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Bryn Mawr, PA, United States

Hodes-Wertz B.,New York University | Grifo J.,New York University | Ghadir S.,Reproductive Center | Kaplan B.,Fertility Centers of Illinois | And 3 more authors.
Fertility and Sterility | Year: 2012

Objective: To determine any beneficial effects of preimplantation genetic screening (PGS) of all chromosomes by array comparative genomic hybridization (aCGH), with either day 3 or blastocyst biopsy, for idiopathic recurrent pregnancy loss (RPL) patients compared with their expected loss rate. Design: Case series report. Setting: Multiple fertility centers. Patient(s): A total of 287 cycles of couples with idiopathic RPL (defined as two or more losses). Intervention(s): PGS was done with day 3 biopsy (n = 193) or blastocyst biopsy (n = 94), followed by analysis with aCGH. Main Outcome Measure(s): Spontaneous abortion rate, euploidy rate. Result(s): A total of 2,282 embryos were analyzed, of which 35% were euploid and 60% were aneuploid. There were 181 embryo transfer cycles, of which 100 (55%) became pregnant with an implantation rate of 45% (136 sacs/299 replaced embryos) and 94 pregnancies (92%) were ongoing (past second trimester) or delivered. The miscarriage rate was found to be only 6.9% (7/102), compared with the expected rate of 33.5% in an RPL control population and 23.7% in an infertile control population. Conclusion(s): Current PGS results with aCGH indicate a significant decrease in the miscarriage rate of idiopathic RPL patients and high pregnancy rates. Furthermore, this suggests that idiopathic recurrent miscarriage is mostly caused by chromosomal abnormalities in embryos. © 2012 by American Society for Reproductive Medicine. Source

Ata B.,McGill University | Ata B.,Uludag University | Kaplan B.,Fertility Centers of Illinois | Danzer H.,Reproductive Center | And 5 more authors.
Reproductive BioMedicine Online | Year: 2012

This study retrospectively analysed array comparative genomic hybridization (CGH) results of 7753 embryos from 990 patients to determine the frequency of embryonic euploidy and its relationship with the cohort size (i.e. the number of embryos available for biopsy and array CGH analysis). Linear regression analysis was performed to assess the effect of cohort size on euploidy rate adjusted for the effect of female age. While increasing female age was associated with a significant decrease in euploidy rate of day-3 and day-5 embryos (P < 0.001 for both groups), cohort size was not significantly associated with euploidy rate. Logistic regression analysis was performed to assess the effect of cohort size, adjusted for maternal age, on the likelihood of having at least one euploid embryo available for transfer. The odds of having at least one euploid embryo in an assisted cycle was significantly decreased by increasing female age (P < 0.01 for both day-3 and day-5 embryos) and was significantly increased by every additional embryo available for analysis (P < 0.001 for both day-3 and day-5 embryos). © 2012, Reproductive Healthcare Ltd. Source

Pereira N.,Drexel University | Anderson S.H.,Main Line Fertility and Reproductive Medicine | Verrecchio E.S.,Main Line Fertility and Reproductive Medicine | Brown M.A.,Valley Forge Ob Gyn Division Phoenixville | Glassner M.J.,Main Line Fertility and Reproductive Medicine
Journal of Minimally Invasive Gynecology | Year: 2014

Herlyn-Werner-Wunderlich syndrome is characterized by a triad of uterine didelphys, obstructed hemivagina, and ipsilateral renal agenesis. The syndrome should be suspected in any young woman with abdominal pain or cyclic dysmenorrhea, and radiologic evidence of müllerian duct and renal anomalies. Herein is presented the case of a 25-year-old woman with a rare variant of Herlyn-Werner-Wunderlich syndrome, characterized by an anomalous connection between the 2 endocervical canals, who underwent hemivaginal septum resection to relieve progressively worsening dysmenorrhea. The right hemivaginal septum was resected medially from the left cervix and laterally off the right vaginal wall. Hydrodissection between the hemivaginal septum and right cervix facilitated surgical resection. After resection of the hemivaginal septum there was complete resolution of dysmenorrhea and no recurrence of hematometra or hematocolpos. © 2014 AAGL. Source

Datar R.S.,Drexel University | Pereira N.,Drexel University | Anderson S.H.,Main Line Fertility and Reproductive Medicine | Stillman J.,Main Line Fertility and Reproductive Medicine | Glassner M.J.,Main Line Fertility and Reproductive Medicine
Journal of Gynecologic Surgery | Year: 2015

Pregnancy-associated breast cancer is the most common one diagnosed in pregnancy. At least two-thirds of all women <40 years of age at diagnosis will present with a stage II or higher breast cancer, and almost all of these women are advised to undergo gonadotoxic chemotherapy. However, these gonadotoxic chemotherapeutic agents can markedly increase ovarian follicular loss, leading to premature menopause. This article reports a case of puerperal fertility preservation via embryo cryopreservation in a patient with pregnancy-associated breast cancer. Case: A 35-year-old woman, gravida 3, para 1, aborta 2, was diagnosed with stage II estrogen-receptor negative, progesterone-receptor negative, and human epidermal growth factor receptor-2 negative breast cancer during her 34th week of pregnancy. The patient delivered a healthy female infant at term and presented within 72 hours of delivery for fertility preservation prior to starting urgent neoadjuvant chemotherapy. Controlled ovarian stimulation was started on postpartum day 4. Results: Ten oocytes were retrieved after 12 days of ovarian stimulation with gonadotropins. Following conventional in vitro fertilization, seven embryos were cryopreserved. The patient subsequently initiated neoadjuvant chemotherapy. Conclusions: Immediate puerperal embryo cryopreservation can be a feasible option for fertility preservation in patients diagnosed with breast cancer during the third trimester of pregnancy requiring urgent neoadjuvant chemotherapy. (J GYNECOL SURG 31:173) © 2015, Mary Ann Liebert, Inc. Source

Wininger J.D.,Main Line Fertility and Reproductive Medicine | Taylor T.H.,Main Line Fertility and Reproductive Medicine | Orris J.J.,Main Line Fertility and Reproductive Medicine | Glassner M.,Main Line Fertility and Reproductive Medicine | Anderson S.H.,Main Line Fertility and Reproductive Medicine
Fertility and Sterility | Year: 2011

Objective: To report a clinical pregnancy after rebiopsy and vitrification of blastocysts following allele dropout (ADO) of biopsied day 3 embryos. Design: Case report. Setting: Private center. Patient(s): Thirty-year-old woman and her 33-year-old husband who carries the single-gene condition paraganglioma. Intervention(s): In vitro fertilization with day 3 embryo biopsy-ET-blastocyst biopsy and vitrification-subsequent frozen ET cycle. Main Outcome Measure(s): Results from preimplantation genetic diagnosis and pregnancy results after fresh and frozen ETs. Result(s): Nineteen oocytes were retrieved of which 13 were mature and 12 fertilized. Eleven embryos were biopsied on day 3: two were normal, five were affected, and four exhibited ADO. The two normal blastocysts were transferred, and three of the ADO blastocysts were biopsied and sent for reanalysis. The biopsied blastocysts were vitrified. No pregnancy resulted from the fresh ET. One of the biopsied blastocysts was normal, one received no result, and one exhibited ADO. A singleton clinical pregnancy resulted from a subsequent frozen ET of the thawed biopsied normal blastocyst. Conclusion(s): Rebiopsy and vitrification of blastocysts could be used in cases of ADO or lack of results after day 3 embryo biopsy. ©2011 by American Society for Reproductive Medicine. Source

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