The Ronald relman And Claudia Cohen Center For Reproductive Medicine

New York City, NY, United States

The Ronald relman And Claudia Cohen Center For Reproductive Medicine

New York City, NY, United States
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Irani M.,The Ronald relman And Claudia Cohen Center For Reproductive Medicine | Seifer D.B.,Dartmouth Hitchcock Medical Center | Grazi R.V.,Genesis Centre | Irani S.,SUNY Downstate Medical Center | And 2 more authors.
Nutrients | Year: 2017

Vascular endothelial growth factor (VEGF) has been suggested to play a role in the pathophysiology of polycystic ovary syndrome (PCOS) and may contribute to increased risk of ovarian hyperstimulation syndrome (OHSS) in affected individuals. Vitamin D (VitD) supplementation improves multiple clinical parameters in VitD-deficient women with PCOS and decreases VEGF levels in several other pathologic conditions. Unveiling the basic mechanisms underlying the beneficial effects of vitamin D on PCOS may enhance our understanding of the pathophysiology of this syndrome. It may also suggest a new treatment for PCOS that can improve it through the same mechanism as vitamin D and can be given regardless of vitamin D levels. Therefore, we aimed to explore the effect of VitD supplementation on serum VEGF levels and assess whether changes in VEGF correlate with an improvement in characteristic clinical abnormalities of PCOS. This is a randomized placebo-controlled trial conducted between October 2013 and March 2015. Sixty-eight VitD-deficient women with PCOS were recruited. Women received either 50,000 IU of oral VitD3 or placebo once weekly for 8 weeks. There was a significant decrease in serum VEGF levels (1106.4 ± 36.5 to 965.3 ± 42.7 pg·mL–1; p < 0.001) in the VitD group. Previously reported findings of this trial demonstrated a significant decrease in the intermenstrual intervals, Ferriman-Gallwey hirsutism score, and triglycerides following VitD supplementation. Interestingly, ∆VEGF was positively correlated with ∆triglycerides (R2 = 0.22; p = 0.02) following VitD supplementation. In conclusion, VitD replacement significantly decreases serum VEGF levels correlating with a decrease in triglycerides in women with PCOS. This is a novel molecular explanation for the beneficial effects of VitD treatment. It also suggests the need to investigate a potential role of VitD treatment in reducing the incidence or severity of OHSS in VitD-deficient women with PCOS. © 2017 by the authors. Licensee MDPI, Basel, Switzerland.


PubMed | The Ronald relman And Claudia Cohen Center For Reproductive Medicine and New York Medical College
Type: | Journal: Journal of minimally invasive gynecology | Year: 2017

To investigate whether the ovarian response and pregnancy outcomes of patients undergoing in vitro fertilization (IVF) after salpingectomy is affected by the underlying indication for salpingectomy.Retrospective cohort study.Classification: II-3.University-affiliated fertility center.All patients <37 years of age undergoing IVF within 12 months of laparoscopic salpingectomy. The underlying indication for laparoscopic salpingectomy in the study cohort was either tubal ectopic pregnancy, unilateral or bilateral hydrosalpinx, or other (hematosalpinx or pyosalpinx), as confirmed by histopathology.IVF and embryo transfer (ET).Surgical characteristics, demographics, ovarian stimulation parameters, total oocytes retrieved, fertilization rates, implantation rates, and clinical pregnancy rates were compared among the salpingectomy groups. Age and time-matched patients undergoing their first IVF-ET cycle for male factor infertility, with no prior history of laparoscopy served as controls.Of the 996 laparoscopic procedures during the study period, 136 patients underwent unilateral salpingectomy for the following indications - ectopic pregnancy: 39; unilateral hydrosalpinx: 81; other: 16. Of these, 29 patients in the ectopic pregnancy group, 75 patients in the unilateral hydrosalpinx group, and 10 patients in the other group underwent subsequent IVF-ET. Thirty-one patients underwent both bilateral salpingectomy and subsequent IVF-ET. There was no difference in the antral follicle counts before and after salpingectomy in all groups. There was a statistical difference in the mean duration of ovarian stimulation in the salpingectomy groups - ectopic pregnancy: 10.9 2.15 days; unilateral hydrosalpinx: 9.56 1.95 days; bilateral hydrosalpinx: 9.51 2.01 days; other: 9.89 2.20 days; control: 9.76 1.99 days. Similar trends were noted for total gonadotropins administered when comparing the ectopic pregnancy group (3375.9 931.0 IU) to the remaining groups (unilateral hydrosalpinx: 2841.3 1160.9 IU; bilateral hydrosalpinx: 2519.3 1004.7 IU; other: 2808.6 990.1 IU; control: 2726.1 1129.8 IU). There was no difference in the total number of oocytes retrieved, fertilization rate, implantation rate or clinical pregnancy rate in the salpingectomy groups compared to controls.Although our findings indicate that patients undergoing IVF after salpingectomy for an ectopic pregnancy have a statistically longer duration of stimulation and require higher gonadotropin doses than patients undergoing IVF after salpingectomy for other indications, these differences are of limited clinical significance given that the total number of oocytes retrieved, implantation rate, and clinical pregnancy rate among the different salpingectomy groups was comparable to controls.


