Schmidt
- The Center for Advanced Reproductive Services, Farmington, Connecticut; Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Alison Bartolucci
- The Center for Advanced Reproductive Services, Farmington, Connecticut; Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Lawrence Engmann
- The Center for Advanced Reproductive Services, Farmington, Connecticut; Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut.
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Koniares K, Benadiva C, Engmann L, Nulsen J, Grow D. Macroprolactinemia: a mini-review and update on clinical practice. F S Rep 2023; 4:245-250. [PMID: 37719092 PMCID: PMC10504566 DOI: 10.1016/j.xfre.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/13/2023] [Accepted: 05/18/2023] [Indexed: 09/19/2023] Open
Abstract
Hyperprolactinemia is common among infertile patients, with up to 15%-20% of women with oligomenorrhea having hyperprolactinemia. Suppression of the hypothalamic-pituitary-gonadal axis via inhibition of pulsatile gonadotropin releasing hormone because of hyperprolactinemia is a common endocrine etiology of infertility. There are 3 forms of human prolactin (PRL): monomeric PRL, dimeric PRL, and macro-PRL. Also known as big-big PRL, macro-PRL has a molecular weight >150 kDa and normally comprises 5%-10% of circulating PRL. When the predominant form of circulating PRL is macro-PRL, macroprolactinemia is diagnosed. Among patients with hyperprolactinemia, 10%-46% have macroprolactinemia. Patients with macroprolactinemia are at risk of unnecessary pituitary imaging and treatment with dopamine agonists if not correctly diagnosed. Given the high prevalence of macroprolactinemia among patients with elevated PRL levels and the different management of patients with macroprolactinemia vs true monomeric hyperprolactinemia, all patients with persistently elevated PRL levels should be screened for macro-PRL.
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Affiliation(s)
- Katherine Koniares
- The Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Claudio Benadiva
- The Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Lawrence Engmann
- The Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut
| | - John Nulsen
- The Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Daniel Grow
- The Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut
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Hallisey S, Makhijani R, Thorne J, Godiwala P, Nulsen J, Benadiva C, Grow D, Engmann L. The association of obesity with euploidy rates in women undergoing in vitro fertilization with preimplantation genetic testing. J Assist Reprod Genet 2022; 39:2521-2528. [PMID: 36214982 PMCID: PMC9723054 DOI: 10.1007/s10815-022-02624-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/17/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose of this study was to determine the impact of body mass index (BMI) on euploidy rates for in vitro fertilization (IVF) cycles with preimplantation genetic testing (PGT) utilizing primarily next-generation sequencing (NGS). METHODS This retrospective cohort study included women aged ≤ 45 years who underwent IVF/PGT between September 2013 and September 2020 at a single university-affiliated fertility center. The primary outcome was euploidy rate. Secondary outcomes included peak serum estradiol (E2), number of oocytes retrieved, oocyte maturation rate, high-quality blastulation rate, clinical loss rate (CLR), clinical pregnancy rate (CPR), and ongoing pregnancy/live birth rate (OPR/LBR). RESULTS The study included 1335 IVF cycles that were stratified according to BMI (normal, n = 648; overweight, n = 377; obese, n = 310). The obese group was significantly older with significantly lower baseline FSH, peak E2, high-quality blastulation rate, and number of embryos biopsied than the normal group. Overall euploidy rates were not significantly different between BMI groups (normal 36.4% ± 1.3; overweight 37.3% ± 1.8; obese 32.3% ± 1.8; p = 0.11), which persisted after controlling for covariates (p = 0.82) and after stratification of euploidy rate by age group and by number of oocytes retrieved per age group. There were no significant differences in CLR, CPR, and OPR/LBR across BMI groups. CONCLUSIONS Despite a lower high quality blastulation rate with obesity, there is not a significant difference in euploidy rates across BMI groups in women undergoing IVF/PGT.
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Affiliation(s)
- Stephanie Hallisey
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology & Infertility, University of Connecticut Health Center, 2 Batterson Park Rd, Farmington, CT, 06032, USA
| | - Reeva Makhijani
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology & Infertility, University of Connecticut Health Center, 2 Batterson Park Rd, Farmington, CT, 06032, USA
| | - Jeffrey Thorne
- Reproductive Medicine Associates of Philadelphia, 1015 Chestnut Street, 8th Floor, Philadelphia, PA, 19107, USA
| | - Prachi Godiwala
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology & Infertility, University of Connecticut Health Center, 2 Batterson Park Rd, Farmington, CT, 06032, USA
| | - John Nulsen
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology & Infertility, University of Connecticut Health Center, 2 Batterson Park Rd, Farmington, CT, 06032, USA
| | - Claudio Benadiva
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology & Infertility, University of Connecticut Health Center, 2 Batterson Park Rd, Farmington, CT, 06032, USA
| | - Daniel Grow
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology & Infertility, University of Connecticut Health Center, 2 Batterson Park Rd, Farmington, CT, 06032, USA
| | - Lawrence Engmann
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology & Infertility, University of Connecticut Health Center, 2 Batterson Park Rd, Farmington, CT, 06032, USA.
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White K, Godiwala PN, Makhijani RB, Bartolucci A, Nulsen J, Benadiva CA, Engmann L, Grow DR. DOES AGE MATTER WITH NATURAL CYCLE FROZEN-THAWED EMBRYO TRANSFER (FET) AFTER PREIMPLANTATION GENETIC TESTING FOR ANEUPLOIDY (PGT-A). Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Koniares K, Grow DR, Nulsen J, Benadiva CA, Engmann L. DAY OF SURGE HORMONAL PARAMETERS AS PREDICTORS OF OUTCOME IN NATURAL FROZEN-THAWED EMBRYO TRANSFER (FET) CYCLES – THE WINDOW OF IMPLANTATION IS WIDE. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.770] [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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Godiwala P, Kwieraga J, Neuber E, Yohe MS, Bartolucci A, Engmann L. Rationale and study design of a double-blinded prospective randomized clinical trial comparing euploidy rates among embryos created from sibling oocytes injected with sperm processed by microfluidics or by density gradient centrifugation. Contemp Clin Trials 2022; 120:106893. [PMID: 36007710 DOI: 10.1016/j.cct.2022.106893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND During the in vitro fertilization (IVF) process, sperm must be processed prior to insemination. While the most common method, density gradient centrifugation, can potentially damage sperm during centrifugation, a recent advancement in sperm processing uses a microfluidics system which selects for the most highly motile sperm. In selecting for these sperm which may be of higher quality, the euploidy rates of embryos created as a result may also be improved. The primary aim of this study is to compare the euploidy rates per mature oocyte between embryos created from sibling oocytes injected with sperm processed by microfluidics sorting or by density gradient centrifugation. METHODS This is a double-blinded prospective randomized sibling oocyte study including patients undergoing treatment with IVF with intracytoplasmic sperm injection (ICSI) and preimplantation genetic testing (PGT). After controlled ovarian hyperstimulation, oocytes from each patient will be separated into two groups. Each group will be randomized to sperm processed using either microfluidics or density gradient centrifugation and embryos biopsied for PGT to assess euploidy rates. A sample size of 686 oocytes in each group for a total of 1372 oocytes will provide 80% power to detect a significant difference in the euploidy rates per mature oocyte between the two groups. An ancillary study examining the relationship between sperm processing method and sperm DNA fragmentation will be assessed. CONCLUSION This study will offer insight into the sperm's contribution to embryo euploidy, and has the potential to provide an alternative method of improving euploidy rates in clinical practice.
