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IntroductionCytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly accepted as the best therapeutic option in primary and some secondary peritoneal malignancies. The ramifications of this... more
IntroductionCytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly accepted as the best therapeutic option in primary and some secondary peritoneal malignancies. The ramifications of this procedure on fertility are unknown. The aim of this study was to assess the current association of CRS/HIPEC with fertility following surgery.MethodsA review of patients who underwent CRS/HIPEC between 2009 and 2018 was performed. Female patients were included if they were between ages 18–50 at the time of surgery. Gynecologic and obstetric history before and following CRS/HIPEC was collected by phone interview.ResultsOf 48 eligible participants, 21 completed the survey. Sixty‐five percent of women underwent a total abdominal hysterectomy before or during CRS. Twenty‐nine percent of these women recall fertility counseling before CRS/HIPEC, while 14.3% saw a fertility specialist for consultation, and only one patient proceeded with oocyte cryopreservation before treatment. There were no pregnancies reported following treatment with CRS/HIPEC.ConclusionFew patients after CRS/HIPEC retain child‐bearing potential, partly due to the high rate of hysterectomy and oophorectomy at time of surgery. Efforts towards improved preoperative counseling, increased oocyte cryopreservation, and evaluating the safety of preserving reproductive organs at the time of surgery are needed.
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Objective: To describe the relationship between severe diminished ovarian reserve (DOR) and assisted reproductive technology outcomes. Study design: Retrospective cohort including all United States’ fertility centers reporting to the CDC... more
Objective: To describe the relationship between severe diminished ovarian reserve (DOR) and assisted reproductive technology outcomes. Study design: Retrospective cohort including all United States’ fertility centers reporting to the CDC National ART Surveillance System, 2004–2012. Among women aged <41 (504,266 fresh autologous IVF cycles), we calculated cancellation rate/cycle and pregnancy rate/transfer, stratified by age, by maximum follicle-stimulating hormone (FSH). Cancellation rate per cycle and pregnancy, live birth, and miscarriage rates per transfer were compared among women with and without DOR. We used multivariable log binomial regression, stratified by age, to calculate adjusted relative risk (aRR) for the association between DOR and these outcomes and, within DOR groups, between stimulation type and outcomes. Results: Cancellation rate/cycle increased with increasing FSH and with DOR severity. For women aged <35 who underwent transfer, aRR for pregnancy and live birth indicated slightly reduced likelihood of these outcomes (severe vs. no DOR); confidence intervals approached the null. Among women with severe DOR, stimulation type was not associated with likelihood of pregnancy or live birth per transfer in any group except women ages 38–40. Conclusion: Women with severe DOR are at significantly increased risk of cancellation; however, those who undergo transfer have pregnancy and live birth chances similar to those of women without DOR after controlling for cycle characteristics.
Research Interests: Obstetrics, Fertility, Infertility, Medicine, Pregnancy, and 15 moreHumans, Female, Assisted Reproductive Technology, Pubmed, Embryo Transfer, Reproductive medicine, Adult, Retrospective Studies, Female Infertility, Miscarriage, Pregnancy Rate, Ovarian Reserve, Pregnancy Outcome, Live birth, and Paediatrics and reproductive medicine
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OBJECTIVE To investigate the association between paternal race and reproductive outcomes following in vitro fertilization (IVF). MATERIALS AND METHODS We compared demographic and clinical characteristics, IVF cycle characteristics, and... more
OBJECTIVE To investigate the association between paternal race and reproductive outcomes following in vitro fertilization (IVF). MATERIALS AND METHODS We compared demographic and clinical characteristics, IVF cycle characteristics, and reproductive outcomes (pregnancy, miscarriage, and live birth), stratified by male and female partner race, for all IVF cycles performed at our institution between 2014-2019. Wilcoxon Rank Sum test and Pearson's Chi Square test were used to compare continuous and categorical data, respectively. A Poisson regression model was used to determine the association between race and clinical outcomes. Significance was set as p< 0.05. RESULTS We examined 1,878 IVF cycles involving 1,069 couples. The study population was diverse; 50.1% of male partners were White, 28.5% Black, 15.1% Asian, and 2.3% Hispanic. The majority of couples (86.5%) shared a common self-reported race category. Black males were older than White males (39.6 vs 37.0 years), with higher BMI (30.4 vs 28.0) and higher frequency of male factor infertility (45.9% vs 33.5%). Female partners of Black males were older than those of White males (35.6 vs 33.8 years), with higher BMI (29.6 vs 25.2), and higher frequency of female factor infertility (91.8% vs 83.9%). Although we noted race-related variability in IVF cycle characteristics, no significant differences in the outcomes of pregnancy, biochemical pregnancy, clinical intrauterine pregnancy (IUP), or ectopic pregnancy were observed between races. CONCLUSIONS Although paternal race was associated with IVF cycle characteristics, after controlling for potential confounders, paternal race did not independently contribute to outcomes in this institutional dataset.
