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Goldman K.N.,New York University | Noyes N.L.,New York University | Knopman J.M.,Reproductive Medicine Associates of New York | McCaffrey C.,New York University | Grifo J.A.,New York University
Fertility and Sterility | Year: 2013

Objective: To compare the efficiency of oocyte cryopreservation (OC) and IVF using the metric "live births per mature oocyte retrieved." Design: Retrospective analysis. Setting: University-based fertility center. Patient(s): Forty women who underwent OC with thaw attempt between 2004 and 2010; 25 autologous and 15 donor-oocyte treatments were included. One thousand nine hundred eight women underwent their first, fresh conventional IVF treatment between 2004 and 2010; 1,392 used autologous oocytes, and 516 used donor oocytes. Autologous and donor-oocyte cycles were analyzed separately. All oocytes were obtained from women


Werner M.D.,Rutgers University | Leondires M.P.,Reproductive Medicine Associates of Connecticut | Schoolcraft W.B.,Colorado Center for Reproductive Medicine | Miller B.T.,Reproductive Medicine Associates of Michigan | And 10 more authors.
Fertility and Sterility | Year: 2014

Objective: To determine the clinically recognizable error rate with the use of quantitative polymerase chain reaction (qPCR)-based comprehensive chromosomal screening (CCS). Design: Retrospective study. Setting: Multiple fertility centers. Patient(s): All patients receiving euploid designated embryos. Intervention(s): Trophectoderm biopsy for CCS. Main Outcome Measure(s): Evaluation of the pregnancy outcomes following the transfer of qPCR-designated euploid embryos. Calculation of the clinically recognizable error rate. Result(s): A total of 3,168 transfers led to 2,354 pregnancies (74.3%). Of 4,794 CCS euploid embryos transferred, 2,976 gestational sacs developed, reflecting a clinical implantation rate of 62.1%. In the cases where a miscarriage occurred and products of conception were available for analysis, ten were ultimately found to be aneuploid. Seven were identified in the products of conception following clinical losses and three in ongoing pregnancies. The clinically recognizable error rate per embryo designated as euploid was 0.21% (95% confidence interval [CI] 0.10-0.37). The clinically recognizable error rate per transfer was 0.32% (95% CI 0.16-0.56). The clinically recognizable error rate per ongoing pregnancy was 0.13% (95% CI 0.03-0.37). Three products of conception from aneuploid losses were available to the molecular laboratory for detailed examination, and all of them demonstrated fetal mosaicism. Conclusion(s): The clinically recognizable error rate with qPCR-based CCS is real but quite low. Although evaluated in only a limited number of specimens, mosaicism appears to play a prominent role in misdiagnoses. Mosaic errors present a genuine limit to the effectiveness of aneuploidy screening, because they are not attributable to technical issues in the embryology or analytic laboratories. ©2014 by American Society for Reproductive Medicine.


VanWort T.A.,Reproductive Medicine Associates of New York | VanWort T.A.,Mount Sinai School of Medicine | Lee J.A.,Reproductive Medicine Associates of New York | Karvir H.,Celmatix | And 4 more authors.
Fertility and Sterility | Year: 2014

Objective: To evaluate the association between female cystic fibrosis (CF) carrier status and invitro fertilization (IVF) response and outcomes. The presence of cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations inmale carriers has been associated with infertility, yet possible adverse effects on the ovarian function and reproductive outcomes of female carriers have not been studied to date. Design: Retrospective cohort study. Setting: Private academic, clinical reproductive center. Patient(s): Females <40 years of age who were screened for CFTR mutations and received IVF treatment between July 2002 and March 2013. Intervention(s): Patients initiated controlled ovarian hyperstimulation with frequent monitoring, vaginal oocyte retrieval, fertilization, embryo transfer, and a pregnancy test. Various measures of IVF stimulation response and cycle outcome were evaluated for both carriers and noncarriers. Main Outcome Measure(s): Analysis was performed by logistic regression and Poisson regression. Result(s): IVF cycles (n = 199) from CFTR mutation carrier patients (n = 112) were analyzed. No signi ficant differences in outcome were noted when carriers of different mutation loci were compared in aggregate with the noncarrier group (n = 6,420 cycles from 3,555 patients). Signifi cant differences were noted for some metrics when the carriers were grouped by mutation loci. Conclusion(s): Overall, no signi ficant differences in stimulation response and cycle outcome were noted between female CFTR mutation carriers and noncarriers. Further research is needed to investigate whether the differences noted between specific CFTR mutation loci are clinically relevant and whether CFTR mutations may impact reproductive outcomes outside the context of assisted reproductive technologies. ©2014 by American Society for Reproductive Medicine.