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Affiliation(s)
- Prachi Godiwala
- The Center for Advanced Reproductive Services, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, CT 06032, United States of America
| | - Jane Kwieraga
- The Center for Advanced Reproductive Services, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, CT 06032, United States of America
| | - Evelyn Neuber
- The Center for Advanced Reproductive Services, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, CT 06032, United States of America
| | - Michael Scott Yohe
- The Center for Advanced Reproductive Services, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, CT 06032, United States of America
| | - Alison Bartolucci
- The Center for Advanced Reproductive Services, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, CT 06032, United States of America
| | - Lawrence Engmann
- The Center for Advanced Reproductive Services, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, CT 06032, United States of America.
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Makhijani R, Godiwala P, Grady J, Christy A, Thornton K, Grow D, Engmann L. Black race associated with lower live birth rate in frozen-thawed blastocyst transfer cycles: an analysis of 7,002 Society for Assisted Reproductive Technology frozen-thawed blastocyst transfer cycles. Fertil Steril 2021; 117:360-367. [PMID: 34933762 DOI: 10.1016/j.fertnstert.2021.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate if racial/ethnic differences in pregnancy outcomes persisted in frozen-thawed embryo transfer (FET) cycles on a national level. DESIGN Retrospective cohort study. SETTING Clinic-based data. PATIENT(S) A total of 189,000 Society for Assisted Reproductive Technology FET cycles from 2014-2016 were screened, of which 12,000 cycles had available fresh cycle linkage information and ultimately, because of missing data, 7,002 FET cycles were included. Cycles were stratified by race (White, Black, Asian, and Hispanic). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The primary outcome was live birth rate. Secondary outcomes were implantation rate, clinical pregnancy rate, multiple pregnancy rate, and clinical loss rate (CLR). RESULT(S) Live birth rate was significantly lower in the Black vs. White and Asian, but not Hispanic group. Implantation rate was also significantly lower and CLR higher in the Black group compared with all other groups (all P<.01). Black women had a lower risk of live birth (adjusted risk ratio, 0.82; 95% confidence interval [CI], 0.73-0.92) and a higher risk of clinical loss (adjusted risk ratio, 1.59; 95% CI, 1.28-1.99) compared with White women. There was no significant difference between groups in clinical pregnancy rate or multiple pregnancy rate. When the analysis was limited to preimplantation genetic testing FET cycles, there remained a significantly lower implantation rate in the Black group compared with all other groups (all P<.01). CONCLUSION(S) Black race remains an independent predictor of reduced live birth rate in FET cycles, likely because of higher CLR.
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Affiliation(s)
- Reeva Makhijani
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Prachi Godiwala
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut
| | - James Grady
- University of Connecticut Health Center, Department of Public Health Sciences, Farmington, Connecticut
| | | | | | - Daniel Grow
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Lawrence Engmann
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, Connecticut.
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Marinelli A, Godiwala PN, Grow DR, Benadiva CA, Engmann L, Nulsen J. DOES A HIGH DOSE PROGESTERONE (P) PROTOCOL IMPROVE PREGNANCY OUTCOMES COMPARED TO A STANDARD DOSE P PROTOCOL IN POOR PROGNOSIS PATIENTS UNDERGOING PROGRAMMED FROZEN-THAWED EMBRYO TRANSFER (FET) CYCLES? Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.692] [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: 10/20/2022]
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Godiwala PN, Akhundzadeh KR, Taggar A, Makhijani RB, David SW, Benadiva CA, Nulsen J, Grow DR, Engmann L. ADDITION OF SUPPLEMENTAL ESTRADIOL (E) AND/OR INCREASING PROGESTERONE (P) DOSE ON THE DAY OF EMBRYO TRANSFER (ET) DOES NOT IMPROVE PREGNANCY OUTCOMES IN NATURAL FROZEN-THAWED EMBRYO TRANSFER (FET) IN VITRO FERTILIZATION (IVF) CYCLES. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hallisey SM, Makhijani RB, Godiwala PN, Taggar A, Bartolucci A, DiLuigi A, Nulsen J, Grow DR, Benadiva CA, Engmann L. BLASTULATION AND EUPLOIDY RATES IN NORMAL AND LOW RESPONDERS AFTER GONADOTROPIN-RELEASING HORMONE AGONIST (GNRHA) TRIGGER. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.626] [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: 11/27/2022]
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Godiwala PN, Taggar A, Makhijani RB, Engmann L, Benadiva CA, DiLuigi A. PRIMARY OMENTAL ECTOPIC PREGNANCY AFTER FROZEN-THAWED SINGLE EMBRYO TRANSFER: A CASE REPORT AND REVIEW OF THE LITERATURE. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.1147] [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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Makhijani R, Bartels CB, Godiwala P, Bartolucci A, DiLuigi A, Nulsen J, Grow D, Benadiva C, Engmann L. Impact of trophectoderm biopsy on obstetric and perinatal outcomes following frozen-thawed embryo transfer cycles. Hum Reprod 2021; 36:340-348. [PMID: 33313768 DOI: 10.1093/humrep/deaa316] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [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: 05/09/2020] [Revised: 10/19/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Does trophectoderm biopsy for preimplantation genetic testing (PGT) increase the risk of obstetric or perinatal complications in frozen-thawed embryo transfer (FET) cycles? SUMMARY ANSWER Trophectoderm biopsy may increase the risk of hypertensive disorders of pregnancy (HDP) in pregnancies following FET cycles. WHAT IS KNOWN ALREADY Trophectoderm biopsy has replaced blastomere biopsy as the standard of care to procure cells for PGT analysis. Recently, there has been concern that trophectoderm biopsy may adversely impact obstetric and perinatal outcomes. Previous studies examining this question are limited by use of inappropriate control groups, small sample size or reporting on data that no longer reflects current IVF practice. STUDY DESIGN, SIZE, DURATION This was a retrospective cohort study conducted at a single university-affiliated fertility center. A total of 756 patients who underwent FET with transfer of previously vitrified blastocysts that had either trophectoderm biopsy or were unbiopsied and resulted in a singleton live birth between 2013 and 2019 were included. PARTICIPANTS/MATERIALS, SETTING, METHODS Obstetric and perinatal outcomes for patients aged 20-44 years who underwent FET with transfer of previously vitrified blastocysts that were either biopsied (n = 241) or unbiopsied (n = 515) were analyzed. Primary outcome was odds of placentation disorders including HDP and rate of fetal growth restriction (FGR). Binary logistic regression was performed to control for potential covariates. MAIN RESULTS AND THE ROLE OF CHANCE The biopsy group was significantly older, had fewer anovulatory patients, was more often nulliparous and had fewer embryos transferred compared to the unbiopsied group. After controlling for potential covariates, the probability of developing HDP was significantly higher in the biopsy group compared with unbiopsied group (adjusted odds ratio (aOR) 1.943, 95% CI 1.072-3.521; P = 0.029).There was no significant difference between groups in the probability of placenta previa or placenta accreta. There was also no significant difference in the rate of FGR (aOR 1.397; 95% CI, 0.815-2.395; P = 0.224) or the proportion of low (aOR 0.603; 95% CI, 0.336-1.084; P = 0.091) or very low (aOR 2.948; 95% CI, 0.613-14.177; P = 0.177) birthweight infants comparing biopsied to unbiopsied groups. LIMITATIONS, REASON FOR CAUTION This was a retrospective study performed at a single fertility center, which may limit the generalizability of our findings. WIDER IMPLICATIONS OF THE FINDINGS Trophectoderm biopsy may increase the risk of HDP in FET cycles, however, a prospective multicenter randomized trial should be performed to confirm these findings. STUDY FUNDING/COMPETING INTEREST(S) No specific funding was obtained for this study. The authors declare no conflict of interest. TRIAL REGISTRATION NUMBER NA.
