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Rockville, MD, United States

Stillman R.J.,Shady Grove Fertility
Fertility and Sterility | Year: 2010

The Suleman case shows that there are "heightened expectations" of our field on the part of our colleagues, the public, legislative and regulatory officials, and our patients. And it can teach us that we have both the history and the promise within our own field to fulfill those heightened expectations through continued clinical progress in promoting safe successful outcomes. © 2010.

Hill M.J.,U.S. National Institutes of Health | Levens E.D.,U.S. National Institutes of Health | Levens E.D.,Shady Grove Fertility | Levy G.,U.S. National Institutes of Health | And 4 more authors.
Fertility and Sterility | Year: 2012

Objective: To evaluate the effect of recombinant LH in assisted reproduction technology (ART) cycles in patients of advanced reproductive age. Design: A systematic review and meta-analysis. Setting: Published randomized controlled clinical trials comparing recombinant LH plus recombinant FSH versus recombinant FSH only in patients of advanced reproductive age. Patient(s): Patients 35 years and older undergoing assisted reproduction. Intervention(s): Recombinant LH plus recombinant FSH controlled ovarian hyperstimulation (COH) versus recombinant FSH stimulation only in assisted reproduction cycles. Main Outcome Measure(s): Implantation and clinical pregnancy. Result(s): Seven trials were identified that met inclusion criteria and comprised 902 assisted reproduction technology cycles. No differences in serum E2 on the day of hCG administration were reported in any trials. Two trials reported lower oocyte yield and one trial reported lower metaphase II oocyte yield in the recombinant LH-supplemented group. One trial reported higher fertilization rates in the recombinant LH-supplemented group. In a fixed effect model, implantation was higher in the recombinant LH-supplemented group (odds ratio 1.36, 95% confidence interval 1.05-1.78). Similarly, clinical pregnancy was increased in the recombinant LH-supplemented group (odds ratio 1.37, 95% confidence interval 1.03-1.83). Conclusion(s): The addition of recombinant LH to ART cycles may improve implantation and clinical pregnancy in patients of advanced reproductive age. © 2012 American Society for Reproductive Medicine, Published by Elsevier Inc.

Johnson L.N.C.,University of Pennsylvania | Sasson I.E.,Shady Grove Fertility | Sammel M.D.,University of Pennsylvania | Dokras A.,University of Pennsylvania
Fertility and Sterility | Year: 2013

Objective: To determine if intracytoplasmic sperm injection (ICSI), compared with conventional insemination, improves fertilization rates and prevents total failed fertilization (TFF) in couples with unexplained infertility. Design: Systematic review and meta-analysis. Setting: IVF centers. Patient(s): Couples with well-defined unexplained infertility undergoing IVF. Intervention(s): A systematic review was performed by searching Medline and Embase for 1992-2012. Studies in which sibling oocytes were randomly split between conventional insemination and ICSI were included. A random effects model was utilized for the meta-analysis. Meta-analysis of Observational Studies in Epidemiology guidelines were applied. Main Outcome Measure(s): Fertilization rate and TFF rate by insemination method. Result(s): Eleven studies with a total of 901 couples (female age range 30-35 years) with 11,767 sibling oocytes were included in the meta-analysis. The pooled relative risk (RR) of a mature oocyte fertilizing was higher with ICSI than with conventional insemination (RR 1.49, 95% confidence interval [CI] 1.35-1.65.) The pooled RR of fertilization per allocated oocyte (before randomization) was higher with ICSI than with conventional insemination (RR 1.27, 95% CI 1.02-1.58; n = 5 studies.) The pooled RR of TFF was significantly higher with conventional insemination than with ICSI (RR 8.22, 95% CI 4.44-15.23). The number of subjects needed to treat with ICSI to prevent one case of TFF was five. Conclusion(s): This meta-analysis favors the use of ICSI to increase fertilization rates and decrease the risk of TFF in couples with well-defined unexplained infertility. Further studies are needed to determine the impact on clinical pregnancy and live birth rate. © 2013 by American Society for Reproductive Medicine.

Hill M.J.,U.S. National Institutes of Health | Levy G.,U.S. National Institutes of Health | Levens E.D.,U.S. National Institutes of Health | Levens E.D.,Shady Grove Fertility
Reproductive BioMedicine Online | Year: 2012

A review of the scientific literature on the use of exogenous LH in assisted reproductive technology was performed by searching the MEDLINE, PubMed and Cochrane online databases. Scientific evidence was reviewed comparing recombinant FSH-only protocols to protocols supplemented with exogenous LH activity: human menopausal gonadotrophin (HMG), recombinant LH and mid-follicular human chorionic gonadotrophin (HCG). Studies were further compared based on pituitary suppression with gonadotrophin-releasing hormone (GnRH) antagonist and agonist protocols. Primary focus was given to randomized controlled trials and meta-analyses. Data from hypogonadotrophic hypogonadal patients demonstrated the importance of LH activity for success of assisted reproduction treatment. However, the majority of normogonadotrophic patients had adequate endogenous LH to successfully drive ovarian steroidogenesis and oocyte maturation. Exogenous LH supplementation was consistently associated with higher peak oestradiol concentrations. The use of HMG in long GnRH agonist cycles was associated with a 3-4% increase in live birth rate. There was insufficient evidence to make definitive conclusions on the need for exogenous LH activity in GnRH antagonist cycles or the benefit of recombinant LH and HCG protocols. Poor responders and patients 35 years of age and older may benefit from exogenous LH. © 2011 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Levy M.J.,Shady Grove Fertility | Ledger W.,University of New South Wales | Kolibianakis E.M.,Aristotle University of Thessaloniki | Gordon K.,Merck And Co.
Reproductive BioMedicine Online | Year: 2013

A retrospective analysis of a large, randomized clinical trial (Engage) assessed whether adjusting the start day of ovarian stimulation and/or day of human chorionic gonadotrophin (HCG) trigger could minimize oocyte retrieval during weekends without adverse effects on clinical outcome. Patients received recombinant FSH/gonadotrophin-releasing hormone (GnRH) antagonist regimens, with stimulation starting on day 2 or 3 of menses. HCG was administered when at least three follicles of 17 mm were present on ultrasound scan or 1 day later. The frequency distribution of the day of reaching the HCG criterion relative to stimulation initiation was analysed to determine the optimal stimulation start day (cycle day 2 or 3) depending on the weekday at which menses started, to minimize weekend retrieval. The number of oocytes retrieved and pregnancy rates were not affected by start day and/or delay in HCG administration in regularly ovulating women aged 18-36 years with bodyweight 60-90 kg, body mass index 18-32 kg/m2 and menstrual cycle length 24-35 days. In recombinant FSH/GnRH antagonist regimens, it appears possible to minimize weekend oocyte retrieval by selecting the cycle day to initiate stimulation, day 2 when menses starts Friday-Tuesday, otherwise day 3 and if necessary in combination with a 1-day HCG delay. © 2012, Reproductive Healthcare Ltd.

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