Lekovich J.,The Ronald relman And Claudia Cohen Center For Reproductive Medicine | Lobel A.L.S.,The Ronald relman And Claudia Cohen Center For Reproductive Medicine | Stewart J.D.,New York Presbyterian Hospital | Pereira N.,The Ronald relman And Claudia Cohen Center For Reproductive Medicine | And 2 more authors.
Journal of Assisted Reproduction and Genetics | Year: 2016

Purpose: The purpose of this study is to investigate if female patients with lymphoma demonstrate diminished ovarian reserve prior to initiation of the lymphoma treatment. Methods: Sixty-four patients with newly diagnosed lymphoma undergoing controlled ovarian hyperstimulation for fertility preservation were compared with 365 healthy controls undergoing elective oocyte cryopreservation (controlled ovarian hyperstimulation (COH)) and 128 patients with other types of malignancy prompting fertility preservation. The data of all lymphoma patients, all elective, and all the patients with other types of malignancy who met the inclusion criteria and underwent COH for fertility preservation during the study period were retrospectively analyzed. Primary outcomes included serum anti-Müllerian hormone (AMH) levels (ng/mL) and antral follicle count (AFC). Results: Patients in the lymphoma group demonstrated significantly lower AMH levels and AFC and had less oocytes harvested and cryopreserved when compared to healthy controls as well as patients with other malignancies. Conclusion: Patients with lymphoma demonstrate diminished ovarian reserve when compared with healthy controls and patients with other malignancies. This should be taken into consideration when deciding on the dose for COH. © 2016 Springer Science+Business Media New York


PubMed | The Ronald relman And Claudia Cohen Center For Reproductive Medicine and New York Presbyterian Hospital
Type: Journal Article | Journal: Journal of assisted reproduction and genetics | Year: 2016

The purpose of this study is to investigate if female patients with lymphoma demonstrate diminished ovarian reserve prior to initiation of the lymphoma treatment.Sixty-four patients with newly diagnosed lymphoma undergoing controlled ovarian hyperstimulation for fertility preservation were compared with 365 healthy controls undergoing elective oocyte cryopreservation (controlled ovarian hyperstimulation (COH)) and 128 patients with other types of malignancy prompting fertility preservation. The data of all lymphoma patients, all elective, and all the patients with other types of malignancy who met the inclusion criteria and underwent COH for fertility preservation during the study period were retrospectively analyzed. Primary outcomes included serum anti-Mllerian hormone (AMH) levels (ng/mL) and antral follicle count (AFC).Patients in the lymphoma group demonstrated significantly lower AMH levels and AFC and had less oocytes harvested and cryopreserved when compared to healthy controls as well as patients with other malignancies.Patients with lymphoma demonstrate diminished ovarian reserve when compared with healthy controls and patients with other malignancies. This should be taken into consideration when deciding on the dose for COH.


PubMed | The Ronald relman And Claudia Cohen Center For Reproductive Medicine, Mount Sinai Hospital and University of Texas Southwestern Medical Center
Type: Journal Article | Journal: Fertility and sterility | Year: 2014

Congenital adrenal hyperplasia (CAH) is the most frequently encountered genetic steroid disorder affecting fertility. Steroid hormones play a crucial role in sexual development and reproductive function; patients with either 21- hydroxylase or 11-hydroxylase deficiency thus face immense challenges to their fertility. Given the relevance of CAH in reproductive medicine as well as the diagnostic challenges posed by the phenotypic overlap with polycystic ovary syndrome, we review the reproductive pahophysiology of both classic and nonclassic CAH and present contemporary treatment options.