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Affiliation(s)
- Reeva Makhijani
- Division of Reproductive Endocrinology and Infertility, Center for Advanced Reproductive Services, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Chantal Barbara Bartels
- Division of Reproductive Endocrinology and Infertility, Center for Advanced Reproductive Services, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Prachi Godiwala
- Division of Reproductive Endocrinology and Infertility, Center for Advanced Reproductive Services, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Alison Bartolucci
- Division of Reproductive Endocrinology and Infertility, Center for Advanced Reproductive Services, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Andrea DiLuigi
- Division of Reproductive Endocrinology and Infertility, Center for Advanced Reproductive Services, University of Connecticut School of Medicine, Farmington, CT, USA
| | - John Nulsen
- Division of Reproductive Endocrinology and Infertility, Center for Advanced Reproductive Services, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Daniel Grow
- Division of Reproductive Endocrinology and Infertility, Center for Advanced Reproductive Services, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Claudio Benadiva
- Division of Reproductive Endocrinology and Infertility, Center for Advanced Reproductive Services, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Lawrence Engmann
- Division of Reproductive Endocrinology and Infertility, Center for Advanced Reproductive Services, University of Connecticut School of Medicine, Farmington, CT, USA
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Engmann L, Sun F, Legro RS, Diamond MP, Zhang H, Santoro N. Factors associated with study protocol adherence and bio banking participation in reproductive medicine clinical trials and their relationship to live birth. Hum Reprod 2021; 35:2819-2831. [PMID: 33190149 DOI: 10.1093/humrep/deaa232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/14/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What demographic and baseline characteristics are predictive of adherence to reproductive medicine clinical trial protocols, live birth or participation in genetic studies? SUMMARY ANSWER Race, BMI and lower income are associated with likelihood of non-adherent to reproductive medicine clinical trial protocols, while race influences collection of biological samples and non-adherent to study protocols is associated with lower probability of live birth. WHAT IS KNOWN ALREADY Although aspects of adherence to study protocol have previously been evaluated as individual factors in infertile women, the factors that affect overall non-adherent to study protocol have not been previously evaluated. STUDY DESIGN, SIZE, DURATION A secondary data analysis of 1650 participants from two prospective multicenter, double-blind controlled studies was carried out: Pregnancy in Polycystic Ovary Syndrome II (PPCOS II) and Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS). PARTICIPANTS/MATERIALS, SETTING, METHODS The participants were women aged 18-40 years old with either polycystic ovary syndrome (PCOS) with ovulatory dysfunction in combination with either hyperandrogenemia and/or polycystic ovarian morphology (PPCOS II), or regular ovulatory cycles with unexplained infertility (AMIGOS). The study was carried out in 14 clinical sites in the USA. Non-adherence to clinical trial protocol was chosen as the primary outcome for this analysis. To evaluate whether demographic and baseline characteristics were predictive of adherence to study protocols, live birth or participation in blood sampling for DNA and repository, and pregnancy registry, these putative factors were compared between the outcome measures. Logistic regression was used to establish a prediction model using the putative predictors introduced above. MAIN RESULTS AND THE ROLE OF CHANCE Women who self-identified as African American or Asian and those with higher BMI and lower household income were less likely to adhere to protocol. Non-adherence to the study protocol was associated with a lower probability of live birth (odds ratio: 0.180, 95% CI: 0.120, 0.272, P < 0.001). African Americans or Asians were less likely to participate in optional study DNA collection compared to Whites. Participants who were African American or with high annual income or from the Southwest sites or had PCOS were less likely to participate in the blood repository studies. LIMITATIONS, REASONS FOR CAUTION Race and ethnicity were self-reported and such self-classification to strict race and ethnicity may not always be representative of a whole racial or ethnic group. This study included two US multicenter trials and therefore the findings may not be extrapolated to international trials. WIDER IMPLICATIONS OF THE FINDINGS Identification of populations with low participation is an important initial step, as further investigation can develop specific measures to improve adherence to study protocols and participation in biospecimen banking and thereby extend the representativeness of reproductive medicine clinical trial findings. STUDY FUNDING/COMPETING INTEREST(S) Supported by NIH Eunice Kennedy Shriver NICHD Grants: U10 HD39005, U10 HD38992, U10 HD27049, U10 HD38998, U10 HD055942, HD055944, U10 HD055936, U10HD055925, PPCOSII: U10 HD27049, U10 HD38992, U10 HD055925, U10 HD39005, U10 HD38998, U10 HD055936, U10 HD055942, U10 HD055944; Clinical Reproductive Endocrine Scientist Training Program (CREST): R25HD075737. Outside this study, M.P.D. received NIH/NIHCD research grant and R.S.L. received research grant from Ferring and was consultant for Bayer, Kindex, Odega, Millendo and AbbVie. TRIAL REGISTRATION NUMBER ClinicalTrials.gov number: NCT00719186; NCT01044862.
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Affiliation(s)
- Lawrence Engmann
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Fangbai Sun
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA, USA
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA, USA
| | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
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Makhijani R, Coulter M, Taggar A, Godiwala P, O'Sullivan D, Nulsen J, Engmann L, Benadiva C, Grow D. Reduction in multiple pregnancy rate in donor oocyte-recipient gestational carrier (GC) in vitro fertilization (IVF) cycles in the USA with single-embryo transfer and preimplantation genetic testing. J Assist Reprod Genet 2021; 38:1441-1447. [PMID: 33709344 DOI: 10.1007/s10815-021-02112-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To evaluate the utilization of single-embryo transfer (SET) and preimplantation genetic testing (PGT) in gestational carrier IVF cycles in the USA with donor oocyte and examine the impact on live birth and multiple gestation. METHODS Retrospective cohort study using the Society of Assisted Reproductive Technology (SART) clinic database of 4776 donor oocyte-recipient IVF cycles in which a GC was used. The cycles were separated into 4 groups by use of PGT and number of embryos transferred as follows: (1) PGT and single-embryo transfer (PGT-SET); (2) PGT and multiple embryo transfer (PGT-MET); (3) no PGT and SET (NoPGT-SET); (4) no PGT and MET (NoPGT-MET). Primary outcomes were live birth rate (LBR) and multiple pregnancy rate (MPR). RESULTS More than one blastocyst was transferred in 48.7% (2323/4774) of the cycles. When ≥1 blastocyst was transferred, with or without the use of PGT, the MPR was 45.5% and 42.0%, respectively. In comparison, in the PGT-SET and NoPGT-SET groups, the MPR was 1.4% (8/579) and 3.3% (29/883), respectively. Live birth rates increased with the use of PGT-A and with MET. CONCLUSION This study shows that SET, with or without PGT, is associated with a significantly reduced MPR in donor oocyte-recipient GC IVF cycles while maintaining high LBR. It also demonstrates that many infertility centers in the USA are not adhering to ASRM embryo transfer guidelines. Our findings highlight an opportunity to increase GC safety, which ultimately may lead to widened access to this increasingly restricted service outside the USA.
