Anthony Wakim

Random-start gonadotropin-releasing hormone (GnRH) antagonist–treated cycles with GnRH agonist trigger for fertility preservation

OBJECTIVE To describe our experience with random-start IVF with the use of GnRH agonist for final oocyte maturation, to reduce the risk of ovarian hyperstimulation syndrome. DESIGN Case series. SETTING University-based center for reproductive endocrinology and infertility. PATIENT(S) Patients with a new diagnosis of cancer who presented with a narrow time frame for IVF before initiating cancer therapy. INTERVENTION(S) Random-start GnRH antagonist cycles with GnRH agonist trigger for final oocyte maturation. MAIN OUTCOME MEASURE(S) Number of oocytes retrieved, fertilization rate, rates of ovarian hyperstimulation syndrome. RESULTS Cycles were started in the late follicular or luteal phase, and the duration of controlled ovarian hyperstimulation ranged between 8-13 days. A total of 14-40 oocytes were retrieved and 5-20 embryos cryopreserved for each patient. CONCLUSION(S) Random-start IVF is a reasonable option for fertility preservation in those cancer patients for whom the treatment window may be narrow. In addition, the use of a GnRH agonist for final oocyte maturation may decrease the potential risk of ovarian hyperstimulation syndrome.

The relationship between perceived stress, acupuncture, and pregnancy rates among IVF patients: A pilot study

UNLABELLED The aim of this paper was to determine the effect of acupuncture on perceived stress levels in women on the day of embryo transfer (ET), and to determine if perceived stress levels at embryo transfer correlated with pregnancy rates. The study was an observational, prospective, cohort study based at the University IVF center. PATIENT(S) 57 infertile patients undergoing IVF or IVF/ICSI. INTERVENTIONS(S) Patients were undergoing Embryo Transfer with or without acupuncture as part of their standard clinical care. MAIN OUTCOME MEASURE(S) Perceive Stress Scale scores, pregnancy rates. RESULT(S) women who received this acupuncture regimen achieved pregnancy 64.7%, whereas those without acupuncture achieved pregnancy 42.5%. When stratified by donor recipient status, only non-donor recipients potentially had an improvement with acupuncture (35.5% without acupuncture vs. 55.6% with acupuncture). Those who received this acupuncture regimen had lower stress scores both pre-ET and post-ET compared to those who did not. Those with decreased their perceived stress scores compared to baseline had higher pregnancy rates than those who did not demonstrate this decrease, regardless of acupuncture status. CONCLUSIONS(S) The acupuncture regimen was associated with less stress both before and after embryo transfer, and it possibly improved pregnancy rates. Lower perceived stress at the time of embryo transfer may play a role in an improved pregnancy rate.

Gonadotropin-releasing hormone agonist or human chorionic gonadotropin for final oocyte maturation in an oocyte donor program

OBJECTIVE To compare leuprolide acetate to hCG as the trigger for final oocyte maturation in oocyte donor cycles. DESIGN Retrospective review. SETTING Academic IVF donor program. PATIENT(S) Thirty-two healthy oocyte donors aged 21-33 years with adequate ovarian reserve. INTERVENTION(S) Donors were down-regulated with cetrorelix and received either leuprolide acetate (n = 12) or hCG (n = 20) for final oocyte maturation. MAIN OUTCOME MEASURE(S) Embryo number, embryo quality, fertilization, implantation, clinical pregnancy, and ovarian hyperstimulation syndrome rates. RESULT(S) The numbers of total oocytes (23 vs. 15), mature (metaphase II) oocytes (22 vs. 13), embryos (15 vs. 10), and cryopreserved embryos (12 vs. 6) per treatment cycle were significantly greater in the leuprolide arm than in the hCG arm. Fertilization rates (73% vs. 78%), implantation rates (30% vs. 29%), and clinical pregnancy rates (40% vs. 50%) were not statistically different between the arms. There were no cases of ovarian hyperstimulation syndrome. CONCLUSION(S) Leuprolide acetate-triggered oocyte donor cycles yielded similar fertilization, implantation, and clinical pregnancy rates to hCG-triggered cycles.