PubMed | Weill Cornell Medicine and The Ronald relman And Claudia Cohen Center For Reproductive Medicine
Type: | Journal: Fertility and sterility | Year: 2017

To determine whether blastocyst grading can predict pregnancy outcomes in the frozen-thawed embryo transfer (FET) of euploid blastocysts.Retrospective cohort study.Academic medical center.Women who underwent FET of euploid embryo(s) between January 2013 and December 2015, with blastocysts were divided into four groups based on their morphologic grading before cryopreservation: excellent (3AA), good (3-6AB, 3-6BA, 1-2AA), average (3-6BB, 3-6AC, 3-6CA, 1-2AB, 1-2BA), and poor (1-6BC, 1-6CB, 1-6CC, 1-2BB).FET.Ongoing pregnancy rate (OPR).A total of 417 FET cycles (477 embryos) were included. Excellent-quality embryos (n = 38) yielded a statistically significantly higher OPR than poor-quality embryos (n = 106) (84.2% vs. 35.8%; adjusted odds ratio 11.0; 95% confidence interval, 3.8-32.1) and average-quality embryos (n = 197) (84.2% vs. 55.8%; adjusted odds ratio 4.8; 95% confidence interval, 1.7-13.3). Good-quality embryos (n = 76) were associated with a statistically significantly higher OPR than poor-quality embryos (61.8% vs. 35.8%). These odds ratios were adjusted for patients age, body mass index, number of transferred embryos, type of frozen cycle, peak endometrial thickness, day of trophectoderm biopsy (5 or 6), and total number of euploid embryos for each patient. An inner cell mass grade of A yielded a statistically significantly higher OPR than ICM grade C (76.2% vs. 13.5%) or grade B (76.2% vs. 53.6%) after controlling for all confounders.Contrary to prior published studies, the current data suggest that blastocyst morphologic grading and particularly inner cell mass grade is a useful predictor of OPR per euploid embryo. Morphologic grading should be used to help in the selection among euploid blastocysts.


Pereira N.,The Ronald relman And Claudia Cohen Center For Reproductive Medicine | Brauer A.A.,The Ronald relman And Claudia Cohen Center For Reproductive Medicine | Melnick A.P.,The Ronald relman And Claudia Cohen Center For Reproductive Medicine | Lekovich J.P.,The Ronald relman And Claudia Cohen Center For Reproductive Medicine | Spandorfer S.D.,The Ronald relman And Claudia Cohen Center For Reproductive Medicine
Journal of Assisted Reproduction and Genetics | Year: 2015

Purpose To investigate the prognostic value of growth of 4- cell embryos on the day of transfer in determining clinical pregnancy and live birth rates after fresh in vitro fertilization (IVF)-embryo transfer (ET) cycles. Methods Retrospective cohort study of all patients between January 2008 and January 2013 initiating fresh IVF-ETcycles resulting in embryos that were not more than 4 cells 72 h after oocyte retrieval in the morning of their transfer. Patients were stratified into 2 groups based on whether embryos did or did not grow more than the 4-cell stage on the afternoon of ET. The odds of clinical pregnancy and live birth were considered as primary outcomes. Student’s t-tests and Chi-square (χ2) tests were used as inidicated, with logistic regression controlling for maternal age and number of embryos transferred. Results Three hundred forty three patients were identified for inclusion: 165 and 178 patients had 4-cell embryos with and without growth on the afternoon of ET, respectively. The demographic and baseline IVF cycle characteristics of the study cohort were comparable. Patients with embryo growth had higher clinical pregnancy (13.9% vs. 4.49%) and live birth (10.9% vs. 3.37%) rates compared to patients without embryo growth. This represented an overall increased odds of clinical pregnancy [Odds ratio (OR)=3.44; 95% Confidence Intervals (CI) 1.49–7.93; P=0.004)] and live birth (OR=3.51; 95% CI 1.36–9.07; P=0.01). The increased odds remained unchanged after adjusting for maternal age and number of embryos transferred. Conclusions Transfer of 4-cell embryos 3 days after oocyte retrieval can result in clinical pregnancies and live births, albeit at a low rate. Growth of an embryo more than the 4-cell stage on the afternoon of ET may serve as a positive prognostic factor for IVF-ET cycle outcome. © Springer Science+Business Media New York 2015.


