Andrea Reh

Impact of breast cancer chemotherapy on ovarian reserve: a prospective observational analysis by menstrual history and ovarian reserve markers

OBJECTIVE To determine whether addition of taxanes to anthracycline and cyclophosphamide regimens impact ovarian function as assessed by menstrual history and ovarian reserve markers. DESIGN Prospective observational analysis. SETTING Large university fertility center. PATIENT(S) Forty-five women with a history of breast cancer of stages I-IIIA who either received anthracycline, cyclophosphamide, and paclitaxel (ACT) or received anthracycline with cyclophosphamide (AC). INTERVENTION(S) Menstrual histories were obtained at 6 months and at a mean of 28 months after chemotherapy. Early follicular phase FSH and E(2) samples were obtained at the second follow-up. MAIN OUTCOME MEASURE(S) Incidence of amenorrhea and abnormal laboratory values. RESULT(S) There was no statistically significant difference in the rates of amenorrhea at 6 months after chemotherapy (AC group, 41.7%; ACT group, 29%). At the second follow-up, a mean of 28 months after chemotherapy, there was a trend toward higher amenorrhea in the ACT patients (35.7%, vs. 9.1% in the AC group). When the ovarian markers were included, an additional eight menstruating patients were identified with abnormally elevated FSH or E(2) levels. CONCLUSION(S) We found no significant long- or short-term impact of taxanes on rates of amenorrhea. Future studies on the reproductive effects of chemotherapeutic agents should incorporate ovarian reserve markers, because menstrual history alone may underestimate the impact of these cytotoxic agents.

Utilization and success rates of unstimulated in vitro fertilization in the United States: an analysis of the Society for Assisted Reproductive Technology database

OBJECTIVE To examine the utilization and outcomes of natural cycle (unstimulated) IVF as reported to the Society of Assisted Reproductive Technology (SART) in 2006 and 2007. DESIGN Retrospective analysis. SETTING Dataset analysis from the SART Clinical Outcome Reporting System national database. PATIENT(S) All patients undergoing IVF as reported to SART in 2006 and 2007. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Utilization of unstimulated IVF; description of patient demographics; and comparison of implantation and pregnancy rates between unstimulated and stimulated IVF cycles. RESULT(S) During 2006 and 2007 a total of 795 unstimulated IVF cycles were initiated. Success rates were age dependent, with patients <35 years of age demonstrating clinical pregnancy rates per cycle start, retrieval, and transfer of 19.2%, 26.8%, and 35.9%, respectively. Implantation rates were statistically higher for unstimulated compared with stimulated IVF in patients who were 35 to 42 years old. CONCLUSION(S) Unstimulated IVF represents <1% of the total IVF cycles initiated in the United States. The pregnancy and live birth rates per initiated cycle were 19.2% and 15.2%, respectively, in patients <35 years old. The implantation rates in unstimulated IVF cycles compared favorably to stimulated IVF. Natural cycle IVF may be considered in a wide range of patients as an alternative therapy for the infertile couple.

Natural cycle in vitro fertilization implantation rates compared to stimulated in vitro fertilization and role of serum antimullerian hormone levels

Objective: The objective of this study is to compare implantation and singleton live birth rates between natural cycle in vitro fertilization (NCIVF) and stimulated IVF. Stratify the results by age and antimullerian hormone (AMH). Design: Retrospective cohort trial of patients who underwent unstimulated IVF between 2007 and 2011. Stimulated patient data from the 2010 Centers for Disease Control (CDC) report. Setting: Private practice. Patients: Infertility patients Intervention: None. Main Outcome Measures: (1) Implantation rates stratified by age and AMH (2) singleton pregnancy rates. Results: A total of 1288 cycles of NCIVF were compared to 94,976 cycles from CDC. In patients Conclusions: Implantation rates were superior in patients 35-40 undergoing NCIVF compared with stimulated IVF. In NCIVF implantation rate was independent of AMH. The live singleton birth rates per embryo transfer for NCIVF and stimulated IVF are similar.