Jack Y.J. Huang

Obstetric and perinatal outcome in 200 infants conceived from vitrified oocytes

Cryopreservation of oocytes by vitrification is a promising new technique for assisted human reproduction. Any new technical development must be accompanied with data concerning obstetric and perinatal outcome. This study analysed the obstetric and perinatal outcomes in 165 pregnancies and 200 infants conceived following oocyte vitrification cycles in three assisted reproduction centres. The results indicate that the mean birth weight and the incidence of congenital anomalies are comparable to that of spontaneous conceptions in fertile women or infertile women undergoing in-vitro fertilization treatment. These preliminary findings may provide reassuring evidence that pregnancies and infants conceived following oocyte vitrification are not associated with increased risk of adverse obstetric and perinatal outcomes.

Obstetric outcomes following vitrification of in vitro and in vivo matured oocytes

OBJECTIVE To evaluate obstetric outcomes with oocyte vitrification after ovarian stimulation (OS) and in vitro maturation (IVM) of immature oocytes. DESIGN A prospective trial from October 2003 to April 2007. SETTING University-based medical center. PATIENT(S) OS group: 38 patients undergoing intrauterine insemination who overresponded to OS. IVM group: 20 patients who had previous unsuccessful intrauterine insemination. INTERVENTION(S) Mature oocyte retrieval following OS. Immature oocyte retrieval and IVM. Oocyte vitrification, thawing, insemination, and transfer of the resulting embryos. MAIN OUTCOME MEASURE(S) Live-birth rates and obstetric outcomes. RESULT(S) The OS group was superior to the IVM group in terms of oocyte survival (81.4 +/- 22.6% vs. 67.5 +/- 26.1%), fertilization rate (75.6 +/- 22.5% vs. 64.2 +/- 19.9%), and cumulative embryo score (38.4 +/- 22.3 vs. 20.0 +/- 13.8). However, the differences in the implantation rate per embryo (19.1 +/- 25.8% vs. 9.6 +/- 24.1%), clinical pregnancy rate per cycle started (44.7%, vs. 20.0%), and live-birth rate per cycle started (39.5% vs. 20.0%) were not statistically significant. Twenty healthy babies were born in the OS group and four in the IVM group. CONCLUSION(S) Pregnancies achieved with vitrification of oocytes after OS and IVM treatments do not appear to be associated with adverse pregnancy outcomes. Vitrification of IVM oocytes represents a novel option for fertility preservation.

Live birth after vitrification of in vitro matured human oocytes

OBJECTIVE To report the first healthy live birth from immature oocytes retrieved in a natural menstrual cycle, followed by in vitro maturation (IVM) and cryopreservation of the oocytes by vitrification. DESIGN Case report. SETTING University-based tertiary medical center. PATIENT(S) A 27-year-old woman with tubal disease and polycystic ovaries. INTERVENTION(S) Immature oocytes were retrieved by transvaginal ultrasound guided follicle aspiration on day 13 of her natural menstrual cycle, matured in vitro and vitrified. The oocytes were thawed in a subsequent menstrual cycle, inseminated by intracytoplasmic sperm injection, and the resulting embryos transferred. MAIN OUTCOME MEASURE(S) Oocyte maturation and survival rates, pregnancy, and live birth. RESULT(S) One metaphase II and 18 germinal vesicle stage oocytes were collected; 16 out of 18 germinal vesicle oocytes matured, and a total of 17 oocytes were vitrified. After thawing, four IVM oocytes survived; three embryos were transferred. The woman went on to deliver a single healthy live baby at term. CONCLUSION(S) We provide proof-of-principle evidence that the novel fertility preservation strategy of immature oocyte retrieval, IVM, and vitrification of oocytes can lead to successful pregnancy and healthy live birth.

Fertility preservation for breast-cancer patients using IVM followed by oocyte or embryo vitrification.

Unstimulated in-vitro maturation (IVM) cycles are considered for fertility preservation in breast cancer due to avoidance of ovarian stimulation and shortened time to oocyte retrieval. This study evaluated the efficacy of this approach in a retrospective cohort analysis of 66 patients with breast cancer. Immature oocytes were collected and matured in vitro and then either vitrified or fertilized and preserved as vitrified embryos. In group 1 (vitrified oocytes, n=35), the average number of oocytes retrieved was 11.4 ± 8.8, the maturation rate was 64.2% and an average of 7.9 ± 6.6 oocytes were vitrified per patient treated. The median duration from the first evaluation to oocyte retrieval was 8 days. In group 2 (vitrified embryos, n=31) the average number of oocytes retrieved was 9.7 ± 6.4, the maturation rate was 53.2% and an average of 5.8 ± 2.7 mature oocytes were available for fertilization/patient. The fertilization rate was 77.8%, resulting in 4.5 ± 2.7 vitrified embryos/patient. The median duration from the first evaluation to oocyte retrieval was 13 days. Calculated pregnancy rates per vitrified oocyte and embryo were 3.8% and 8.1%, respectively. IVM can be considered a useful option for fertility preservation in breast-cancer patients.

