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Dumesic D.A.,University of California at Los Angeles | Meldrum D.R.,Reproductive Partners Medical Group | Katz-Jaffe M.G.,Colorado Center for Reproductive Medicine | Krisher R.L.,Colorado Center for Reproductive Medicine | Schoolcraft W.B.,Colorado Center for Reproductive Medicine
Fertility and Sterility | Year: 2015

Bidirectional somatic cell-oocyte signaling is essential to create a changing intrafollicular microenvironment that controls primordial follicle growth into a cohort of growing follicles, from which one antral follicle is selected to ovulate a healthy oocyte. Such intercellular communications allow the oocyte to determine its own fate by influencing the intrafollicular microenvironment, which in turn provides the necessary cellular functions for oocyte developmental competence, which is defined as the ability of the oocyte to complete meiosis and undergo fertilization, embryogenesis, and term development. These coordinated somatic cell-oocyte interactions attempt to balance cellular metabolism with energy requirements during folliculogenesis, including changing energy utilization during meiotic resumption. If these cellular mechanisms are perturbed by metabolic disease and/or maternal aging, molecular damage of the oocyte can alter macromolecules, induce mitochondrial mutations, and reduce adenosine triphosphate production, all of which can harm the oocyte. Recent technologies are now exploring transcriptional, translational, and post-translational events within the human follicle with the goal of identifying biomarkers that reliably predict oocyte quality in the clinical setting. © 2015 American Society for Reproductive Medicine.


Surrey E.S.,Colorado Center for Reproductive Medicine
Seminars in Reproductive Medicine | Year: 2013

In vitro fertilization (IVF) represents the most efficient means of overcoming endometriosis-related infertility. Compromised pelvic anatomy and a hostile peritoneal environment are bypassed. Despite the results of early trials, more contemporary outcomes data would suggest that when controlled for age, IVF cycle outcome is not compromised by the presence of endometriosis. One exception to this concept is the finding that patients with ovarian endometriomas demonstrate poorer response to gonadotropin therapy, although it is not clear that this affects the likelihood of implantation. Surgical ablation of superficial endometriosis has no clear impact on IVF pregnancy rates, although a small number of recent trials suggest that pre-cycle resection of deeply infiltrative disease may be beneficial. With the exception of traditional gynecologic indications, there is no evidence to suggest that resection of ovarian endometriomas has any positive impact on cycle outcome. There are, in fact, data demonstrating that resection may exert a deleterious effect on ovarian reserve. A subset of patients will benefit from administration of a prolonged course of a gonadotropin-releasing hormone agonist prior to an IVF cycle. However, the characteristics of that subset have not been identified. It would be logical to consider this approach in women with more advanced disease, severe symptoms, and a history of implantation failure. Data on the impact of other pre-cycle medical interventions such as aromatase inhibitors, danazol, or oral contraceptives are more limited. There is also no evidence to suggest that the ovarian stimulation associated with IVF induces progression of endometriosis. © 2013 by Thieme Medical Publishers, Inc.


Boots C.E.,University of Chicago | Gustofson R.L.,Colorado Center for Reproductive Medicine | Feinberg E.C.,University of Chicago | Feinberg E.C.,Fertility Centers of Illinois
Fertility and Sterility | Year: 2013

Objective To evaluate the effects of methotrexate (MTX) on the future fertility of women undergoing IVF by comparing ovarian reserve and ovarian responsiveness in the IVF cycle before and after an ectopic pregnancy (EP) treated with MTX. Design Retrospective cohort study. Setting Private reproductive endocrinology and infertility practice. Patient(s) Sixty-six women undergoing IVF before and after receiving MTX for an EP. Intervention(s) Methotrexate administration and ovarian stimulation. Main Outcome Measure(s) Markers of ovarian reserve (day 3 FSH, antral follicle count), measures of ovarian responsiveness (duration of stimulation, peak E2 level, total dose of gonadotropins, number of oocytes retrieved, fertilization rate), and time from MTX administration to subsequent IVF cycle. Result(s) There were no differences after MTX administration in body mass index (BMI), FSH, or antral follicle count. A greater dose of gonadotropins was used in the cycle after MTX, but there were no differences in numbers of oocytes retrieved or high quality embryos transferred. As expected, there was a slight increase in age in the subsequent IVF cycle. The pregnancy rates (PR) were comparable to the average PRs within the practice when combining all age groups. Conclusion(s) Methotrexate remains the first line of therapy for medical management of asymptomatic EP and does not compromise ovarian reserve, ovarian responsiveness, or IVF success in subsequent cycles. © 2013 American Society for Reproductive Medicine, Published by Elsevier Inc.