Meiotic products of two reciprocal translocations studied by multicolor fluorescence in situ hybridization

The sperm products of two male carriers of reciprocal translocations were studied by fluorescence in situ hybridization (FISH) using a combination of three probes for each translocation. One patient carried a t(2;18)(p21;q11.2), the other a t(8;9)(q24.2;q32). The probes selected included a centromeric marker for each chromosome involved in the translocation plus a third probe distal to the translocation breakpoint of one of the translocation chromosomes. This assay identifies alternate, adjacent 1, adjacent 2, and 3:1 types of meiotic products. It allows the identification of recombination events and also estimation of the frequency of diploidy. For the t(2;18), the frequency of normal and balanced sperm and of adjacent 1, adjacent 2, and 3:1 products was 43.6%, 29.8%, 10.5%, and 12.8%, respectively. Similar segregation patterns had been reported for this donor by direct sperm karyotyping of sperm cells. For the t(8;9), the frequency of normal and balanced sperm and of adjacent 1, adjacent 2, and 3:1 products was 44.4%, 41%, 3.1%, and 9.4%, respectively. The frequency of complementary adjacent 1 products was statistically different in both the t(2;18) (P < 0.0001) and the t(8;9) (P < 0.0001) carrier. When the number of adjacent 2 products with one translocation chromosome (regardless of normal or derivative) was compared to the number of adjacent 2 products with the second translocation chromosome (again, regardless of normal or derivative), no statistical difference was noted for either the t(2;18) (P = 0.32) or the t(8;9) (P = 0.69). Recombination events within the interstitial segment of chromosome 2 were statistically higher than those seen in chromosome 18 (P < 0.0001), whereas in chromosomes 8 and 9, recombination in the interstitial segments was similar (P = 0.64). The rate of diploidy was similar in both the t(2;18) (0.5%) and the t(8;9) (0.6%). Thus, FISH provides chromosome information on the sperm products produced by translocation carriers, although it cannot provide an assessment of the full chromosome complement of the spermatozoon.

Complex X chromosome rearrangement delineated by array comparative genome hybridization in a woman with premature ovarian insufficiency

OBJECTIVE To investigate candidate genes affected by a complex X chromosome rearrangement that may play a role in the diagnosis of spontaneous premature ovarian insufficiency (POI). DESIGN Prospective cytogenetic analysis, fluorescence in situ hybridization (FISH) analysis and oligonucleotide array comparative genome hybridization (CGH). SETTING University medical center. PATIENT(S) A 36-year-old woman with POI found to have a highly rearrangement X chromosome. INTERVENTION(S) FISH analysis and oligonucleotide array CGH. MAIN OUTCOME MEASURE(S) Oligonucleotide microarray analysis to detect duplicated, deleted, or translocated regions of the X chromosome. RESULT(S) Complex rearrangement of the X chromosome involving ≥12 breakpoints resulting in two deletions, four duplications, and several intrachromosomal translocations. At least 13 genes with possible relevance to POI may be affected by the rearrangement. CONCLUSION(S) Array CGH can reveal candidate genes that may have essential roles in fertility and POI.

Progesterone level at oocyte retrieval predicts in vitro fertilization success in a short-antagonist protocol: a prospective cohort study

OBJECTIVE To evaluate the distribution of P levels on the day of oocyte retrieval as it relates to pregnancy outcome in an antagonist protocol, which may be at higher risk for elevated P levels. DESIGN Prospective cohort study. SETTING Academic IVF center. PATIENT(S) One hundred eighty-six women undergoing controlled ovarian hyperstimulation with an antagonist protocol. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Implantation, pregnancy, and spontaneous abortion rates were collected. RESULT(S) Implantation rate (positive hCG 14 days after ET) and pregnancy rate were significantly higher when the P level was <12 ng/mL on the day of oocyte retrieval. Miscarriage rates were higher when the P level was ≥12 ng/mL, although this did not reach statistical significance. CONCLUSION(S) Elevated P on the day of oocyte retrieval is associated with significantly lower implantation and ongoing pregnancy rates. This is the first study to date to both uncover the distribution of P on the day of oocyte retrieval in an antagonist cycle and determine the impact an elevation may have on pregnancy outcome.