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Affiliation(s)
- Reeva Makhijani
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, 2 Batterson Park Road, Farmington, CT, 06032, USA
| | - Madeline Coulter
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, 2 Batterson Park Road, Farmington, CT, 06032, USA
| | - Arti Taggar
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, 2 Batterson Park Road, Farmington, CT, 06032, USA
| | - Prachi Godiwala
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, 2 Batterson Park Road, Farmington, CT, 06032, USA
| | - David O'Sullivan
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, 2 Batterson Park Road, Farmington, CT, 06032, USA
| | - John Nulsen
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, 2 Batterson Park Road, Farmington, CT, 06032, USA
| | - Lawrence Engmann
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, 2 Batterson Park Road, Farmington, CT, 06032, USA
| | - Claudio Benadiva
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, 2 Batterson Park Road, Farmington, CT, 06032, USA
| | - Daniel Grow
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, 2 Batterson Park Road, Farmington, CT, 06032, USA.
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Godiwala PN, Makhijani RB, Bartels C, Bartolucci A, Grow DR, Nulsen J, Benadiva CA, Engmann L. PREGNANCY OUTCOMES IN LETROZOLE OVULATION INDUCTION FROZEN-THAWED EMBRYO TRANSFER CYCLES AS COMPARED TO NATURAL AND PROGRAMMED CYCLES. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.791] [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: 11/24/2022]
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Schmidt AR, Godiwala PN, Makhijani RB, Bartels C, Nulsen J, Benadiva CA, Grow DR, Engmann L. EFFECT OF BODY MASS INDEX (BMI) ON PREGNANCY OUTCOMES IN FROZEN-THAWED BLASTOCYST TRANSFER (FET) CYCLES. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.1390] [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: 11/26/2022]
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Hallisey SM, Makhijani RB, Thorne J, Godiwala PN, Nulsen J, Benadiva CA, Grow DR, Engmann L. THE EFFECT OF OBESITY ON EUPLOIDY RATES IN WOMEN UNDERGOING IN VITRO FERTILIZATION (IVF) WITH PREIMPLANTATION GENETIC TESTING (PGT). Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.322] [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: 10/23/2022]
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Makhijani RB, Christy AY, Godiwala PN, Thornton KL, Grow DR, Engmann L. BLACK RACE RESULTS IN LOWER LIVE BIRTH RATE (LBR) IN FROZEN-THAWED BLASTOCYST TRANSFER CYCLES (FET): AN ANALYSIS OF 7,002 SART FET CYCLES. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Godiwala PN, Kwieraga JL, Makhijani RB, Bartels C, Bartolucci A, Grow DR, Nulsen J, Benadiva CA, Engmann L. EMBRYOLOGIC OUTCOMES IN INTRACYTOPLASMIC SPERM INJECTION (ICSI) CYCLES UTILIZING SPERM SELECTED VIA A MICROFLUIDICS DEVICE COMPARED TO STANDARD SELECTION. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Makhijani RB, Hallisey SM, Godiwala PN, Bartels C, Grow DR, Engmann L, Nulsen J, Benadiva CA. OUTCOMES AFTER ADJUNCT GROWTH HORMONE TREATMENT WITH A LOW, INTERMEDIATE, OR HIGH DOSE PROTOCOL IN IVF CYCLES WITH POOR RESPONDERS. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.744] [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: 11/24/2022]
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Makhijani R, Bartels C, Godiwala P, Bartolucci A, Nulsen J, Grow D, Benadiva C, Engmann L. Maternal and perinatal outcomes in programmed versus natural vitrified-warmed blastocyst transfer cycles. Reprod Biomed Online 2020; 41:300-308. [PMID: 32505542 DOI: 10.1016/j.rbmo.2020.03.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/07/2020] [Accepted: 03/16/2020] [Indexed: 01/23/2023]
Abstract
RESEARCH QUESTION Do maternal and perinatal outcomes differ between natural and programmed frozen embryo transfer (FET) cycles? DESIGN Retrospective cohort study at a university-affiliated fertility centre including 775 patients who underwent programmed or natural FET cycles resulting in a singleton live birth using blastocysts vitrified between 2013 and 2018. RESULTS A total of 384 natural and 391 programmed FET singleton pregnancies were analysed. Programmed FET resulted in higher overall maternal complications (32.2% [126/391] versus 18.8% [72/384]; P < 0.01), including higher probability of hypertensive disorders of pregnancy (HDP) (15.3% [60/391] versus 6.3% [24/384]; P < 0.01), preterm premature rupture of membranes (2.6% [10/391] versus 0.3% [1/384]; P = 0.02) and caesarean delivery (53.2% [206/387] versus 42.8% [163/381]; P = 0.03) compared with natural FET. After controlling for potential confounders, including age, body mass index, parity, smoking status, history of diabetes or chronic hypertension, infertility diagnosis, number of embryos transferred and use of preimplantation genetic testing, the adjusted odds ratio for HDP was 2.39 (95% CI 1.37 to 4.17) and for overall maternal complications was 2.21 (95% CI 1.51 to 3.22) comparing programmed with natural FET groups. The groups did not significantly differ for any perinatal outcomes analysed, including birth weight (3357.9 ± 671.6 g versus 3318.4 ± 616.2 g; P = 0.40) or rate of birth defects (1.5% [6/391] versus 2.1% [8/384]; P = 0.57), respectively. CONCLUSION Vitrified-warmed blastocyst transfer in a programmed cycle resulted in a twofold higher probability of HDP compared with transfer in a natural cycle. Natural FET cycle should, therefore, be recommended as first line for all eligible patients undergoing FET to reduce the risk of HDP.
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Affiliation(s)
- Reeva Makhijani
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, 2 Batterson Park Road, Farmington CT, USA
| | - Chantal Bartels
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, 2 Batterson Park Road, Farmington CT, USA
| | - Prachi Godiwala
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, 2 Batterson Park Road, Farmington CT, USA
| | - Alison Bartolucci
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, 2 Batterson Park Road, Farmington CT, USA
| | - John Nulsen
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, 2 Batterson Park Road, Farmington CT, USA
| | - Daniel Grow
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, 2 Batterson Park Road, Farmington CT, USA
| | - Claudio Benadiva
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, 2 Batterson Park Road, Farmington CT, USA
| | - Lawrence Engmann
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, 2 Batterson Park Road, Farmington CT, USA.
