Entity

Time filter

Source Type

Atlanta, GA, United States

Noyes N.,New York University | Boldt J.,Community Health Network Inc. | Nagy Z.P.,Reproductive Biology Associates
Journal of Assisted Reproduction and Genetics | Year: 2010

As more reproductive-age women survive cancer at the expense of gonadotoxic therapy, the need for viable fertility preservation options has become paramount. Embryo cryopreservation, often using donor sperm, has been the standard offered these women over the past 20 years. Preservation of unfertilized oocytes now represents an acceptable and often equally viable alternative, particularly for single women, due to technologic advances made in the past decade. Given such, oocyte cryopreservation's experimental designation and need for IRB approval should thus be revisited. © 2010 Springer Science+Business Media, LLC. Source


Ly K.D.,Cleveland Clinic | Agarwal A.,Cleveland Clinic | Nagy Z.P.,Reproductive Biology Associates
Journal of Assisted Reproduction and Genetics | Year: 2011

Despite an ongoing debate over its efficacy, preimplantation genetic screening (PGS) is increasingly being used to detect numerical chromosomal abnormalities in embryos to improve implantation rates after IVF. The main indications for the use of PGS in IVF treatments include advanced maternal age, repeated implantation failure, and recurrent pregnancy loss. The success of PGS is highly dependent on technical competence, embryo culture quality, and the presence of mosaicism in preimplantation embryos. Today, cleavage stage biopsy is the most commonly used method for screening preimplantation embryos for aneuploidy. However, blastocyst biopsy is rapidly becoming the more preferred method due to a decreased likelihood of mosaicism and an increase in the amount of DNA available for testing. Instead of using 9 to 12 chromosome FISH, a 24 chromosome detection by aCGH or SNP microarray will be used. Thus, it is advised that before attempting to perform PGS and expecting any benefit, extended embryo culture towards day 5/6 should be established and proven and the clinical staff should demonstrate competence with routine competency assessments. A properly designed randomized control trial is needed to test the potential benefits of these new developments. © 2011 Springer Science+Business Media, LLC. Source


Griesinger G.,University of Lubeck | Shapiro D.B.,Reproductive Biology Associates | Kolibianakis E.M.,Aristotle University of Thessaloniki | Witjes H.,Biostatistics and Research Decision science | Mannaerts B.M.,Merck And Co.
Reproductive BioMedicine Online | Year: 2011

The association between endogenous LH concentrations during ovarian stimulation in a gonadotrophin-releasing hormone (GnRH) antagonist protocol and pregnancy likelihood was examined in a large combined analysis of individualized patient data obtained after treatment with recombinant FSH and a GnRH antagonist prior to IVF/intracytoplasmic sperm injection. Data from 1764 patients from six randomized controlled trials were pooled for retrospective analysis. Ongoing pregnancy and miscarriage rates for patients stratified by LH percentiles were assessed. Patients in the lowest LH quartile (P75). With adjustment for identified predictive factors of pregnancy, estimated odds ratios (95% confidence interval) for ongoing pregnancy for LH categories P75 versus ≤P75 and P75 were 0.96 (0.75-1.22), 1.13 (0.88-1.45) and 0.89 (0.66-1.21) on stimulation day 8, and 0.96 (0.76-1.21), 1.03 (0.82-1.30) and 0.95 (0.72-1.26) on the day of human chorionic gonadotrophin, respectively. No significant differences in pregnancy or miscarriage rates between the LH categories were observed. Endogenous LH concentrations have no association with the likelihood of ongoing pregnancy in women undergoing ovarian stimulation using a recombinant FSH/GnRH antagonist protocol. Circulating concentrations of LH are suppressed during ovarian stimulation for IVF/intracytoplasmic sperm injection with either gonadotrophin-releasing hormone (GnRH) agonists or antagonists to prevent premature LH rises. The association between circulating LH concentrations during ovarian stimulation and the likelihood of pregnancy was examined in a large combined analysis of individualized patient data obtained after treatment with recombinant FSH to stimulate multifollicular development and a GnRH antagonist (ganirelix) to prevent LH surges. Data from 1764 patients from six randomized controlled trials were pooled for retrospective analysis. Patients were divided into three groups based on their circulating LH concentrations being either low, normal or high on stimulation day 8 and on the day of human chorionic gonadotrophin (HCG) administration, and their ongoing pregnancy and miscarriage rates were calculated. Patients with low LH concentrations were in general younger, had a higher ovarian reserve and more retrieved eggs than patients with high LH concentrations. With adjustment for factors known to affect pregnancy, the chance of ongoing pregnancy was not lower for patients with low or high LH concentrations on stimulation day 8 or day of HCG administration. No significant differences in miscarriage rates between the LH categories were observed either. This combined analysis confirms that the concentrations of circulating LH during GnRH antagonist treatment do not affect the likelihood of ongoing pregnancy in women undergoing ovarian stimulation with recombinant FSH. © 2011, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved. Source