Fertility preservation treatment for young women with autoimmune diseases facing treatment with gonadotoxic agents

OBJECTIVE To describe a case series of seven women with SLE and other systemic autoimmune rheumatic diseases (SARDs) who required cyclophosphamide therapy and underwent fertility preservation treatments. METHODS Of the seven patients reported here, five women had SLE with nephritis, the sixth had immune thrombocytopenia purpura (ITP) and the seventh had microscopic polyangiitis (MPA) with renal involvement. All women were nulliparous and younger than 35 yrs. RESULTS Patients with SLE underwent in vitro maturation (IVM) of immature oocytes aspirated during a natural menstrual cycle followed by vitrification of the matured oocytes if a male partner was not available, or vitrification of embryos if one was available. The patient with ITP and the patient with MPA underwent gonadotropin ovarian stimulation followed by oocyte or embryo vitrification. All women completed fertility preservation treatment successfully and mature oocytes or embryos (36 and 13, respectively) were vitrified. No complications were associated with this treatment and cytotoxic therapy was initiated as scheduled in all cases. CONCLUSIONS Oocyte or embryo cryopreservation should be considered for fertility preservation in young women with SARDs who face imminent gonadotoxic treatment. In patients, where gonadotropin ovarian stimulation is deemed unsafe, IVM of immature oocytes, aspirated during a natural menstrual cycle, followed by vitrification or fertilization of the mature oocytes, seems to be safe and feasible. For patients in whom hormonal ovarian stimulation is not contraindicated, this method may be considered depending on the urgency to start cytotoxic therapy.

Internet use by patients seeking infertility treatment

The Internet has become a resource of health information w1x. The purpose of our study was to evaluate how infertile couples access health information on the Internet and to assess their reasons for doing so. Couples seeking consultation were asked to complete a questionnaire, entailing questions on demographics, reproductive history, general computer and Internet usage, and Internet use for fertility issues. Using 5-point scales, they were asked to rate their responses to specific questions, including their satisfaction with information available on the Internet, reasons for its use, and the impact on their decision-making process. Of the total 200 respondents, 178 (89%) used the Internet for general purposes and 89 (44.5%) for fertility-related issues. Women, high level of education and high annual income characterized those who used the Internet for reproductive reasons (Table 1). Information on fertility-related websites was obtained using search engines (91%), from fertility clinics (28.1%) or from news media (22.5%). Commercial health websites (41.6%), academic institution websites (30.3%) and fertility clinic websites (28.1%) were the three most com-

Assisted reproductive techniques.

Assisted reproductive technologies (ART) encompass fertility treatments, which involve manipulations of both oocyte and sperm in vitro. This chapter provides a brief overview of ART, including indications for treatment, ovarian reserve testing, selection of controlled ovarian hyperstimulation (COH) protocols, laboratory techniques of ART including in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI), embryo transfer techniques, and luteal phase support. This chapter also discusses potential complications of ART, namely ovarian hyperstimulation syndrome (OHSS) and multiple gestations, and the perinatal outcomes of ART.

Feasibility of fertility preservation in young females with Turner syndrome

Women with Turner syndrome (TS) are at risk of premature ovarian failure. The objective of this retrospective study was to identify patients with TS who could be potential candidates for fertility preservation and to determine their present reproductive and fertility status. Criteria for fertility preservation included: (i) spontaneous menarche; (ii) confirmation by ultrasound examination of the presence of at least one normal ovary; and (iii) serum FSH concentrations below 40 IU/l. Using the Montreal Childrens Hospital Cytogenetic Database from 1990 to 2006, 28 patients with complete or partial absence of one X chromosome were identified: 13 (46%) were 45,X; nine (32%) had mosaic karyotypes; and six (21%) had karyotypes containing isochromosome or ring X chromosome. Six patients (21%) had spontaneous pubertal development and four (14%) were identified as potential candidates for fertility preservation. One underwent an ovarian stimulation protocol of gonadotrophin-releasing hormone agonist down-regulation followed by recombinant FSH and human menopausal gonadotrophin stimulation. Two metaphase-II-stage oocytes were aspirated and vitrified using the McGill Cryoleaf vitrification system. Another patient conceived spontaneously at the age of 24 years. In conclusion, fertility preservation may not be feasible for most patients with TS. However, after careful consideration of increased pregnancy-associated risks, fertility preservation may be offered to young females with mosaic TS.

Fertility preservation for young women with rectal cancer--a combined approach from one referral center.

BackgroundUp to 6% of women with colorectal cancer are diagnosed in the reproductive age and are at risk for premature ovarian failure and infertility due to pelvic irradiation and chemotherapy.Study DesignBetween 1997 and 2007, six women with rectal carcinoma were referred to the McGill Reproductive Center (Montreal, Canada) for fertility preservation. Following resection of their primary tumor, they were scheduled to undergo pelvic irradiation.ResultsFive patients underwent laparoscopic ovarian lateral transposition before radiotherapy in order to relocate their ovaries outside the radiation field. A concomitant ovarian wedge resection was performed for ovarian cryopreservation. In two of these women, before dissecting the ovarian cortical tissue for cryopreservation, all visible follicles were aspirated. The sixth patient who had had low anterior resection underwent hormonal ovarian stimulation followed by oocyte retrieval and embryo vitrification.ConclusionsFertility preservation in women with rectal cancer is feasible. This includes laparoscopic ovarian transposition and cryopreservation of ovarian tissue, embryo, or oocyte.

Ovarian Hyperstimulation Syndrome Prevention Strategies: In Vitro Maturation

The only reliable way to eliminate the risk of ovarian hyperstimulation syndrome (OHSS) is complete avoidance of gonadotropin ovarian stimulation. It could be argued that in vitro maturation (IVM) of oocytes represents the most effective strategy to prevent OHSS. IVM has been an established treatment option in many centers worldwide for over a decade. The use of IVM and natural cycle in vitro fertilization (IVF) combined with IVM can result in clinical pregnancy rates that compare to those obtained with conventional IVF. The obstetric and perinatal outcomes of IVM pregnancies are similar to those conceived from stimulated IVF or spontaneous conceptions. To date, more than a thousand healthy infants have been born without an increase in fetal abnormalities. Although IVM may not replace standard IVF, it plays an increasingly important role in assisted reproductive technology, especially in the settings of high responders and those patients at risk of OHSS.