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Makhijani R, Thorne J, Bartels C, Bartolucci A, Nulsen J, Grow D, Benadiva C, Engmann L. Pregnancy outcomes after frozen-thawed single euploid blastocyst transfer following IVF cycles using GNRH agonist or HCG trigger for final oocyte maturation. J Assist Reprod Genet 2020; 37:611-617. [PMID: 31897845 DOI: 10.1007/s10815-019-01646-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/29/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess whether GnRH agonist trigger impacts the implantation potential of euploid embryos. METHODS Retrospective cohort study done at an academic IVF center evaluating frozen-thawed embryo transfer (FET) cycles in which single-euploid blastocysts were transferred between 2014 and 2019. All embryos were generated in an IVF cycle which used GnRHa or hCG trigger and then were transferred in a programmed or natural FET cycle. Only the first FET cycle was included for each patient. Primary outcome was ongoing pregnancy rate or live birth rate (OPR/LBR). Secondary outcomes were implantation rate (IR), clinical pregnancy rate (CPR), clinical loss rate (CLR), and multiple pregnancy rate (MPR). Logistic regression was performed to control for confounding variables. A p value of < 0.05 was considered statistically significant. RESULTS Two hundred sixty-three FET cycles were included for analysis (GnRHa = 145; hCG = 118). The GnRHa group was significantly younger (35.2 vs. 37.5 years) and had higher AMH values (4.50 ng/ml vs. 2.03 ng/ml) than the hCG group, respectively (p < 0.05). There was no significant difference in OPR/LBR (64.1% (93/145) vs. 65.3% (77/118); p = 0.90) between the GnRHa and hCG groups, respectively. There was also no significant difference in IR, CPR, CLR, or MPR between groups. After controlling for confounding variables, the adjusted odds ratio for OPR/LBR was 0.941 (95% CI, 0.534-1.658); p = 0.83) comparing GnRHa to hCG. Pregnancy outcomes did not significantly differ when groups were stratified by age (< 35 vs. > 35 years old). CONCLUSIONS Our findings confirm that euploid embryos created after hCG or GnRHa trigger have the same potential for pregnancy.
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Affiliation(s)
- Reeva Makhijani
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Jeffrey Thorne
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Chantal Bartels
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Alison Bartolucci
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, CT, USA
| | - John Nulsen
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Daniel Grow
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Claudio Benadiva
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Lawrence Engmann
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, Farmington, CT, USA.
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Bartels C, Thorne J, Makhijani RB, Daniel GR, Nulsen J, Benadiva C, Engmann L. Longer duration of progesterone elevation adversely impacts pregnancy outcomes during IVF in women ≤ 40 years. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.633] [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: 11/26/2022]
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Makhijani RB, Bartels C, Thorne J, Daniel GR, Nulsen J, Engmann L, Benadiva C. Ovulation rate with letrozole stair-step protocol and in subsequent letrozole cycle. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Makhijani RB, Coulter M, Thorne J, Bartels C, Nulsen J, Engmann L, Benadiva C, Daniel GR. Impact of preimplantation genetic testing for aneuploidy (PGT-A) on gestational carrier (GC) cycles in the United States. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bartels CB, Ditrio L, Grow DR, O'Sullivan DM, Benadiva CA, Engmann L, Nulsen JC. The window is wide: flexible timing for vitrified–warmed embryo transfer in natural cycles. Reprod Biomed Online 2019; 39:241-248. [DOI: 10.1016/j.rbmo.2019.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/08/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022]
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Thorne J, Loza A, Kaye L, Nulsen J, Benadiva C, Grow D, Engmann L. Euploidy rates between cycles triggered with gonadotropin-releasing hormone agonist and human chorionic gonadotropin. Fertil Steril 2019; 112:258-265. [DOI: 10.1016/j.fertnstert.2019.03.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/28/2019] [Accepted: 03/28/2019] [Indexed: 11/27/2022]
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Kaye L, Griffin D, Thorne J, Neuber E, Nulsen J, Benadiva C, Engmann L. Independent serum markers of corpora lutea function after gonadotropin-releasing hormone agonist trigger and adjuvant low dose human chorionic gonadotropin in in vitro fertilization. Fertil Steril 2019; 112:534-544. [PMID: 31227286 DOI: 10.1016/j.fertnstert.2019.04.034] [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] [Received: 10/31/2018] [Revised: 03/29/2019] [Accepted: 04/22/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To characterize corpora lutea (CL) function after gonadotropin-releasing hormone agonist (GnRHa) trigger with the use of adjuvant human chorionic gonadotropin (hCG). DESIGN Secondary analysis of serum from prospective randomized clinical trial. SETTING University-based fertility center. PATIENT(S) Women under 40 years of age at risk of ovarian hyperstimulation syndrome (OHSS) with serum E2 level <4,000 pg/mL. INTERVENTIONS(S) All subjects underwent ovarian stimulation with the use of a GnRH antagonist protocol. Within a larger study, subjects were randomized to receive 1,000 IU hCG at the time of GnRHa trigger and placebo at the time of vaginal oocyte retrieval (VOR) or placebo at the time of GnRHa trigger and 1,500 IU hCG at the time of VOR. MAIN OUTCOME MEASURE(S) Luteal phase and early pregnancy curves of serum prorenin and 17α-hydroxyprogesterone (17OH-P). RESULT(S) Thirty subjects enrolled in this secondary analysis. Serum 17OH-P peaked in the early luteal phase, 5 days after GnRHa trigger, with a nadir in the mid-luteal phase 9 days after trigger. Serum prorenin peaked in the luteal phase 2 days after GnRHa trigger, independently from adjuvant hCG timing, and reached a nadir at 9 days after trigger. CL function appears higher when adjuvant hCG is given at VOR compared with adjuvant hCG given at the time of trigger. CONCLUSION(S) CL function, as interpreted by proxy measures of serum prorenin and 17OH-P with pregnancy, continues despite GnRHa trigger. Both options for adjuvant hCG timing are sufficient for CL rescue and successful pregnancy, so the potential for OHSS risk with increased CL activity after hCG at VOR should be considered. CLINICAL TRIAL REGISTRATION NUMBER NCT01815138.
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Affiliation(s)
- Leah Kaye
- Fertility Center of Las Vegas, Las Vegas, Nevada
| | | | - Jeffrey Thorne
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Evelyn Neuber
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Connecticut
| | - John Nulsen
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Claudio Benadiva
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Lawrence Engmann
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Connecticut.
