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Schiewe M.C.,361 Hospital Road | Whitney J.B.,361 Hospital Road | Anderson R.E.,361 Hospital Road | Anderson R.E.,Southern California Center for Reproductive Medicine
Fertility and Sterility | Year: 2015

Objective To document the risk of in vitro monochorionic dizygotic twin formation in the implementation of a program of blastocyst biopsy with preimplantation genetic screening (PGS). Design Case report. Setting Private infertility laboratory. Patient(s) Prospective PGS patients with intracytoplasmic sperm injection-derived, group-cultured blastocysts over a 3-year period. Intervention(s) Group culture in Global medium (Life Global) to optimize blastocyst formation of zygotes produced for blastocyst biopsy for PGS (n ≤ 8 embryos/25 μL droplet), and laser zona dissection (LZD) of all day-3 cleaved embryos to promote pre-expansion trophectodermal extrusion at the blastocyst stage (i.e., premature hatching). Main Outcome Measure(s) Blastocyst formation and quality grading on days 5 and 6 of in vitro culture for the vitrified embryo transfer of single or dual euploid blastocysts. Result(s) Over 3,000 blastocysts were produced in vitro. On two separate occasions, complete trophectodermal amalgamation was observed between two hatching blastocysts. Vitrified single-euploid blastocyst transfers efficiently implanted and established clinical pregnancies similar to dual-euploid blastocyst transfers, without the risk of twin formation. Conclusion(s) The amazing occurrence of monochorionic dizygotic twin formation has now been documented in vitro, supporting the theory that assisted reproductive technology may facilitate this rare perinatal condition. Furthermore, we have provided clinical evidence that the transfer of a single-euploid blastocyst can optimize a patient's pregnancy success while reducing potentially undesirable conditions associated with monochorionic twin pregnancies. © 2015 American Society for Reproductive Medicine.


Schiewe M.C.,Ovagen Fertility | Rothman C.,California Cryobank CCB | Rothman C.,Center for Male Reproduction and Vasectomy Reversal | Spitz A.,University of California at Irvine | And 3 more authors.
Journal of Assisted Reproduction and Genetics | Year: 2016

Purpose: The aim of our paper was to validate a testicular biopsy procedure that simplifies handling, processing, and cryopreservation, while at the same time optimizes sperm motility before freezing and after thawing. Methods: Two prospective studies were conducted to verify, optimize, and understand the virtues of pre-freeze testicular tissue IVC at different temperatures (21, 30, or 37 °C). Testicular tissue was obtained from clinical specimens designated for whole tissue cryopreservation (i.e., intact mass of tubules) and/or for fresh use in IVF-ICSI cycles. Whole testicular biopsy pieces (1–3 mm3) were diluted in glycerol containing freeze solutions, slow cooled to 4 °C and then rapidly frozen in LN2 vapor. Fresh and post-thaw testicular biopsy tissue were evaluated for changes in the quantity (%) and pattern of motility (I–IV: twitching to rapid progression, respectively) over a 1 week duration. The clinical effectiveness of IVC-cryopreserved whole testicular biopsy tissue was also validated analyzing fresh embryo transfers. Results: More reliable recovery of motile testicular sperm was achieved using whole tissue freeze preservation combined with IVC (24–96 h) post-acquisition at an incubation temperature of 30 °C compared to ambient temperature (21 °C) or 37 °C. Up to 85 % of the pre-freeze motility was conserved post-thaw (+3 h) for easy ICSI selection. Sperm longevity was optimized to fresh tissue levels by implementing testicular biopsy sucrose dilution post-thaw. Favorable clinical outcomes were proven using frozen-thawed testicular biopsy sperm for ICSI. Conclusions: By employing minimal tissue manipulation, integrating pre-freeze IVC processing at 30 °C and the freezing of whole testicular biopsy tissue, we have reduced the labor and improved the efficacy of processing testicular tissue for freeze-preservation and subsequent ICSI use. © 2016 The Author(s)


PubMed | California Cryobank CCB, University of California at Irvine, Ovagen Fertility, Center for Male Reproduction and Vasectomy Reversal and 2 more.
Type: Journal Article | Journal: Journal of assisted reproduction and genetics | Year: 2016