Cobo A.,IVI Valencia | Remohi J.,IVI Valencia | Chang C.-C.,Reproductive Biology Associates | Nagy Z.P.,Reproductive Biology Associates
Reproductive BioMedicine Online | Year: 2011

Oocyte donation is an efficient alternative to using own oocytes in IVF treatment for different indications. Unfortunately, 'traditional' (fresh) egg donations are challenged with inefficiency, difficulties of synchronization, very long waiting periods and lack of quarantine measures. Given the recent improvements in the efficiency of oocyte cryopreservation, it is reasonable to examine if egg donation through oocyte cryopreservation has merits. The objective of the current manuscript is to review existing literature on this topic and to report on the most recent outcomes from two established donor cryobank centres. Reports on egg donation using slow freezing are scarce and though results are encouraging, outcomes are not yet comparable to a fresh egg donation treatment. Vitrification on the other hand appears to provide high survival rates (90%) of donor oocytes and comparable fertilization, embryo development, implantation and pregnancy rates to traditional (fresh) egg donation. Besides the excellent outcomes, the ease of use for both donors and recipients, higher efficiency, lower cost and avoiding the problem of synchronization are all features associated with the benefit of a donor egg cryobank and makes it likely that this approach becomes the future standard of care. Oocyte donation is one of the last resorts in IVF treatment for couples challenged with infertility problems. However, traditional (fresh) egg donation, as it is performed today, is not very efficient, as typically all eggs from one donor are given to only one recipient, it is arduous as it requires an excellent synchronization between the donor and recipient and there are months or years of waiting time. Because of the development of an efficient oocyte cryopreservation technique, it is now possible to cryo-store donor (as well as non-donor) eggs, maintaining their viability and allowing their use whenever there is demand. Therefore, creating a donor oocyte cryobank would carry many advantages. In the present manuscript, the current experience with oocyte donation using cryopreservation technology is reviewed. The outcomes of two recently established donor egg cryobanks at Instituto Valenciano de Infertilidad in Spain and Reproductive Biology Associates in the USA (involving a large number of cases) demonstrate that egg cryo-survival is high and that fertilization, embryo development, implantation and pregnancy rates are similar to those reported after fresh egg donation. It also provides additional advantages of being more efficient, more economical, easier for both donors and recipients and potentially also safer, because eggs can now be quarantined for 6 months (or longer) to retest for infectious diseases in the donors. It is the opinion of the authors, based on several advantages associated with the use of donor egg cryobanking, that in the future there will be fewer traditional egg donations and increasingly more cryo-egg donations. © 2011, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved. Source


Nel-Themaat L.,Reproductive Biology Associates | Nagy Z.P.,Reproductive Biology Associates
Placenta | Year: 2011

Embryo viability assessment is one of the most important and challenging tasks in IVF. Evaluation of embryo quality is critical when selecting the best embryo(s) to transfer or cryopreserve. Until recently, the only instrument used for embryo evaluation was the inverted light microscope, which provided information based on morphological characteristics. Developmental and morphological information gained from microscopic assessment have been positively associated with IVF outcomes, including pregnancy and implantation rates. However, based on general statistics, it is clear that IVF currently still results in relatively low pregnancy rates, while simultaneously being associated with relatively high multiple implantation rates. Only with novel embryo assessment and selection procedures would it be possible to improve these outcomes. Accordingly, it has been proposed that it is possible to test the culture environment of a developing embryo to gain valuable information regarding its viability. Different approaches have been used. These include the measurement of oxygen consumption by the embryo and testing of the soluble HLA-G in the environment, as it was proposed that secretion of HLA-G is associated with higher implantation rates. Amino acid turnover, which appears to be correlated to blastocyst development, can be measured as an indication of embryo viability. Other approaches, such as time-lapse video observation or cumulus cell gene expression analysis, may be used in the future to gain a broader understanding of embryo viability. Proteomics and metabolomics are also useful tools for assessment of embryo developmental potential. Results from recent studies on predicting embryo viability by analyzing the metabolome of different stage embryos are promising, as increases in pregnancy and implantation rates were obtained using the metabolomic profile for embryo selection. Several novel approaches are currently being developed to aid in viability assessment. These need to be evaluated in prospective clinical trials, while considering their practicality in the clinical laboratory. © 2011 Elsevier Ltd. All rights reserved. Source

Discover hidden collaborations