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Thorne J, Loza A, Benadiva C, Nulsen J, Engmann L, Grow D. Mixed stimulation protocols do not improve euploidy rates in embryos tested with next generation sequencing. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.928] [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: 10/28/2022]
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Thorne J, Loza A, Kaye L, Nulsen J, Engmann L, Benadiva C, Grow D. Higher rates of mosaic only embryos found in younger patients evaluated by next generation sequencing. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.1157] [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: 10/28/2022]
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Benadiva C, Engmann L. Luteal phase support after gonadotropin-releasing hormone agonist triggering: does it still matter? Fertil Steril 2018; 109:763-767. [DOI: 10.1016/j.fertnstert.2018.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/26/2018] [Accepted: 02/01/2018] [Indexed: 12/17/2022]
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Griffin D, Benadiva C, Budinetz T, Sueldo C, DiLuigi A, Nulsen J, Engmann L. The dual trigger study: Rationale and study design of a prospective double-blind randomized clinical trial comparing pregnancy rates after co-administration of low dose hCG at the time of GnRH agonist trigger or 35 h later for the prevention of OHSS. Contemp Clin Trials Commun 2018; 8:18-24. [PMID: 29696192 PMCID: PMC5898565 DOI: 10.1016/j.conctc.2017.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 03/20/2017] [Revised: 08/03/2017] [Accepted: 08/15/2017] [Indexed: 11/17/2022] Open
Abstract
Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of controlled ovarian stimulation. The use of gonadotropin releasing hormone (GnRH) agonist for the trigger of oocyte maturation is effective in the prevention of OHSS although it may result in a lower pregnancy rate. The use of adjuvant low dose human chorionic gonadotropin (hCG) at the time of trigger or at the time of oocyte retrieval may improve pregnancy rates. The goal of this dual trigger study is to evaluate the safety and efficacy of the use of low dose hCG administered at the time of GnRH agonist trigger or 35 h later as well as the potential impact on pregnancy rates. The population will consist of 82 women undergoing IVF treatment who are at risk of developing OHSS. This study will be a single center prospective randomized double-blind placebo controlled trial. The randomization schedule will be administered by the Investigational Drug Services of the University. After controlled ovarian stimulation, induction of oocyte maturation will be achieved using a GnRH agonist and patients will be randomized to receive either low dose hCG 1000 IU at the time of trigger and placebo at oocyte retrieval (Study group) or placebo at the time of trigger and hCG 1500 IU at the time of oocyte retrieval (Control group). The main outcomes will be live birth rates and incidence of OHSS. Two ancillary studies will include a quality of life survey and serum assessment of independent corpus luteum function.
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Affiliation(s)
| | | | | | | | | | | | - Lawrence Engmann
- Corresponding author. Center for Advanced Reproductive Services, 2 Batterson Park Road, Farmington, CT 06030, USA.
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Kaye L, Marsidi A, Rai P, Thorne J, Nulsen J, Engmann L, Benadiva C. Frozen blastocyst transfer outcomes in immediate versus delayed subsequent cycles following GnRH agonist or hCG triggers. J Assist Reprod Genet 2018; 35:669-675. [PMID: 29297113 DOI: 10.1007/s10815-017-1111-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 11/15/2017] [Accepted: 12/22/2017] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aim of this study is to analyze clinical pregnancy rates (CPR) and ongoing pregnancy rates (OPR) for frozen embryo transfers (FET) performed with blastocysts in the cycle immediately after GnRH agonist (GnRHa) versus human chorionic gonadotropin (hCG) triggers, with outcomes of delayed FET for comparison. METHODS Retrospective cohort study at a university-affiliated in vitro fertilization (IVF) clinic, including patients undergoing IVF between 2013-16 with a blastocyst FET performed within two menstrual cycles of a previous stimulation cycle and vaginal oocyte retrieval (VOR). FETs included programmed and natural endometrial preparation. Outcome measures were clinical and ongoing pregnancy rates. RESULTS CPR and OPR for 344 FET cycles were similar when comparing immediate and delayed transfer overall (crude CPR 67.5 versus 76.5%, p = 0.11; OPR 57.5 versus 66.7%, p = 0.13), and after stratifying by cycles following hCG trigger (OPR 62.5 versus 66.3%, p = 0.61) and GnRHa trigger (OPR 55.6 versus 64.5%, p = 0.17). When considering a number of predictors for OPR, an adjusted odds ratio (OR) of 1.74 [95% CI 1.00-3.03] approached significance in favor of delayed FET. CONCLUSIONS Regardless of trigger modality, patients can be reassured that pregnancy rates with FET are high in immediate and delayed cycles. However, our study suggests a potential benefit in delaying a cycle before proceeding with FET.
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Affiliation(s)
- Leah Kaye
- Department of Obstetrics and Gynecology, University of Connecticut, 263 Farmington Avenue, Farmington, CT, 06030, USA
| | - Audrey Marsidi
- Department of Obstetrics and Gynecology, University of Connecticut, 263 Farmington Avenue, Farmington, CT, 06030, USA
| | - Puja Rai
- Department of Obstetrics and Gynecology, University of Connecticut, 263 Farmington Avenue, Farmington, CT, 06030, USA
| | - Jeffrey Thorne
- Department of Obstetrics and Gynecology, University of Connecticut, 263 Farmington Avenue, Farmington, CT, 06030, USA
| | - John Nulsen
- Center for Advanced Reproductive Services, 2 Batterson Park Road, Farmington, CT, 06032, USA
| | - Lawrence Engmann
- Center for Advanced Reproductive Services, 2 Batterson Park Road, Farmington, CT, 06032, USA
| | - Claudio Benadiva
- Center for Advanced Reproductive Services, 2 Batterson Park Road, Farmington, CT, 06032, USA.
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Bartolucci A, Benadiva C, Nulsen J, Neuber E, Engmann L. Is cleavage stage morphology necessary for selecting blastocysts for transfer? Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.1033] [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: 11/26/2022]
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Thorne J, Kaye L, Bartolucci A, Benadiva C, Nulsen J, Engmann L. Pregnancy outcomes between euploid and non-tested blastocysts in frozen embryo transfer cycles. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.832] [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: 12/01/2022]
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Thorne J, Kaye L, Bartolucci A, Benadiva C, Nulsen J, Engmann L. Are pregnancy rates affected by day of blastocyst cryopreservation in single euploid frozen embryo transfer cycles? Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.499] [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: 11/29/2022]
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Kaye L, Will EA, Bartolucci A, Nulsen J, Benadiva C, Engmann L. Pregnancy rates for single embryo transfer (SET) of day 5 and day 6 blastocysts after cryopreservation by vitrification and slow freeze. J Assist Reprod Genet 2017; 34:913-919. [PMID: 28500451 DOI: 10.1007/s10815-017-0940-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 04/30/2017] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The purpose of this study was to compare clinical and ongoing pregnancy rates in cycles with single embryo transfer (SET) of blastocysts cryopreserved on day 5 or day 6. Our aim was to determine whether day 6 blastocysts perform adequately to recommend SET. METHODS Retrospective cohort study including 468 transfer cycles for 392 women younger than age 38 undergoing SET at a university-affiliated IVF clinic in the USA. A total of 261 day 5 blastocysts and 207 day 6 blastocysts for frozen-thawed SET between 2010 and 2016 were analyzed. Data included cryopreservation by both a slow freeze method and vitrification. RESULTS In total, 59.0% of day 5 SET cycles resulted in a clinical pregnancy compared to 54.1% of day 6 blastocysts (p = 0.54). Ongoing pregnancy rates from day 5 frozen-thawed blastocysts (51.7%) were comparable to day 6 (44.9%, p = 0.14). When looking at vitrified blastocysts only, there were no significant differences between day 5 and day 6 blastocysts, with a clinical pregnancy rate of 69.2% for day 5 and 72.5% for day 6 (p = 0.68). CONCLUSIONS SETs of day 6 cryopreserved blastocysts resulted in similar clinical and ongoing pregnancy rates compared to day 5, particularly after vitrification.