Surrey E.S.,Colorado Center for Reproductive Medicine
Current Opinion in Obstetrics and Gynecology | Year: 2010

Purpose of Review: Endometriosis is a gynecologic disorder that can lead to debilitating chronic pelvic pain and infertility. Gonadotropin-releasing hormone agonists (GnRHa) have emerged as a primary medical therapy for patients with symptomatic disease, but secondary hypoestrogenic side effects may limit compliance. Add-back therapy is a means of surmounting this problem. Recent Findings: Progestins such as norethindrone acetate may be administered with or without addition of low doses of estrogens to safely and effectively extend GnRHa therapy while minimizing side effects. Recent studies have demonstrated that the use of add-back enhances compliance and duration of therapy. The initiation of an add-back should not be deferred given evidence demonstrating an increase in vasomotor symptoms and bone loss if not administered concomitantly. The subset of adolescents with endometriosis who require GnRHa therapy should be administered an add-back, but require careful monitoring of bone mineral density. Summary: Implementation of an appropriately selected add-back will significantly reduce hypoestrogenic side effects, enhance compliance, and allow for prolongation of therapy without interfering with the efficacy of GnRHa in treating symptomatic endometriosis. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Katz-Jaffe M.G.,National Foundation for Fertility Research | Katz-Jaffe M.G.,Colorado Center for Reproductive Medicine | McReynolds S.,National Foundation for Fertility Research
Fertility and Sterility | Year: 2013

Proteomic technologies have begun providing evidence that viable embryos possess unique protein profiles. Some of these potential protein biomarkers have been identified as extracellular and could be used in the development of a noninvasive quantitative method for embryo assessment. The field of assisted reproductive technologies would benefit from defining the human embryonic proteome and secretome, thereby expanding our current knowledge of embryonic cellular processes. Copyright © 2013 American Society for Reproductive Medicine, Published by Elsevier Inc.


Krisher R.L.,National Foundation for Fertility Research | Schoolcraft W.B.,Colorado Center for Reproductive Medicine | Katz-Jaffe M.G.,National Foundation for Fertility Research
Fertility and Sterility | Year: 2015

The advent of advanced omics technologies and the application of these techniques to the analysis of extremely limited material have opened the door to the investigation of embryo physiology in a focused, in-depth approach never before possible. The application of noninvasive metabolomic and proteomic platforms to understanding embryo viability permits the characterization of individual embryos in culture. Initial clinical data have highlighted the promise of these technologies for the development of noninvasive embryo selection criteria. In this way, a complex view of embryo function can be compiled and related to embryo development, quality, and outcome. Application of knowledge gained from omics will transform both our understanding of embryo physiology as well as our ability to select viable embryos for transfer in assisted reproductive technology. © 2015 American Society for Reproductive Medicine.


Schoolcraft W.B.,Colorado Center for Reproductive Medicine | Katz-Jaffe M.G.,Colorado Center for Reproductive Medicine
Fertility and Sterility | Year: 2013

The universal goal of assisted reproduction technologies is a singleton delivery of a healthy full-term baby. For younger women (<35 years of age) single-embryo transfer is a viable option resulting in clinical success similar to multiple-embryo transfers. In contrast, older women have significantly lower pregnancy rates following single-embryo transfer. To provide effective single-embryo transfer options for older women, improved methods of embryo selection are required to overcome the marked differences in outcome of single- versus double-embryo transfer. With the development of comprehensive chromosome screening, blastocyst vitrification, and trophectoderm biopsy techniques, older women have the opportunity of elective single-embryo transfer with live birth rates as high as those reported for younger good-prognosis infertility patients. © 2013 by American Society for Reproductive Medicine.


Surrey E.S.,Colorado Center for Reproductive Medicine
Journal of Minimally Invasive Gynecology | Year: 2012

The role of routine uterine cavity evaluation before an in vitro fertilization-embryo transfer (IVF-ET) cycle has not been uniformly accepted. Published trials have demonstrated a relatively high incidence of cavitary abnormalities diagnosed at outpatient hysteroscopy in patients with previous IVF-ET cycle failure, the correction of which markedly improves outcomes. The value of performing this procedure before an initial cycle in patients without previous implantation failure has not been definitively confirmed in prospective randomized trials, but would seem logical in an effort to minimize the number of cycles a patient must undergo. The incidence of cavitary abnormalities in this population varies. One large series has reported a 22.9% incidence of endometrial cavitary abnormalities diagnosed at pre-cycle office hysteroscopy in this patient group. Hysterosalpingography and baseline transvaginal ultrasonography are insufficiently sensitive alternatives. Sonohysterography with infusion of saline solution, in particular with 3-dimensional technology, may be a reasonable alternative to diagnostic hysteroscopy, although relatively few well-designed trials have addressed this issue. There are an insufficient number of prospective randomized trials to clearly demonstrate that surgical removal of all abnormalities improves IVF-ET outcome. However, investigators suggest a benefit for resection of submucosal leiomyomas, adhesions, and at least a subset of polyps. Appropriately designed trials are required before a definitive recommendation can be made. © 2012 AAGL.


