Wilson C

Controlled Ovarian Hyperstimulation Adversely Affects Implantation Following In Vitro Fertilization–Embryo Transfer

Purpose:Our purpose was to determine if controlled ovarian hyperstimulation adversely affects implantation.Methods:A retrospective comparison of pregnancy rates (PRs) and implantation rates was made between oocyte recipients versus their donors, who shared half of the retrieved oocytes, and regular patients undergoing in vitro fertilization–embryo transfer (IVF-ET) who were not sharing eggs.Results:Higher implantation rates (39.0 vs 22.5%; P < 0.05) were found in recipients compared to donors in the stimulated cycle. However, no differences were seen in PRs or implantation rates in frozen ET cycles. The data for standard IVF patients were almost-identical to those for donors.Conclusions:Superior implantation rates and PRs in oocyte recipients versus donors were not related to better oocyte quality for recipients because of egg sharing or to a better uterine environment because of similar results with frozen ET in all three groups. An adverse effect of the hyperstimulation regimen best explains the difference.

A cost-effectiveness comparison of embryo donation with oocyte donation.

OBJECTIVE To compare the cost-effectiveness of embryo donation (ED) to that of oocyte donation (OD). DESIGN Calculation of cost-effectiveness ratios (costs per outcome achieved) using data derived from clinical practices. SETTING In vitro fertilization centers and embryo donation programs. PATIENT(S) Infertile couples undergoing oocyte donation or embryo donation. INTERVENTION(S) Oocyte donation or embryo donation cycles. MAIN OUTCOME MEASURE(S) Cost-effectiveness ratios. RESULT(S) For a single cycle, ED is approximately twice as cost-effective as OD, with a cost-effectiveness ratio of

Evaluation of the effect of endometriosis on oocyte quality and endometrial environment by comparison of donor and recipient outcomes following embryo transfer in a shared oocyte program

21,990 per live delivery compared to 40,600 dollars. When strategies of up to three cycles (to achieve one live delivery) are used, ED costs 13,505 dollars per live delivery compared to 31,349 dollars for OD. CONCLUSION(S) Cost-effectiveness is a compelling reason for infertile couples to consider embryo donation.

Abstract 4876: Long-term high quality survival with single agent mifepristone treatment despite advanced lung cancer and advanced renal cell carcinoma - 2 case reports

PURPOSE To determine whether endometriosis has an effect on the uterine environment vs the oocyte itself. METHODS A retrospective study comparing pregnancy outcome of infertile donors sharing oocytes with donor egg recipients according to whether the donor or recipient had endometriosis or not was carried out. RESULTS There were 26 transfers from donors with endometriosis vs 144 in donors without endometriosis. The clinical and viable PRs and implantation rates were 42.9%, 38.1%, and 29.4% for the endometriosis group vs 60.9%, 51.9%, and 33.2%, respectively, for donors without endometriosis (p = NS). The clinical and viable PRs and implantation rates for donors with endometriosis per ET was 41.2%, 35.3%, and 20.4% vs 50.4%, 48.0% and 28.4% for donors without endometriosis, respectively (p = NS). CONCLUSIONS Though no significant differences were found in donors with or without endometriosis in any parameters, there did appear to be a trend for lower PRs and implantation rates in women undergoing controlled ovarian hyperstimulation.

Effect of embryo quality on pregnancy outcome following single embryo transfer in women with a diminished egg reserve

The objective is to report long-term high quality survival in 2 patients with advanced cancer treated by single agent mifepristone. Case 1: An 80 year old woman was admitted to the ICU for respiratory failure. Chest x-ray revealed many lung lesions most consistent with lung cancer with multiple lung metastases. She was subsequently admitted several more times with very low arterial pO2 levels and her serum sodium progressively decreased to 118 mmol/L. The radiologic and clinical diagnosis was probable advanced lung cancer with the syndrome of inappropriate antidiuretic hormone (SIADH) from ectopic tumor production of arginine vasopressin. She refused surgery or chemotherapy. She agreed to experimental use of 200mg daily oral mifepristone. Her pO2 returned to 99-100 mmHg with 1 month and her sodium returned to normal. Six weeks later all her lung lesions were gone by CT scan. Three and a half years after initial treatment, her PO2 remains 96-98 mmHg, she is feeling fine, and her CT-scan continues to show no tumors. Her treatment had been approved by the FDA on a compassionate basis. Case 2 - A 60 year old male with was found to have bilateral renal cell carcinoma with metastases to local lymph nodes. He refused bilateral nephrectomy but agreed to only laparoscopic right hemi nephrectomy to remove the largest lesion, leaving the left kidney intact. He received FDA approval to use 200mg daily mifepristone because at that time there was no chemotherapy that was known to be effective. The left kidney lesions did not recede but stayed stable for 10 years. Furthermore, no new lesions appeared on bi-annual CT scan. After 10 years of therapy, he developed renal failure secondary to diabetes. At this time he underwent bilateral nephrectomy, followed by kidney transplant. 11 years from diagnosis he is doing well. Neither patient has reported any side effects to 200mg mifepristone daily despite a combined 14 years of treatment. The mechanism of action responsible for these phenomena has not been proven thus far. The proposed mechanism is that progesterone inhibits an intracytoplasmic immunomodulatory protein known as the progesterone induced blocking factor (PIBF). By inhibiting PIBF, the cellular immune cells (specifically natural killer (NK) cells) are able to attack the rapidly growing tumor cells. The FDA has approved an investigator initiated study for the use of single agent mifepristone for stage IV human non-small cell lung cancer which has progressed despite either 2 rounds of chemotherapy or 1 round of chemotherapy plus one round of biologic therapy. Mifepristone, a progesterone receptor modulator, has been demonstrated to inhibit the production of a 34-36 kDa intracytoplasmic splice variant of the 90 kDa centrosomally associated parent compound. However, this potent abortifacient failed to suppress serum PIBF levels. Citation Format: Jerome H. Check, Diane Check, Jasmine Aly, Carrie Wilson. Long-term high quality survival with single agent mifepristone treatment despite advanced lung cancer and advanced renal cell carcinoma - 2 case reports. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4876.