Ariel Revel

At what age can human oocytes be obtained

OBJECTIVEnTo determine whether oocyte retrieval and in vitro maturation (IVM) is effective in girls undergoing fertility preservation before cancer treatment.nnnDESIGNnCohort study.nnnSETTINGnTertiary university medical center.nnnPATIENT(S)nPatients <or=20 years old before gonadotoxic chemotherapy undergoing ovarian cortex cryopreservation.nnnINTERVENTION(S)nBefore ovarian cortex cryopreservation, oocytes in all observed follicles were aspirated, matured in vitro, and cryopreserved.nnnMAIN OUTCOME MEASURE(S)nMaturation of oocytes.nnnRESULT(S)nOne hundred seventy-nine oocytes were detected in 17/19 patients (89%) aged 5-20 years. We found 7, 8, and 17 oocytes in patients 5, 8, and 10 years old, respectively. The median number of oocytes per patient was 9 (0-37). Maturation rate was 45/133 oocytes (34%). In total, 81 oocytes were cryopreserved. We cryopreserved 4 of 12 detected, 4 of 9 detected, 1 of 8 detected, and 4 of 9 detected IVM oocytes for patients aged 5-10, 11-14, 15-17, and 18-20 years old, respectively.nnnCONCLUSION(S)nPatients undergoing ovarian cryopreservation could benefit from supplementary oocyte aspiration from the cortex. Surprisingly, oocytes were detected even in young premenarcheal girls. The number of oocytes detected, matured, and cryopreserved was not age dependent. Retrieved oocytes can be matured in vitro and cryopreserved. Because no pregnancy has yet resulted from this procedure it should be considered to be experimental. We describe the youngest patients to undergo ovum collection, IVM, and oocyte cryopreservation.

Fertility considerations and preservation in haemato-oncology patients undergoing treatment

The improved survival rates among patients with haematological malignancies, such as lymphoma and leukaemia, are shifting areas of focus towards understanding and preventing treatment‐induced sequelae. Of these, infertility is one of the most devastating consequences for patients with reproductive potential. The degree of treatment‐induced gonadal dysfunction depends on age and gender‐related differences, the type and dosage of chemotherapy used and the field and cumulative dose of abdomino‐pelvic irradiation. There is also the interesting phenomenon of reduced pre‐treatment fertility among male lymphoma patients. At present, the only established methods of fertility preservation are cryopreservation of sperm, oocytes and embryos, as well as gonadal shielding and transposition of ovaries during irradiation. Several other methods, such as cryopreservation and subsequent transplantation of gonadal tissue and the gonadoprotective role of hormonal suppression, are under investigation. Pre‐pubertal patients present a unique constellation of fertility considerations, especially as embryo and sperm cryopreservation are not applicable to this age group.

Beginning IVF Treatments After Age 30 Increases the Risk of Breast Cancer: Results of a Case–Control Study

Abstract:u2002 The long‐term risks of in vitro fertilization (IVF) treatment remain unclear. This study was designed to determine breast cancer risk factors in women who underwent IVF, and to establish characteristics of these tumors. Records of 7,162 consecutive women who underwent IVF at a single center between 1984 and 2002 were linked with the Israel Cancer Registry to identify women who developed breast cancer. IVF‐related parameters were compared between 28 breast cancer patients who had undergone IVF (IVF BC) and for whom complete IVF data were available with 140 women who underwent IVF and did not develop breast cancer (IVF non‐BC). Tumor parameters were compared between 38 patients who developed breast cancer after IVF and 114 age‐matched breast cancer patients who did not undergo IVF (non‐IVF BC). Age over 30 at the time of first IVF treatment, even after controlling for age at first birth, was the only parameter significantly associated with increased breast cancer risk (RRu2003=u20031.24, pu2003=u20030.02, 95% CIu2003=u20031.03–1.48). There were no differences between IVF‐BC and IVF non‐BC patients in all other IVF‐related parameters. The only statistically significant difference in tumors developing in IVF‐BC patients compared with non‐IVF BC patients was in grade distribution, particularly for grade II tumors. However, the significance of such a difference is unclear. Women who start IVF after the age of 30 appear to be at increased risk of developing breast cancer. The characteristics of breast tumors in women who underwent IVF are no different than in patients without previous exposure to IVF.