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Affiliation(s)
- Leah Kaye
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, 2 Batterson Park Road, Farmington, CT, 06032-6224, USA
| | - Erica Anspach Will
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, 2 Batterson Park Road, Farmington, CT, 06032-6224, USA
| | - Alison Bartolucci
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, 2 Batterson Park Road, Farmington, CT, 06032-6224, USA
| | - John Nulsen
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, 2 Batterson Park Road, Farmington, CT, 06032-6224, USA
| | - Claudio Benadiva
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, 2 Batterson Park Road, Farmington, CT, 06032-6224, USA
| | - Lawrence Engmann
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, 2 Batterson Park Road, Farmington, CT, 06032-6224, USA.
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Bartolucci A, Engmann L, Nulsen J, Neuber E, Benadiva C. Should we leave the past behind us? determining the role of static cleavage stage morphology in the selection of blastocysts for transfer. Fertil Steril 2016. [DOI: 10.1016/j.fertnstert.2016.07.891] [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: 10/21/2022]
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Maslow B, Griffin D, Benadiva C, Nulsen J, Engmann L. Prospective double-blind randomized placebo controlled clinical trial comparing pregnancy rates after co-administration of low dose HCG at the time of GnRH-agonist trigger or 35 hours later, for the prevention of OHSS. Fertil Steril 2016. [DOI: 10.1016/j.fertnstert.2016.07.176] [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: 10/21/2022]
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Maslow BSL, Davis S, Engmann L, Nulsen JC, Benadiva CA. Correlation of normal-range FMR1 repeat length or genotypes and reproductive parameters. J Assist Reprod Genet 2016; 33:1149-55. [PMID: 27189053 DOI: 10.1007/s10815-016-0732-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/06/2016] [Indexed: 12/15/2022] Open
Abstract
PURPOSE This study aims to ascertain whether the length of normal-ranged CGG repeats on the FMR1 gene correlates with abnormal reproductive parameters. METHODS We performed a retrospective, cross-sectional study of all FMR1 carrier screening performed as part of routine care at a large university-based fertility center from January 2011 to March 2014. Correlations were performed between normal-range FMR1 length and baseline serum anti-Müllerian hormone (AMH), cycle day 3 follicle stimulating hormone (FSH), ovarian volumes (OV), antral follicle counts (AFC), and incidence of diminished ovarian reserve (DOR), while controlling for the effect of age. RESULTS Six hundred three FMR1 screening results were collected. One subject was found to be a pre-mutation carrier and was excluded from the study. Baseline serum AMH, cycle day 3 FSH, OV, and AFC data were collected for the 602 subjects with normal-ranged CGG repeats. No significant difference in median age was noted amongst any of the FMR1 repeat genotypes. No significant correlation or association was found between any allele length or genotype, with any of the reproductive parameters or with incidence of DOR at any age (p > 0.05). However, subjects who were less than 35 years old with low/low genotype were significantly more likely to have below average AMH levels compared to those with normal/normal genotype (RR 3.82; 95 % CI 1.38-10.56). CONCLUSIONS This large study did not demonstrate any substantial association between normal-range FMR1 repeat lengths and reproductive parameters.
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Affiliation(s)
- Bat-Sheva L Maslow
- Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, 2 Batterson Park Rd, Farmington, CT, 06032, USA
| | - Stephanie Davis
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Lawrence Engmann
- Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, 2 Batterson Park Rd, Farmington, CT, 06032, USA
| | - John C Nulsen
- Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, 2 Batterson Park Rd, Farmington, CT, 06032, USA
| | - Claudio A Benadiva
- Division of Reproductive Endocrinology and Infertility, University of Connecticut School of Medicine, 2 Batterson Park Rd, Farmington, CT, 06032, USA.
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Hansen KR, He ALW, Styer AK, Wild RA, Butts S, Engmann L, Diamond MP, Legro RS, Coutifaris C, Alvero R, Robinson RD, Casson P, Christman GM, Huang H, Santoro N, Eisenberg E, Zhang H. Predictors of pregnancy and live-birth in couples with unexplained infertility after ovarian stimulation-intrauterine insemination. Fertil Steril 2016; 105:1575-1583.e2. [PMID: 26949110 DOI: 10.1016/j.fertnstert.2016.02.020] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 02/11/2016] [Accepted: 02/11/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify baseline characteristics of couples that are likely to predict conception, clinical pregnancy, and live birth after up to four cycles of ovarian stimulation with IUI in couples with unexplained infertility. DESIGN Secondary analyses of data from a prospective, randomized, multicenter clinical trial investigating pregnancy, live birth, and multiple pregnancy rates after ovarian stimulation-IUI with clomiphene citrate, letrozole, or gonadotropins. SETTING Outpatient clinical units. PATIENT(S) Nine-hundred couples with unexplained infertility who participated in the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation clinical trial. INTERVENTION(S) As part of the clinical trial, treatment was randomized equally to one of three arms and continued for up to four cycles or until pregnancy was achieved. MAIN OUTCOME MEASURE(S) Conception, clinical pregnancy, and live-birth rates. RESULT(S) In a multivariable logistic regression analysis, after adjustment for other covariates, age, waist circumference, income level, duration of infertility, and a history of prior pregnancy loss were significantly associated with at least one pregnancy outcome. Other baseline demographic and lifestyle characteristics including smoking, alcohol use, and serum levels of antimüllerian hormone were not significantly associated with pregnancy outcomes. CONCLUSION(S) While age and duration of infertility were significant predictors of all pregnancy outcomes, many other baseline characteristics were not. The identification of level of income as a significant predictor of outcomes independent of race and education may reflect differences in the underlying etiologies of unexplained infertility or could reveal disparities in access to fertility and/or obstetrical care. CLINICAL TRIAL REGISTRATION NCT01044862.