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OBJECTIVE To describe the trends and characteristics of oocyte cryopreservation (OC) cycles stratified by self-reported race/ethnicity in the United States DESIGN: Retrospective cohort analysis using the Society for Assisted Reproductive... more
OBJECTIVE To describe the trends and characteristics of oocyte cryopreservation (OC) cycles stratified by self-reported race/ethnicity in the United States DESIGN: Retrospective cohort analysis using the Society for Assisted Reproductive Technology Clinical Outcome Reporting System SETTING: US fertility clinics PATIENTS: All patients undergoing OC from 2012 through 2016 INTERVENTIONS: None MAIN OUTCOME MEASURES: The OC cycle trends were analyzed on the basis of race/ethnicity: non-Hispanic white, non-Hispanic black, Asian/Pacific islander, Hispanic, and other (American Indian, Alaskan native, or mixed race). RESULTS Between 2012 and 2016, there was a total of 29,631 OC cycles; the total number of cycles increased yearly from 2,925 in 2012 to 8,828 in 2016. When compared with the demographics of the United States, OC was underused by some minority patient groups because majority of the cycles (66.5%) were performed in white patients. The total number of OC cycles increased annually among all the ethnic groups, most notably among Asian patients. The patients of all the ethnic backgrounds were most commonly under 35 years of age and underwent 1 OC cycle, except for Asian patients, who most frequently underwent OC between the ages of 35 and 37 years and were more likely to have undergone ≥2 cycles than patients of other minority groups. After adjustment for cofounders, there were no clinically significant differences in oocyte yield and the percentage of maturation across the racial/ethnic groups. CONCLUSIONS Nationally, OC cycles have been increasing in number, most often in patients under the age of 35 years, with similar proportions of patients of minority groups pursuing OC over time. The oocyte yield was comparable across the ethnic groups. Future research regarding subsequent thawing outcomes is warranted.
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Purpose: Women who carry an FMR1 premutation (PM) can experience two well-established PM-associated disorders: fragile X-associated primary ovarian insufficiency (FXPOI, affects ~20–30% carriers) and fragile X-associated tremor-ataxia... more
Purpose: Women who carry an FMR1 premutation (PM) can experience two well-established PM-associated disorders: fragile X-associated primary ovarian insufficiency (FXPOI, affects ~20–30% carriers) and fragile X-associated tremor-ataxia syndrome (FXTAS, affects ~6–15% carriers); however, emerging evidence indicates that some of these women experience complex health profiles beyond FXPOI and FXTAS.Methods: In an effort to better understand predictors for these comorbid conditions, we collected self-reported medical histories on 413 women who carry an FMR1 PM.Results: There were 22 health conditions reported by at least 9% of women. In an exploratory analysis, 12 variables were tested in logistic regression models for each comorbid condition, including demographic variables, environmental variables, PM-associated factors, and endorsement of depression and/or anxiety. More than half of the comorbid conditions studied were associated with women who self-reported having anxiety. Age, smoki...
