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Altun T.,Ankara State Research and Training Hospital | Jindal S.,Yeshiva University | Jindal S.,MontefioResearch Institute for Reproductive Medicine and Health | Greenseid K.,Yeshiva University | And 4 more authors.
Journal of Assisted Reproduction and Genetics | Year: 2011

Purpose: Relationships between follicular fluid levels of IL-6 with ovarian response and clinical pregnancy were evaluated in IVF-ET cycles. Methods: Follicular fluid was collected from ovarian follicles ≥∈14 mm, pooled for each patient, and IL-6 levels were assessed using ELISA (n∈=∈68). Relationships between IL-6 levels and IVF cycle parameters were assessed using nonparametric tests, and between IL-6 levels and clinical pregnancy using multivariable logistic regression analyses. Results: Significant positive correlations were observed between IL-6 with age (p∈=∈0.035), and IL-6 with estradiol on the day of hCG (p∈=∈0.011). On adjusted analyses, IVF cycles in patients with IL-6 levels <4.0 pg/ml (median value for the group) demonstrated an almost 4-fold increase in likelihood for clinical pregnancy (p∈=∈0.045). Conclusions: Lower follicular fluid IL-6 levels in IVF patients are associated with increased likelihood of clinical pregnancy. We hypothesize that endometrial receptivity is a likely target for any deleterious influences of elevated IL-6 levels. © 2010 Springer Science+Business Media, LLC.

Merhi Z.,University of Vermont | Zapantis A.,MontefioResearch Institute for Reproductive Medicine and Health | Berger D.S.,MontefioResearch Institute for Reproductive Medicine and Health | Jindal S.K.,MontefioResearch Institute for Reproductive Medicine and Health | Jindal S.K.,Yeshiva University
Journal of Assisted Reproduction and Genetics | Year: 2013

Purpose: Serum anti-Mullerian hormone (AMH) levels estimate ovarian reserve. The purpose of this study was to identify a minimum serum AMH level that correlates with acceptable clinical pregnancy rate (CPR) in women with severe diminished ovarian reserve (DOR) undergoing in vitro fertilization (IVF). Methods(s): A historical cohort of severe DOR participants (age ≥35) with day 3 FSH of >10 ng/mL were included (n = 120). Participants were categorized into 3 groups: AMH <0.2 (Group 1, n = 38), AMH = 0.2-0.79 (Group 2, n = 57) and AMH ≥ 0.8 (Group 3, n = 25) ng/mL. The main outcome was CPR. The number of retrieved and mature oocytes, transferred embryos, spontaneous abortion (SAB) and live birth (LB) rates were also evaluated. Result(s): Among the three groups, there was no difference in day 3 FSH and estradiol, total gonadotropins dose used per cycle, or LB. Participants in Group 1 were two years older than those in Group 2 and had significantly higher BMI than those in Groups 2 and 3. The three groups significantly differed in AFC (Group 1< Group 2< Group 3; p = 0.001) and cycle cancellation rate (Group 1> Group 2> Group 3; p = 0.006), and had a trend toward significance in SAB rate (Group 1> Group 2> Group 3; p = 0.06). Group 3 had significantly more retrieved and mature oocytes than Groups 1 or 2. Group 2 and 3 had significantly higher CPR per cycle start compared to Group 1. Although Group 2 had significantly fewer oocytes retrieved and mature oocytes than Group 3, CPR per cycle start for both groups was not different. ROC curve indicated that the point of maximal inflection between lower and higher CPR represents an AMH value of 0.2 ng/mL. Conclusion(s): AMH of 0.2 ng/mL appears to be a meaningful threshold for predicting CPR in women with severe DOR at our practice. This information can be crucial during the pre-cycle counseling of these women. © 2013 Springer Science+Business Media New York.

Kulak D.,The New School | Kulak D.,University Reproductive Assoct | Jindal S.K.,MontefioResearch Institute for Reproductive Medicine and Health | Jindal S.K.,Yeshiva University | And 5 more authors.
Fertility and Sterility | Year: 2016

Objective To assess the relationship between live birth rates (LBRs) and the incidence of under-reported cycles by IVF clinics. Design Cohort study. Setting Not applicable. Patient(s) All patients undergoing IVF cycles in the aforementioned clinics. Intervention(s) Not applicable. Main Outcome Measure(s) The reporting percentage (RP), defined as number of cycles with reported pregnancy rates divided by total cycles performed. Results from cryopreservation cycles are only presented by SART if an embryo transfer occurs. Thus, RP decreases as incidence of embryo or oocyte banking cycles increases. The LBRs in women aged <35 years were compared between clinics. Result(s) The median RP of all clinics was 93%-97%. Clinics with RP <80% increased from 2 in 2004 to 30 in 2012. Twenty-one clinics had an RP that fell 2 standard deviations below the mean in any year. Over the 9 years, there was a negative correlation between RP and LBR of -0.17, but for the 21 outlier clinics the correlation increased to -0.26. In 2012 alone, in outlier clinics, for every 10% drop in RP there was an associated rise in LBR of 4.3%; some clinics reported 40% fewer cycles than the median. Conclusion(s) In clinics with very low RP, the cycles that are reported have higher success rates. Regardless of intent, the reduction of reported data to SART makes it increasingly difficult for clinicians and patients to accurately assess a clinic's success rates. © 2016 American Society for Reproductive Medicine.