Underdiagnosed Menorrhagia in Adolescents is Associated with Underdiagnosed Anemia

OBJECTIVEnTo test the hypothesis that adolescent girls with menorrhagia rarely seek medical attention.nnnSTUDY DESIGNnA total of 705 adolescent girls attended a lecture on menorrhagia, completed an initial anonymous questionnaire, and were asked to participate in a more comprehensive study comprising a detailed bleeding questionnaire, a pictorial blood loss assessment chart, and blood tests.nnnRESULTSnA total of 105 adolescents (15%) reported they had heavy periods on the initial questionnaire. Among the 94 girls who completed the full questionnaire, 34 reported menorrhagia (36%; 95% CI, 26.5%-46.7%). Almost one-third (11 of 34) of these girls did not perceive having menorrhagia according to their response to the initial questionnaire. Menorrhagia was not related to age, years since menarche, or family history of menorrhagia. Among the 62 girls who consented to blood testing, 6 had anemia (9.6%; 95% CI, 3.6%-19.6%), all of whom had bleeding symptoms.nnnCONCLUSIONnUsing standardized questionnaires, we were able to identify adolescents with menorrhagia associated with anemia. Importantly, some of these adolescents were not aware of having menorrhagia and/or anemia. Screening programs for menorrhagia in schools could result in better detection of menorrhagia among adolescents and consequent appropriate referral for medical consultation.

The benefit of human chorionic gonadotropin supplementation throughout the secretory phase of frozen-thawed embryo transfer cycles

OBJECTIVEnTo assess whether supplementation with hCG throughout the secretory phase of hormonally modulated cycles of frozen-thawed embryos might positively affect the outcome of such cycles.nnnDESIGNnProspective, randomized controlled trial.nnnSETTINGnUniversity teaching hospital.nnnPATIENT(S)nPatients undergoing frozen-thawed embryo transfer cycles.nnnINTERVENTION(S)nPatients were randomly divided into two groups by the last digit of their identification number. Group A received our standard protocol for endometrial preparation, whereas group B patients were given an additional 250 microg of recombinant hCG on day of P initiation, the day of embryo transfer, and 6 days later. Throughout the cycle, and to compare between the groups, serial ultrasound examinations and hormonal tests of E(2) and P serum levels were obtained.nnnMAIN OUTCOME MEASURE(S)nImplantation and clinical pregnancy rates (PR).nnnRESULT(S)nOne hundred sixty-five patients were enrolled in this study, 78 in the control group and 87 in the hCG-treated group. Progesterone levels and endometrial thickness were similar throughout the cycle in both groups. The E(2) level was significantly higher in group B on the day of embryo transfer and 6 days later. The PRs did not differ between the two groups (28.2% and 32.2% for groups A and B, respectively). Similarly, the implantation rates were comparable between the groups (12.7% and 14.9%, respectively).nnnCONCLUSION(S)nNo advantage was found concerning PR and implantation rate by supplementing the secretory phase with hCG in patients undergoing transfer of frozen-thawed embryo in hormonally modulated cycles.

Assisted reproduction policies in Israel: a retrospective analysis of in vitro fertilization–embryo transfer

OBJECTIVEnTo analyze whether the results and effectiveness of the open-ended treatment with IVF in Israel justifies the policy of limitless nondonor IVF rounds.nnnDESIGNnThe research sample included 535 patients. The files of these patients were reviewed; data were extracted into a questionnaire, transferred into digital files, and analyzed with SPSS.nnnSETTINGnIVF clinics.nnnPATIENT(S)nTwo hundred ten women who began IVF treatment in 2000 and 325 women who were in IVF treatment duringxa02010.nnnINTERVENTION(S)nNone.nnnMAIN OUTCOME MEASURE(S)nRetrospective analysis of the success rates of live births resulting from cycles with IVF in women who started treatment in 2000, retrospective analysis of IVF results during 2010, and number of cycles in women who were in IVF treatment duringxa02010.nnnRESULT(S)nIn the 2000 cohort, the rate of success with IVF was 54%. The success rate fell as the number of unsuccessful cycles and duration of infertility increased; age at the beginning of the treatment was influential. A similar pattern appeared in the group that was in treatment during 2010. The rate of success in the group that was in IVF treatment during 2010 was 16.6%; of the women in this group (2010, ongoing), 25% had already undergone more than five cycles and 12% of the women had already undergone more than seven cycles.nnnCONCLUSION(S)nAlthough limited in scope, this study suggests that the policy of limitless nondonor IVF-ET cycles in Israel should be further examined and assessed.