PubMed | The Ronald relman And Claudia Cohen Center For Reproductive Medicine
Type: Journal Article | Journal: Fertility and sterility | Year: 2014

To determine the predictive attributes of antimllerian hormone (AMH) in terms of oocyte yield, cycle cancellation, and pregnancy outcomes.Retrospective cohort.Academic center.All patients initiating IVF at the Weill-Cornell Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine from April 2010 through January 2013.In vitro fertilization without preimplantation genetic testing.Number of oocytes retrieved, cycle cancellation, clinical and ongoing pregnancy, implantation, and miscarriage rates.Antimllerian hormone was positively correlated with number of eggs retrieved. Number of oocytes retrieved increased with increasing AMH within each age group and diminished slightly within AMH groupings as age increased. Overall, AMH was significantly correlated with risk of cycle cancellation, with an area under the curve (AUC) of 0.74. Patients with undetectable AMH had a 13.3-fold increased risk of cancellation as compared with patients with an AMH >2.0 ng/mL. Antimllerian hormone had an AUC of 0.83 for prediction of three or fewer oocytes; undetectable AMH exhibited sensitivity and specificity of 21.1% and 98.2%, respectively, for three or fewer oocytes retrieved. Antimllerian hormone was less predictive of pregnancy, with AUCs ranging from 0.55 to 0.65. Even with undetectable AMH, 23.5% of patients <40 years old achieved live birth after transfer.Antimllerian hormone is a fairly robust metric for the prediction of cancellation and how many oocytes may be retrieved after stimulation but is a relatively poor test for prediction of pregnancy after any given treatment cycle. Patients with extremely low levels of AMH still can achieve reasonable treatment outcomes and should not be precluded from attempting IVF solely on the basis of an AMH value.


PubMed | The Ronald relman And Claudia Cohen Center For Reproductive Medicine
Type: Journal Article | Journal: Journal of assisted reproduction and genetics | Year: 2015

To investigate the prognostic value of growth of 4-cell embryos on the day of transfer in determining clinical pregnancy and live birth rates after fresh in vitro fertilization (IVF)-embryo transfer (ET) cycles.Retrospective cohort study of all patients between January 2008 and January 2013 initiating fresh IVF-ET cycles resulting in embryos that were not more than 4 cells 72 h after oocyte retrieval in the morning of their transfer. Patients were stratified into 2 groups based on whether embryos did or did not grow more than the 4-cell stage on the afternoon of ET. The odds of clinical pregnancy and live birth were considered as primary outcomes. Students t-tests and Chi-square (2) tests were used as indicated, with logistic regression controlling for maternal age and number of embryos transferred.Three hundred forty three patients were identified for inclusion: 165 and 178 patients had 4-cell embryos with and without growth on the afternoon of ET, respectively. The demographic and baseline IVF cycle characteristics of the study cohort were comparable. Patients with embryo growth had higher clinical pregnancy (13.9 % vs. 4.49 %) and live birth (10.9 % vs. 3.37 %) rates compared to patients without embryo growth. This represented an overall increased odds of clinical pregnancy [Odds ratio (OR)=3.44; 95 % Confidence Intervals (CI) 1.49-7.93; P=0.004)] and live birth (OR=3.51; 95 % CI 1.36-9.07; P=0.01). The increased odds remained unchanged after adjusting for maternal age and number of embryos transferred.Transfer of 4-cell embryos 3 days after oocyte retrieval can result in clinical pregnancies and live births, albeit at a low rate. Growth of an embryo more than the 4-cell stage on the afternoon of ET may serve as a positive prognostic factor for IVF-ET cycle outcome.


PubMed | The Ronald relman And Claudia Cohen Center For Reproductive Medicine
Type: Journal Article | Journal: Current opinion in obstetrics & gynecology | Year: 2016

Oocyte cryopreservation is no longer experimental and one of its rapidly growing indications is elective fertility preservation. Currently there is no sufficient evidence to support its practice and therefore its place in IVF remains uncertain.Vitrification has superior post-thaw survival and fertilization outcomes compared with oocytes that were frozen with the slow-freeze technique. Oocyte vitrification produces similar IVF outcomes compared with fresh oocytes and is not associated with further obstetrical or perinatal morbidity. Undergoing elective oocyte cryopreservation between ages 35 and 37 will optimize live birth rates as well as cost effectiveness from mathematical models.In women who delay child bearing, elective oocyte cryopreservation in the mid 30s may be beneficial in terms of live birth rates and cost effectiveness. Prospective studies of women who have undergone oocyte cryopreservation and are now attempting conception are needed before official recommendations can be made regarding elective egg freezing.

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