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Affiliation(s)
- Karl R Hansen
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
| | - Amy Linnea W He
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
| | - Aaron K Styer
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Robert A Wild
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Samantha Butts
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lawrence Engmann
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, Georgia
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey, Pennsylvania
| | - Christos Coutifaris
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ruben Alvero
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, Colorado
| | - Randal D Robinson
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, Texas
| | - Peter Casson
- Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont
| | - Gregory M Christman
- Department of Obstetrics and Gynecology, Shands Hospital, University of Florida, Gainesville, Florida
| | - Hao Huang
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, Colorado
| | - Esther Eisenberg
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland
| | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
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Engmann L, Benadiva C, Humaidan P. GnRH agonist trigger for the induction of oocyte maturation in GnRH antagonist IVF cycles: a SWOT analysis. Reprod Biomed Online 2016; 32:274-85. [PMID: 26803205 DOI: 10.1016/j.rbmo.2015.12.007] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [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: 09/26/2015] [Revised: 12/19/2015] [Accepted: 12/22/2015] [Indexed: 01/26/2023]
Abstract
Gonadotrophin releasing hormone agonist (GnRHa) trigger is effective in the induction of oocyte maturation and prevention of ovarian hyperstimulation syndrome during IVF treatment. This trigger concept, however, results in early corpora lutea demise and consequently luteal phase dysfunction and impaired endometrial receptivity. The aim of this strenghths, weaknesses, opportunities and threats analysis was to summarize the progress made over the past 15 years to optimize ongoing pregnancy rates after GnRHa trigger. The advantages and potential drawbacks of this type of triggering are reviewed. The current approach to the management of GnRHa trigger in autologous cycles is based on the peak serum oestradiol level or follicle number and aims at a fresh embryo transfer or a segmentation approach with elective cryopreservation policy. We recommend intensive luteal support with transdermal oestradiol and intramuscular progesterone alone if peak serum oestradiol is 4000 or more pg/ml after GnRHa trigger or dual trigger with GnRHa and HCG 1000 IU if peak serum oestradiol is less than 4000 pg/mL. On the contrary, we recommend HCG 1500 IU 35 h after GnRHa trigger if there are less than 25 follicles, or freeze all oocytes or embryos if there are over 25 follicles.
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Affiliation(s)
- Lawrence Engmann
- Department of Obstetrics and Gynecology, Center for Advanced Reproductive Services, University of Connecticut School of Medicine, 2 Batterson Park Road, Farmington, CT, USA.
| | - Claudio Benadiva
- Department of Obstetrics and Gynecology, Center for Advanced Reproductive Services, University of Connecticut School of Medicine, 2 Batterson Park Road, Farmington, CT, USA
| | - Peter Humaidan
- The Fertility Clinic, Skive Regional Hospital and Faculty of Health, Aarhus University, Resenvej 25, 7800 Skive, Denmark
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Kaye L, Sueldo C, Engmann L, Nulsen J, Benadiva C. Survey assessing obesity policies for assisted reproductive technology in the United States. Fertil Steril 2015; 105:703-706.e2. [PMID: 26690012 DOI: 10.1016/j.fertnstert.2015.11.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 09/09/2015] [Revised: 10/25/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine what assisted reproductive technologies (ART) policies, if any, have been instituted in response to an increasingly overweight and obese patient population. DESIGN Cross-sectional survey. SETTING University-affiliated IVF clinic. PATIENT(S) Women in the overweight and obese body mass index (BMI) categories seeking ART treatments. INTERVENTION(S) Anonymous survey sent to medical directors at 395 IVF centers listed in Society for Assisted Reproductive Technology database. MAIN OUTCOME MEASURE(S) Assessment of recommendations, policies, and restrictions for patients who are overweight/obese and who desire treatment for infertility, including in IVF, IUI, and donor egg cycles. RESULT(S) Seventy-seven anonymous responses were received (19.5% response rate): 64.9% of centers have a formal policy for obesity, and 84% of those have a maximum BMI at which they will perform IVF, while 38% of those have a maximum BMI for performing IUI; 64.6% of respondents reported anesthesia requirements/concerns as the primary criteria for patient exclusion. Other primary considerations included safety during ongoing pregnancy and ART outcomes. CONCLUSION(S) Centers that have policies regarding obesity and access to ART consider efficacy, procedural safety, safety in pregnancy, and overall health status. Policies vary widely. The patient's autonomy must be balanced with nonmaleficence and the avoidance of interventions that may be unsafe both immediately and long term.
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Affiliation(s)
- Leah Kaye
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut
| | - Carolina Sueldo
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut
| | - Lawrence Engmann
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut
| | - John Nulsen
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut
| | - Claudio Benadiva
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut.
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Hansen K, He A, Styer A, Butts S, Engmann L, NICHD's Reproductive Med Network T. Predictors of pregnancy and live-birth in couples with unexplained infertility following superovulation-intrauterine insemination. Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2015.07.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Marsidi A, Anspach E, Engmann L, Benadiva C, Nulsen J. The effect of insurance coverage on the utilization of frozen embryos in in vitro fertilization. Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2015.07.599] [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: 10/23/2022]
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Kol S, Humaidan P, Alsbjerg B, Engmann L, Benadiva C, García-Velasco JA, Fatemi H, Andersen CY. The updated Cochrane review 2014 on GnRH agonist trigger: repeating the same errors. Reprod Biomed Online 2015; 30:563-5. [DOI: 10.1016/j.rbmo.2015.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 02/18/2015] [Indexed: 10/23/2022]
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Elassar A, Nulsen J, Engmann L, Benadiva C. Estradiol and Antagonist Pretreatment Prior to Microdose Leuprolide in in Vitro Fertilization. Does It Improve IVF Outcomes in Poor Responders as Compared to Oral Contraceptive Pill? J Reprod Med 2015; 60:199-204. [PMID: 26126304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To compare in vitro fertilization (IVF) outcomes in low responders stimulated with microdose leuprolide protocol (ML) following pretreatment with either oral contraceptive pill (OCP) or luteal estradiol (E2) + GnRH antagonist (E2 + antag) for follicular synchronization prior to controlled ovarian hyperstimulation (COH). STUDY DESIGN This was a retrospective study of 130 women, who were poor responders, undergoing IVF with either OCP/ML or E2+ antag/ML protocols. The main outcome measures were ongoing pregnancy rates, number of oocytes retrieved, and cancellation rate. RESULTS Both groups were similar in baseline characteristics. There were no significant differences in gonadotropin requirement, cancellation rate, and number of embryos transferred. Ongoing pregnancy rates (40% vs. 15%) were significantly higher in the OCP/ML group. Trends toward greater number of oocytes retrieved (7.7 ± 3.4 vs. 5.9 ± 4.2) and improved implantation rates (20% vs. 12%) were also noted, but these did not reach statistical significance. CONCLUSION E2+antag pretreatment does not appear to improve IVF outcomes in ML protocol when compared to the standard OCP in poor responders. Randomized trials with adequate power to study the optimal method of steroid pretreatments appear justified.
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Humaidan P, Engmann L, Benadiva C. Luteal phase supplementation after gonadotropin-releasing hormone agonist trigger in fresh embryo transfer: the American versus European approaches. Fertil Steril 2015; 103:879-85. [DOI: 10.1016/j.fertnstert.2015.01.034] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/13/2015] [Accepted: 01/22/2015] [Indexed: 11/15/2022]
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M Sueldo C, Budinetz T, Maslow BS, Nulsen J, Engmann L, Benadiva C. Concurrent ovarian and ipsilateral tubal ectopic pregnancies after a double embryo transfer: a case report. J Assist Reprod Genet 2014; 31:1643-6. [PMID: 25256554 DOI: 10.1007/s10815-014-0338-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 09/04/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- Carolina M Sueldo
- Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT, 06030, USA,
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