Paczkowski K.,National Foundation for Fertility Research | Silva E.,Urbana University | Schoolcraft W.B.,National Foundation for Fertility Research | Schoolcraft W.B.,Colorado Center for Reproductive Medicine | Krisher R.L.,National Foundation for Fertility Research
Biology of Reproduction | Year: 2013

The objective of these experiments was to evaluate the importance of fatty acid beta-oxidation (FAO) in the cumulus oocyte complex (COC) during in vitro maturation (IVM) to oocyte nuclear maturation and gene expression in both the oocyte and cumulus cells in three species with differing amounts of oocyte intracellular lipids (mouse, low; bovine, moderate; porcine, high). We inhibited FAO using etomoxir at 0, 10, 25, 100, or 250 μM. Completion of oocyte nuclear maturation was inhibited after COC exposure to 250 lM etomoxir in mouse oocytes, 100 μM etomoxir in bovine oocytes, and as little as 10 lM etomoxir in porcine oocytes (P < 0.05). When FAO was inhibited in mouse and porcine COCs resulting in inhibition of meiosis, the abundance of FAO, glycolytic, and oxidative stress gene transcripts were decreased in oocytes and cumulus cells (P < 0.05), although to a much greater extent in the pig. In bovine oocytes and cumulus cells, FAO gene transcripts were increased and glycolytic gene expression altered following meiotic inhibition due to etomoxir. Etomoxir, at doses that did not inhibit nuclear maturation in bovine and murine COCs, increased glucose consumption (P < 0.05), suggesting glucose metabolism is increased to meet the metabolic demands of the COCs when fatty acid metabolism is compromised. Our data demonstrates that FAO is essential to oocyte nuclear maturation in all three species. Sensitivity of nuclear maturation to FAO inhibition reflects the amount of lipid present in the ooplasm and may suggest a relative reliance on this metabolic pathway. © 2013 by the Society for the Study of Reproduction, Inc.


News Article | October 28, 2016
Site: www.prweb.com

Atlanta Center for Reproductive Medicine (ACRM), a Colorado Center for Reproductive Medicine (CCRM) Network Clinic, will participate in the 46th annual Atlanta Pride Festival October 8th through 9th at Piedmont Park in Atlanta, Georgia. The Atlanta Pride Festival is the largest Pride event in the southeast and the largest event in the country to coincide with National Coming Out Day. ACRM has supported this festival for the past six years. Find ACRM team members at Booth B34. “At ACRM, we are proud to have a successful history assisting LGBTQ couples and individuals achieve their dream of parenthood,” said board certified Reproductive Endocrinologist Dr. Robin H. Fogle. “We are excited to take part in the 46th annual Atlanta Pride Festival and to show our support for our local LGBTQ community in Atlanta.” ACRM has been helping members of the LGBTQ community build families through surrogacy and reproductive procedures, such as in vitro fertilization and intrauterine insemination, for over 15 years. “We are sensitive to the unique needs of the LGBTQ community and develop treatment plans that are specific to each person or couple and their desire for family building,” said Dr. Fogle. “From our past LGBTQ patients, we’ve heard that the process of family building can often be a daunting experience. To help ease this process, several years ago we began offering Prospective Patient Seminars that directly address the specific needs of the LGBTQ community. We have found these to be a great success.” The next LGBT Family Building Options seminar will take place at ACRM’s Perimeter office Wednesday, October 26th at 6:30 pm. This free seminar will cover family building options available to the Lesbian, Gay, Bisexual, and Transgender community, as well as a Q&A session. Attendees also have the opportunity to speak with the physician individually following the Q&A session. Additionally, one of our patient support representatives will answer questions regarding insurance and financial programs available to our patients. About Atlanta Center for Reproductive Medicine Founded in 1998, Atlanta Center for Reproductive Medicine (ACRM) specializes in the diagnosis and treatment of infertility. With Georgia fertility clinics in Atlanta, Johns Creek and Marietta, our team of Board Certified and Board eligible Reproductive Endocrinologists offer a wide variety of infertility treatments including ovulation induction and intrauterine insemination (IUI) to the most advanced treatments of in vitro fertilization (IVF), egg donation and preservation (egg freezing), preimplantation genetic diagnosis (PGD) and comprehensive chromosome screening (CCS). ACRM offers a team approach in a patient-centered, supportive environment. ACRM is unique among infertility programs in the Atlanta area offering on-site acupuncture and support groups provided by professionally licensed practitioners.

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