Tanmoy Mukherjee

Elevated day 3 serum follicle stimulating hormone and/or estradiol may predict fetal aneuploidy

OBJECTIVE To determine whether baseline serum FSH and/or E2 concentrations can predict the risk for fetal chromosomal abnormalities. DESIGN Case control study. SETTING Reproductive technology program at a university hospital. PATIENT(S) Patients who underwent dilation and curettage (D + C), and whose products of conception were karyotyped. INTERVENTION(S) Patients underwent natural conception or controlled ovarian hyperstimulation followed by intrauterine insemination, in vitro fertilization and embryo transfer, gamete intrafallopian transfer, or zygote intrafallopian transfer. MAIN OUTCOME MEASURE(S) Baseline serum FSH and E2 concentrations and fetal karyotype. RESULT(S) Genetic evaluation of 78 D + C specimens revealed 34 normal and 44 abnormal fetal karyotypes. A significantly greater proportion of women with abnormal fetal karyotype had elevated baseline serum FSH (> or =15 mIU/mL [RIA] or 10 mIU/mL [Immulite]) and/or E2 > or = 50 pg/mL [Immulite]) compared with women of normal fetal karyotype. Among karyotypically abnormal abortuses, autosomal trisomy was the most common abnormality noted (79.5%), followed by mosaicism (6.8%), triploidy (6.8%), monosomy XO (4.5%), and balanced translocation (2.3%). CONCLUSION(S) Baseline serum FSH and/or E2 concentrations may be valuable as predictors of fetal aneuploidy.

Molecular Cytogenetic Analysis of Uterine Leiomyoma and Leiomyosarcoma by Comparative Genomic Hybridization

Uterine leiomyomata are among the most common of human neoplasms and are associated with abnormal uterine bleeding, infertility, and abdominal pain. Uterine leiomyosarcomata are presumed to be the malignant counterpart to uterine leiomyomata and are very rare. Transformation of uterine leiomyoma (ULM) into uterine leiomyosarcoma (ULMS) is yet to be conclusively confirmed, and each type of tumor may represent a distinct genetic entity. We used comparative genomic hybridization (CGH) to evaluate DNA sequence copy-number changes in 12 specimens of ULM and 8 of ULMS. CGH analysis of ULM demonstrated chromosomal imbalances in 8 of 12 (66. 7%) specimens. The most frequent ULM gains were observed at 9q34 (a novel finding) and on chromosome 19. Other ULM imbalances included gains and losses of chromosome 1p, losses on 7q, and gains on 12q. All ULMS specimens demonstrated chromosomal aberrations. Chromosome 1 imbalances were very prominent. The most frequent losses were detected on 14q and 22q. Losses on 14q are rarely seen in other types of leiomyo-sarcoma and may be a distinctive feature of ULMS. Gains on chromosomes 8, 17, and X were observed in half the cases and were accompanied by high-level amplification. Other chromosome arms overrepresented included 12q and 19p. The absence of specific anomalies common to all ULM and ULMS argues against their being benign-malignant counterparts.

Endometriosis is not detrimental to embryo implantation in oocyte recipients

AbstractPurpose: Our purpose was to determine the effects of endometriosis on implantation and pregnancy rates in ovum recipients. Methods: The medical records of 239 consecutive oocyte recipient patients who were treated between January 1, 1991, and June 30, 1995, were analyzed retrospectively. Recipients with endometriosis (group I; n=55) were compared to recipients without endometriosis (group II; n=184). Patients in group I had active endometriotic disease confirmed by laparoscopy and were subdivided into mild (Stages I and II; n=18) and moderate to severe (Stages III and IV; n=37) endometriosis. Results: No difference was found in recipient age, endometrial thickness, donor age, and embryos transferred. The pregnancy rates (28 versus 29%) and implantation rates (12 and 13%) were also comparable between group I and group II, as well as between patients with mild and patients with moderate to severe endometriosis. Conclusions: The presence of endometriosis in oocyte recipients does not lower implantation or pregnancy rates. We conclude that the adverse effect of endometriosis on reproductive outcome is not related to implantation but, in fact, is most likely an effect on oocyte or embryo quality.

Sisters of women with premature ovarian failure may not be ideal ovum donors.

OBJECTIVES To determine whether the sisters of women with premature ovarian failure (POF) showed a response to gonadotropin stimulation comparable to that of anonymous ovum donors. DESIGN Historical cohort study. SETTING Records of 228 consecutive ovum recipients in an academic assisted reproductive technology program. PATIENT(S) Criteria for inclusion were oocyte recipients age < or = 40 years, FSH > 18 mIU/mL (conversion factor to SI unit, 1.00), and/or failure to respond appropriately to controlled ovarian hyperstimulation (COH). Seventy-nine recipients were classified on the basis of whether they received oocytes from anonymous donors (group I, n = 66) or sister donors (group II, n = 13). MAIN OUTCOME MEASURE(S) Controlled ovarian hyperstimulation response, pregnancy rates (PRs), and implantation rates. RESULT(S) The ages of the donors to groups I and II were comparable (31.1 +/- 16.7 versus 29.8 +/- 7.2 years), but those in group II exhibited a higher baseline FSH level (12.8 +/- 2.1 versus 8.6 +/- 5.8 mIU/mL). Group II versus I had a relative risk of 5.1 for cancellation (4 of 13 [30.8%] versus 4 of 66 [6.1%], respectively). In completed cycles of groups I and II, respectively, there was no difference in serum E2 on the day of hCG administration (2,356 +/- 826 versus 1,847 +/- 843 pg/mL; conversion factor to SI unit, 3,671), number of oocytes retrieved (25 +/- 14 versus 22 +/- 13), number of embryos transferred (4.4 +/- 2.1 versus 4.0 +/- 1.0), spontaneous abortion rate (22.7% versus 25.0%), PR (35.5% versus 36.4%), and implantation rate (16.2% versus 16.4%). CONCLUSION(S) There is an increased cancellation rate and, consequently, an overall trend toward decreased ovarian response to gonadotropin stimulation in the sisters of patients with POF. Despite these factors, the implantation rates and PRs of embryos derived from patients reaching retrieval were similar to those from anonymous donors. We recommend counseling women with POF that their sisters may not be ideal ovum donors.