Relwani R.,Laureate Medical Group | Relwani R.,MontefioResearch Institute for Reproductive Medicine and Health | Berger D.,MontefioResearch Institute for Reproductive Medicine and Health | Santoro N.,University of Colorado at Denver | And 7 more authors.
Reproductive Sciences | Year: 2011

Background: Male infertility affects approximately 6% of reproductive-aged men. It has been suggested that overweight men or men with obese body mass index (BMI) experience prolonged time to pregnancy, though the influence of male BMI on fertility remains understudied. Aims: We hypothesized that BMI is inversely correlated with fertility, manifested by reduced sperm concentration, motility, and morphology. Methods: Males of age 18 to 50 with semen analyses and self-reported BMI were included (n = 530). Patient parameters analyzed included age, BMI, smoking, urological, and fertility history. Leutinizing hormone (LH), Follicle-stimulating hormone, testosterone, steroid hormone-binding globulin (SHBG) and free androgen index (FAI) levels (n = 55), and selective serotonin reuptake inhibitor (SSRI) use (n = 12) were also measured. Results: The men in this study had a mean BMI of 28.2 ± 4.9 kg/m2 (range = 15-60), which is considered overweight, and a mean semen concentration of 55.4 ± 46.8 million/mL, which is in normal range, according to WHO standard. No consistent relationship was observed between increasing BMI and sperm concentration, motility, or morphology, although the testosterone levels trended downward with increasing BMI; there was a suggestion for decreased sperm concentration in current smokers. Men treated with combination SSRI and other psychotropic agent therapy (n = 12) had significantly reduced sperm motility (P =.009). Not unexpectedly, prior urological surgery (n = 77) was associated with lower sperm concentration (P =.0001) and morphology (P =.0008). When in vitro fertilization-embryo transfer (IVF-ET) was used as a treatment modality (n = 121), male BMI was not a significant predictor of clinical pregnancy (P =.06). Conclusions: In our study, we did not observe a significant association between male BMI and sperm concentration, motility or morphology, or clinical pregnancy following IVF-ET. Significantly, SSRI use may affect sperm parameters negatively. © The Author(s) 2011.

Greenseid K.,Institute for Reproductive Medicine and Science of St Barnabas | Jindal S.,Yeshiva University | Jindal S.,MontefioResearch Institute for Reproductive Medicine and Health | Hurwitz J.,Reproductive Medicine Associates of Connecticut | And 2 more authors.
Reproductive Sciences | Year: 2011

Objective: To investigate if a diagnosis of diminished ovarian reserve (DOR) is associated with a differential gene profile of ovarian granulosa cells (GCs) in infertile women undergoing in vitro fertilization (IVF). Design: Prospective Cohort Study. Setting: Academic IVF Program. Patients: Infertile women <38 years were prospectively enrolled into 2 groups: normal ovarian reserve (NOR, follicle-stimulating hormone [FSH] < 10 mIU/mL, n = 4) and DOR (FSH ≥ 10.0 mIU/mL, n = 4). Interventions: Cumulus (C) and mural (M) GCs were isolated at egg retrieval; messenger RNA was extracted and transcribed. Main Outcome Measure(s): Differential gene expression in cerebellar granule cells (CGCs) in the 2 groups was assessed by cDNA microarray. Microarray findings were validated by quantitative real-time polymerase chain reaction (qRTPCR) in CGCs and explored in multinucleated giant cells (MGCs). Results: Of the 1256 differentially regulated genes identified in CGCs of women with DOR, the insulin-like growth factor (IGF) family was a biologically relevant gene family of a priori interest. Downregulation of IGF1 and IGF2 ligands (-3.28- and -2.54-fold, respectively), and their receptors, (-3.53- and -1.32-fold downregulation of IGF1R and IGF2R, respectively) was identified in luteinized CGCs in women with DOR compared to those with NOR. Downregulation of both IGF1 and IGF 2 ligands (-4.35- and 3.89-fold, respectively) was furthermore observed in MGCs in women with DOR compared to those with NOR; no differences in the expression of respective receptors were however observed in MGCs in the 2 groups. Conclusions: Components of the IGF gene family are downregulated in GCs of women with DOR. These findings maybe contributory to the reproductive compromise observed in women with DOR, and merit further exploration. © 2011 The Author(s).

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