Is routine screening needed for coagulation abnormalities before oocyte retrieval

A cross-sectional retrospective study was performed to question the utility of coagulation screening to prevent procedure-related bleeding before oocyte retrieval in IVF. Among 1,032 patients evaluated we found that 534 coagulation tests were needed to prevent one case of bleeding associated with an abnormal coagulation test result.

In Vitro Fertilization Outcomes After Placement of Essure Microinserts in Patients With Hydrosalpinges Who Previously Failed In Vitro Fertilization Treatment: A Multicenter Study

STUDY OBJECTIVEnTo investigate whether hysteroscopic proximal tubal occlusion with Essure microinsertsxa0(Conceptus Inc.; Bayer, AG, North Rhine-Westphalia, Germany) can improve pregnancy rates in patients with hydrosalpinges who had failed inxa0vitro fertilization (IVF) treatment.nnnDESIGNnA prospective cohort study.nnnSETTINGnUniversity-affiliated tertiary centers.nnnPATIENTSnTwenty-four consecutive women with hydrosalpinges who had failed IVF treatment were included.nnnINTERVENTIONSnHysteroscopic placement of Essure microinserts for hydrosalpinx blockage followed by IVF treatment.nnnMEASUREMENTS AND MAIN RESULTSnOngoing pregnancy and live birth rates were recorded. Of the 24 patients undergoing a total of 42 IVF cycles after Essure insertion, 18 (75% of patients and 42.8% of IVF cycle attempts) conceived and 16 delivered live births (66.6% of patients and 38.1% of IVF cycle attempts).nnnCONCLUSIONnHysteroscopic proximal occlusion of hydrosalpinges with Essure microinserts is a valuable alternative to laparoscopic salpingectomy, resulting in reasonable pregnancy rates.

The value of human chorionic gonadotropin stimulation test in predicting ovarian response during in-vitro fertilization.

PurposeTo assess the predictive value of human Chorionic Gonadotropin (hCG) theca-stimulation test for ovarian reserve in women undergoing in-vitro fertilization (IVF) treatments.Methods39 women were included in the study. All participants received a single hCG 10000xa0IU injection on cycle day 2–3. Serum levels of estradiol, testosterone, androstenedione and 17-OH progesterone were measured prior to the injection and on days 1, 3 and 7 following the injection. hCG-induced hormone levels were compared with ovarian response during the subsequent IVF cycle.ResultsThere were 11 good responders (>10 oocytes) and 22 low responders (<3 oocytes). Before hCG stimulation serum E2 levels were higher in low responders compared to good responders (370.3u2009±u2009443 vs. 138.3u2009±u200954 pmol/ml). Following hCG stimulation, day 3 androstendione levels showed an increase in good responders compared to low responders. The ratio between day 3 androstendione and day 0 estradiol was significantly different between the two groups (pu2009=u20090.03). ROC analysis of this test revealed area = 0.837 (good prediction), which was much better than day 3 FSH (area = 0.635, poor prediction).ConclusionsThese preliminary results demonstrate the potential use of the hCG theca stimulation test in differentiating between good and poor responders. Larger series are needed for further verification of the test in routine clinical application.

Women's post-chemotherapy parity is affected by offspring number and marital status

Childbearing rates post-chemotherapy for breast cancer (BC) are affected by age and chemotherapy-type but may also depend on personal characteristics. In this single institution retrospective study we evaluated post-chemotherapy fertility and its association with offspring number and marital-status at the time of BC diagnosis. We identified 65 fertile BC patients under 38y, who received adjuvant-chemotherapy. Menses resumption and pregnancies along with offspring-number and marital-status were recorded. Menses resumed in 95.4% and 33.8% gave birth. Of those who did not give birth 46.5% had at least three children at diagnosis and of those without children 83% were unmarried. Our data associates multiparity with lower childbearing post-chemotherapy, suggesting it as a possible surrogate for womens preferences in retrospective studies. Unlike multiparity, marital status association with lower childbearing may be culture-dependent and not a universal surrogate for womens intentions and would be best investigated prospectively.