McDonald C.A.,Reproductive Medicine Associates of New York | Valluzo L.,Reproductive Medicine Associates of New York | Chuang L.,Reproductive Medicine Associates of New York | Poleshchuk F.,Reproductive Medicine Associates of New York | And 4 more authors.
Fertility and Sterility | Year: 2011

Oocyte cryopreservation for fertility preservation, in both medical and elective situations, has significantly increased as freezing technology has improved. Slow freezing techniques demonstrated ∼50-80% survival of mature oocytes, however vitrification with ∼97% survival has become the preferred method for oocyte cryopreservation around the world. Our work investigated the effect of transporting cryopreserved oocytes to and from a long-term storage facility. Our findings demonstrate that extra caution should be practiced for vitrified oocytes, especially when handling and transferring between shipping and long-term cryopreservation storage containers. © 2011 by American Society for Reproductive Medicine.


Moschini R.M.,Reproductive Medicine Associates of New York | Chuang L.,Reproductive Medicine Associates of New York | Poleshchuk F.,Reproductive Medicine Associates of New York | Slifkin R.E.,Reproductive Medicine Associates of New York | And 4 more authors.
Fertility and Sterility | Year: 2011

Improvements in in vitro maturation techniques have focused on culture optimization to increase oocyte maturation rates. Specialized culture media, now commercially available, did not perform significantly better than standard IVF culture media for maturation of immature oocytes in our normal IVF cases. © 2011 by American Society for Reproductive Medicine.


Vela G.,Reproductive Medicine Associates of New York | Vela G.,Mount Sinai School of Medicine | Luna M.,Reproductive Medicine Associates of New York | Luna M.,Mount Sinai School of Medicine | And 6 more authors.
Fertility and Sterility | Year: 2011

Objective: To analyze the outcomes and particular characteristics of monozygotic (MZ) pregnancies conceived by in vitro fertilization (IVF). Design: Retrospective data analysis. Setting: Large private-academic fertility center. Patient(s): IVF-conceived MZ pregnancies. Intervention(s): Statistical analysis of MZ pregnancy outcomes depending on fetal order and pregnancy reductions status. Main Outcome Measure(s): Spontaneous pregnancy reduction, pregnancy loss, take-home baby rate, perinatal mortality, gestational age at delivery, and birth weight. Result(s): A total of 72 of 3,426 pregnancies (2.1%) were MZ, and 70 were included in the study. Of these, 34 cases (48.5%) were high-order multiple pregnancies (HOMP), and 36 (51.5%) were non-HOMP. In the HOMP group, only 2.9% (1 of 34) had a complete pregnancy loss while 38.8% (14 of 36) of the non-HOMP were lost by 20 weeks' gestation. Of the HOMP patients, 73.1% therapeutically reduced the MZ component, and a statistically significant difference in gestational age of delivery (37.8 ± 3.2 vs. 28.1 ± 7.7) and birth weight (2796 ± 865.8 vs. 1110.0 ± 731.6) was seen when compared with nonreduced HOMP. Conclusion(s): Twinning with MZ is encountered in a small but important number of pregnancies derived from assisted reproduction. The prognosis for these patients is unfavorable, particularly for single-implantation MZ pregnancies and for nonreduced HOMP. Patients who do not spontaneously reduce a MZ-HOMP by 12 weeks may benefit from therapeutically reducing the MZ component of the pregnancy. © 2011 American Society for Reproductive Medicine, Published by Elsevier Inc.


To compare the incidence of numerical chromosomal abnormalities (NCAs) reported after preimplantation genetic screening (PGS) analysis compared with that reported after cytogenetic analysis of products of conception after spontaneous abortion.Retrospective study.Private academic invitro fertilization center.Cytogenetic reports of patients who underwent an IVF cycle with PGS of at least one biopsied embryo were compared with cytogenetic analysis reported from patients who had dilation and curettage (D&C) for the treatment of a spontaneous abortion after assisted reproductive technology (ART) treatment.None.Frequencies for each numerical chromosomal abnormality from both groups were compared.A total of 1,069 NCAs were reported after PGS (trisomy 54.3%, monosomy 45.7%, no polyploidies), resulting in a trisomy/monosomy ratio of 0.82. A total of 447 NCAs was reported after D&C (trisomy 83%, polyploidy 10.7%, monosomy 6.3%). The aneuploidies most frequently identified were similar in both groups and included 15, 16, 18, 21, and 22. Monosomies (n = 28, 6.3%) were rarely observed in the group that underwent D&C after ART.This review provides an analysis of the most commonly identified NCAs after PGS and in first-trimester D&C samples in an infertile population utilizing ART. Although monosomies comprised >50% of all cytogenetic anomalies identified after PGS, there were very few identified in the post-D&C samples. This suggests that although monosomies occur frequently in the IVF population, they commonly do not implant. Despite this difference, this study demonstrated that the specific NCAs observed after PGS analysis and D&C were comparable.