Does increasing ovum donor compensation lead to differences in donor characteristics

OBJECTIVE To evaluate the effects of a compensation increase for anonymous ovum donors on demographic and social characteristics. DESIGN Retrospective analysis. SETTING The Mount Sinai Medical Center Ovum Donation Program. PATIENT(S) All program applicants for 2 years preceding (group I, n = 2,934) and 1 year following an increase in donor compensation (group II, n = 1,114; total N = 4,048). INTERVENTION(S) Compensation was increased from

PD07-07 IS SPERM MORPHOLOGY ASSESSMENT OF PATIENTS UTLIZING IN VITRO FERTILIZATION USEFUL IN PREDICTING ANEUPLOIDY?

2,500 to

CHAPTER 24 – Polycystic Ovarian Syndrome

5,000 per cycle. MAIN OUTCOME MEASURE(S) Demographic and social characteristics of applicants and donors. RESULT(S) More group II applicants (65.7%) than group I applicants (49.2%) returned an initial biographical questionnaire. Compensation level did not affect the percentage rejected at any stage in the application process or ultimately selected. There were no differences in donors in age, marital status, education, race, religion, or psychological profile. Group II donors had more previous pregnancies (group II mean = 1.2, group I mean = 0.6) and previous abortions (group II mean = 0.8, group I mean = 0.4). CONCLUSION(S) Increasing compensation may result in a higher percentage of potential donors completing an initial questionnaire but does not alter the demographic and social characteristics of selected donors. Adherence to a rigorous applicant screening ensures that donor characteristics remain independent from compensation.

Report of four donor-recipient oocyte cryopreservation cycles resulting in high pregnancy and implantation rates

INTRODUCTION AND OBJECTIVES: It is generally accepted that semen quality, as judged by the volume, motility, and morphology of spermatozoa, predicts both in vitro and in vivo fertilization. Kruger et al. demonstrated that microscopic assessment of sperm morphology plays an integral role in evaluating the male. This study aims to determine whether there is a correlation between specimens with extremely low percentages of structurally normal sperm and embryonic aneuploidy in couples that pursue IVF with Comprehensive Chromosomal Screening (CCS). METHODS: Couples who underwent IVF and utilized aneuploidy screening (preimplantation genetic screening (PGS)) from July 2010 e October 2015 were included. At least 100 sperm in four different areas of the slide were evaluated according to Kruger’s strict criteria (Kruger et al: 1⁄44%: normal; >4%: abnormal). Female and male partner ages were binned (A: 1⁄435; B: (35-38]; C: (38-41]; D: (41-43]; and E: >43). Male age group E was subbinned (a: 1⁄443; b: (43-50]; c: (50-55]; d: (55-60]; and e: >60). Aneuploidy rate for each female age group was calculated, with 95% confidence intervals calculated by Clopper-Pearson method. Chi-square and ANOVA were used to test significance, established at p 4% was similar between all five male age groups (A: 61.7%, B: 66.2%, C: 59.7%, D: 75.2%, E: 59.7%). When male age group E was subdivided, the proportion of patients with an abnormal morphology count increased with age (a: 36.2%, b: 44.1%, c: 70.4%, d: n/a, e: 100%). Aneuploidy rate was similar between normal and abnormal sperm morphology groups in all five age female groups (Table 1). Additionally, PR, clinical PR and early pregnancy loss rate were similar between groups in each female age group (Table 1). CONCLUSIONS: No correlation was identified between teratozoospermic specimens and increased incidence of embryonic aneuploidy. Male partners with specimens found to have abnormal Kruger morphology should be reassured that they do not have an increased incidence of producing chromosomally abnormal embryos.

Three-dimensional measurement of gestational and yolk sac volumes as predictors of pregnancy outcome in the first trimester

Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders. It is recognized as a heterogeneous syndrome involving chronic anovulation accompanied by hyperandrogenism, with clinical manifestations including hirsutism, acne, androgen dependent alopecia, and frequently, obesity. PCOS is the leading cause of anovulatory infertility. After initial onset in the peripubertal years, PCOS affected women develop signs and symptoms of elevated androgen levels, menstrual irregularity and amenorrhea, virilization, and bilaterally enlarged multicystic ovaries Metabolic derangements in PCOS are not limited to the sex steroids but are also affected on insulin resistance and compensatory hyperinsulinemia. Ovulatory women with hyperandrogenism, hirsutism, and polycystic ovaries accompanied by normal menstrual cycles display normal insulin sensitivity signifying that insulin resistance can be the primary process leading to anovulation. With recent advancement, treatment options result in higher pregnancy rates, and improved methods to counter the long-term deletrious effects on the health of women with PCOS. It is important to gain further insights by following a detailed approach so that new drugs can be studied and developed and existing drugs can be purified and produced at lower costs. The ultimate goal is to minimize harm and achieve optimal long-term outcome in patients with PCOS.