The aim of our paper was to validate a testicular biopsy procedure that simplifies handling, processing, and cryopreservation, while at the same time optimizes sperm motility before freezing and after thawing.Two prospective studies were conducted to verify, optimize, and understand the virtues of pre-freeze testicular tissue IVC at different temperatures (21, 30, or 37C). Testicular tissue was obtained from clinical specimens designated for whole tissue cryopreservation (i.e., intact mass of tubules) and/or for fresh use in IVF-ICSI cycles. Whole testicular biopsy pieces (1-3mm(3)) were diluted in glycerol containing freeze solutions, slow cooled to 4C and then rapidly frozen in LN2 vapor. Fresh and post-thaw testicular biopsy tissue were evaluated for changes in the quantity (%) and pattern of motility (I-IV: twitching to rapid progression, respectively) over a 1week duration. The clinical effectiveness of IVC-cryopreserved whole testicular biopsy tissue was also validated analyzing fresh embryo transfers.More reliable recovery of motile testicular sperm was achieved using whole tissue freeze preservation combined with IVC (24-96h) post-acquisition at an incubation temperature of 30C compared to ambient temperature (21C) or 37C. Up to 85% of the pre-freeze motility was conserved post-thaw (+3h) for easy ICSI selection. Sperm longevity was optimized to fresh tissue levels by implementing testicular biopsy sucrose dilution post-thaw. Favorable clinical outcomes were proven using frozen-thawed testicular biopsy sperm for ICSI.By employing minimal tissue manipulation, integrating pre-freeze IVC processing at 30C and the freezing of whole testicular biopsy tissue, we have reduced the labor and improved the efficacy of processing testicular tissue for freeze-preservation and subsequent ICSI use.


Whitney J.B.,Ovation Fertility | Schiewe M.C.,Ovation Fertility | Anderson R.E.,Ovation Fertility | Anderson R.E.,Southern California Center for Reproductive Medicine
Journal of Assisted Reproduction and Genetics | Year: 2016

Purpose: The study aims to contrast the efficacy of trophectoderm biopsy preimplantation genetic screening (PGS)/vitrification (VTF)-all cycles to past treatment protocols. Specifically, do these applied technologies increase live birth rates on a per cycle/first transfer basis? Materials and methods: An observational, retrospective cohort study of first transfer outcomes was performed in two groups. Group 1 (PGS) included PGS/VTF-all cycles, and group 2 (no PGS) included the first transfer from non-PGS fresh cycles or VTF-ALL cycles. In group 1, all blastocysts were biopsied on days 5/6, vitrified and array CGH performed. Group 2 patients had embryo transfers on day 3 or day 5. All blastocysts were vitrified and warmed according to μS-VTF protocols. Clinical pregnancies and implantation were confirmed by ultrasound and live birth information attained. Results were stratified by age with donor cycles excluded, and to eliminate bias, the same groups were then validated on a per cycle basis. Chi-squared used to determine significance. Results: Analyzing 287 embryo transfers and 1,000+ PGS-tested blastocysts, an overall 97 % increase in live births favored group 1 (PGS). When utilizing PGS/VTF-ALL cycles, patients under 43 years old exhibited higher implantation, clinical pregnancy, and ongoing/live birth rates. Re-analyzing the data to include all cycles initiated revealed higher live birth rates in group 1 age groups ≤34 and 38–40 years old. Conclusion: Validating PGS on a per cycle basis eliminated data bias by including patients without blastocysts to biopsy or euploid embryos. Clearly, PGS uses blastocysts more efficiently to achieve success, while many women over 40 may benefit most by understanding why some failures occur. Support: None © 2016 The Author(s)


PubMed | Reproductive science Center, Reproductive Research Section, Southern California Center for Reproductive Medicine, The Scotia Clinic and Rosenblatt Securities Inc
Type: Journal Article | Journal: Birth defects research. Part C, Embryo today : reviews | Year: 2016

Preimplantation genetic screening (PGS) is a component of IVF entailing selection of an embryo for transfer on the basis of chromosomal normalcy. If PGS were integrated with single embryo transfer (SET) in a surrogacy setting, this approach could improve pregnancy rates, minimize miscarriage risk, and limit multiple gestations. Even without PGS, pregnancy rates for IVF surrogacy cases are generally satisfactory, especially when treatment utilizes embryos derived from young oocytes and transferred to a healthy surrogate. However, there could be a more general role for PGS in surrogacy, since background aneuploidy in embryos remains a major factor driving implantation failure and miscarriage for all infertility patients. At present, the proportion of IVF cases involving GS is limited, while the number of IVF patients requesting PGS appears to be increasing. In this report, the relevance of PGS for surrogacy in the rapidly changing field of assisted fertility medicine is discussed.


Lathi R.B.,Stanford University | Moayeri S.E.,Southern California Center for Reproductive Medicine | Reddy C.D.,University of California at Irvine | Gebhardt J.,Stanford University | And 2 more authors.
Reproductive BioMedicine Online | Year: 2012

This prospective cohort study of infertility patients compared testosterone concentrations in early pregnancy in infertility patients who conceived naturally or after treatment. Although all groups demonstrated some increase in pregnancy testosterone from baseline concentrations, subjects who conceived following ovulation induction showed a significantly increased rise in testosterone as compared with controls (P < 0.01). © 2011 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

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