PubMed | Reproductive Medicine Associates of New York
Type: | Journal: Reproductive biology and endocrinology : RB&E | Year: 2015

Elevated follicle stimulating hormone (FSH) is associated with poor vaginal oocyte retrieval (VOR) outcomes and cycle cancellations but intercycle variability in basal FSH reportedly does not predict ovarian response.We conducted a retrospective cohort study of basal FSH (n=15573cycles) in couples (n=9132) who initiated IVF cycle(s) with basal estradiol (E2) <100pg/mL between 2002 and 2014 to reevaluate this hypothesis. The most recent (current) FSH, maximum FSH (Max FSH) and prior cycle maximum basal FSH (PMax FSH) were computed for each cycle. Metaphase II (MII) oocyte counts were modeled by age, stimulation type, prior peak E2 level, prior MII count, Max FSH, PMax FSH and current FSH. Antral follicle counts, pregnancy, clinical pregnancy and live birth rates were modeled as secondary outcomes.Max FSH level distinguished completed cycles from cancelled cycles better than PMax FSH or current FSH (AUC of 0.72, 0.71 and 0.61, respectively, p<0.001). Fewer MIIs were retrieved (5.73.8) in cycles with Max FSH >13 mIU/mL (n=1475) than those with 13 mIU/mL (n=11978) (11.67.1) (p<0.001). Max FSH was a better predictor of MII count than PMax FSH or current FSH after controlling for age, stimulation type, prior peak E2 level and prior MII count. Additional MIIs were retrieved on average in cycles with PMax FSH >13 mIU/mL (n=1930) whose current FSH was 13 mIU/ml rather than >13 mIU/ml (p<0.01) after controlling for age, cycle number and stimulation type. However, no improvement in pregnancy or live birth rate was detected.Max FSH is the best FSH-based predictor of ovarian reserve. Retrieval benefits from waiting for a better month appear to exist but are limited.


PubMed | Mount Sinai School of Medicine and Reproductive Medicine Associates of New York
Type: Comparative Study | Journal: Fertility and sterility | Year: 2015

To evaluate the relationship of endometrial thickness (EnT) and endometrial pattern (EnP) to euploid embryo transfer (ET) outcomes.Retrospective cohort.Private academic clinic.Patients (n = 277; age 36.1 4.0years) whose embryos (n = 476) underwent aneuploidy screening with fresh (n = 176) or frozen (n = 180) ET from July 2010 to March2014.The EnT and EnP were measured on trigger day and at ET. Patients were stratified by age and cycle type (fresh or frozen). Cycle data were combined at trigger day, but separated at ET day.Outcome measures were implantation rate, pregnancy rate, and clinical pregnancy rate. Analysis was conducted using (2) analysis and Fishers exact test.A total of 234 gestational sacs, 251 pregnancies, and 202 clinical pregnancies resulted from 356 cycles. The EnT (9.61.8mm; range: 5-15mm) at trigger day (n = 241 cycles), as a continuous or categorical variable (8 vs. >8mm), was not associated with implantation rate, pregnancy rate, or clinical pregnancy rate. The EnT at day of fresh ET (9.7 2.2mm; range: 4.4-17.9mm) (n = 176 cycles) or frozen ET (9.1 2.1mm; range: 4.2-17.7mm) (n = 180 cycles) was not associated with implantation rate, pregnancy rate, or clinical pregnancy rate. Type 3 EnP at trigger day was associated with increased serum progesterone at trigger and a decreased implantation rate, compared with type 2 EnP. The EnP at fresh or frozen ET was not associated with implantation rate, pregnancy rate, or clinical pregnancy rate.Within the study population, EnT was not significantly associated with clinical outcomes of euploid ETs. A type 3 EnP at trigger day suggests a prematurely closed window of implantation.


PubMed | Reproductive Medicine Associates of New York
Type: Clinical Trial | Journal: Journal of assisted reproduction and genetics | Year: 2016

The aim of this study is to compare implantation and live birth rates (LBR) between fresh euploid embryo transfers versus cryo-all cycles with a subsequent embryo transfer into a prepared endometrium.This is a retrospective cohort study. Patients who underwent an IVF cycle with PGS with trophectoderm biopsy from January 2011 to July 2015 were included. Patients were divided into three groups: Fresh Only, Frozen Embryo Transfer (FET) Only, and Fresh ET then FET. For Fresh Only group (n = 345), PGS results were received within 24 h. For FET Only group (n = 514), results were expected after 24 h, and embryos were cryopreserved after biopsy; only FET was performed in this group (no fresh transfer). For FET with a previous fresh ET (n = 139) group, patients underwent a fresh ET with a subsequent FET, in which the same cohort of embryos was utilized. The main outcome measures were pregnancy rate (PR), clinical PR, implantation rate (IR), LBR, and early pregnancy loss rate.IRs were statistically higher in the FET Only group when compared to the Fresh Only group (59.5 vs. 50.6%, p < 0.01) and the FET with a previous fresh ET (59.5 vs. 50.6%, p < 0.05). LBR was statistically significant in the FET Only group when compared to the Fresh Only group (57.6 vs. 46.5 %, p < 0.005) but not when compared to FET with a previous fresh ET group (57.6 vs. 47.7%, p = 0.07).This analysis suggests euploid embryos to be more likely to implant and achieve a LBR in a synthetic FET cycle than in a fresh cycle.

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