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RESEARCH QUESTION Is race/ethnicity or access to care, as defined by insurance coverage, distance to the clinic and zip code (postal code), associated with care discontinuation following IVF? DESIGN A retrospective cohort study of 878... more
RESEARCH QUESTION Is race/ethnicity or access to care, as defined by insurance coverage, distance to the clinic and zip code (postal code), associated with care discontinuation following IVF? DESIGN A retrospective cohort study of 878 diverse women who underwent 1571 IVF cycles from 2014 to 2018 at a Southeastern academic medical centre was performed. Women were divided into low (LAC) and high (HAC) access to care groups. HAC was defined as possessing IVF insurance coverage, living ≤25 miles from the clinic, and living in a zip code with a median income ≥$75,000. Access groups and racial/ethnic groups were compared for differences in relative risk of care discontinuation following an unsuccessful IVF cycle. RESULTS Women with HAC had a poorer IVF prognosis than the LAC group, which possibly impacted the association with care discontinuation. Distance to the clinic, but not insurance coverage or zip code, was associated with increased risk of care discontinuation. Among women ≤34 years, HAC showed some evidence of an association with an increased risk of care discontinuation (adjusted relative risk 2.5, 95% confidence interval 0.8-8.1). Despite having higher rates of insurance coverage (51.2% versus 36.5%), non-Hispanic Black women were more likely to discontinue care (58.3% versus 40.2%) and less likely to achieve a live birth (53.0% versus 68.0%) than non-Hispanic White women. CONCLUSIONS Identification as non-Hispanic Black, and distance to the clinic, but not insurance coverage or zip code, were associated with increased risk of care discontinuation following an unsuccessful IVF cycle. In women ≤34 years old, HAC may be associated with a higher rate of care discontinuation.
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PurposeThe majority of data regarding oocyte cryopreservation (OC) outcomes focuses on healthy women. We compare trends, cycle characteristics, and outcomes between women freezing oocytes for fertility preservation due to cancer versus... more
PurposeThe majority of data regarding oocyte cryopreservation (OC) outcomes focuses on healthy women. We compare trends, cycle characteristics, and outcomes between women freezing oocytes for fertility preservation due to cancer versus elective and other medical or fertility-related diagnoses.MethodsRetrospective cohort using national surveillance data includes all autologous OC cycles between 2012 and 2016. Cycles were divided into 4 distinct groups: cancer, elective, infertility, and medically indicated. We calculated trends and compared cycle and outcome characteristics between the 4 groups. We used multivariable log-binomial models to estimate associations between indication and gonadotropin dose, hyperstimulation, and cancelation and used Poisson regression models to estimate associations between indication and oocyte yield and maturity.ResultsThe study included 29,631 autologous OC cycles. Annual total (2925 to 8828) and cancer-related (177 to 504) cycles increased over the study period; the proportions remained constant. Compared to elective, cancer-related cycles were more likely to be performed among women < 35 years old, with higher BMI, living in the South, using an antagonist protocol. Compared to elective OC cycles, gonadotropin dose (aRR 0.89, 95%CI 0.80–0.99), cancelation (aRR 0.90, 95%CI 0.70–1.14), and hyperstimulation (aRR 1.46, 95%CI 0.77–2.29) were not different for cancer-related cycles. Oocyte yield and percent maturity were comparable in both groups.ConclusionThe number of OC cycles among women with cancer has increased; however, the percentage OC cycles for cancer have remained stable. While patient demographic characteristics were different among those undergoing OC for cancer indication, cycle outcomes were comparable to elective OC. The outcomes of the subsequent oocyte thaw, fertilization, and embryo transfer cycles remain unknown.Electronic supplementary materialThe online version of this article (10.1007/s10815-020-01715-8) contains supplementary material, which is available to authorized users.
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OBJECTIVE To characterize national outcomes of oocyte thaw (OT) cycles. DESIGN Retrospective descriptive study. SETTING All autologous OT cycles reported to the Society of Assisted Reproductive Technology Clinic Outcome Reporting System... more
OBJECTIVE To characterize national outcomes of oocyte thaw (OT) cycles. DESIGN Retrospective descriptive study. SETTING All autologous OT cycles reported to the Society of Assisted Reproductive Technology Clinic Outcome Reporting System from 2012 to 2018. PATIENT(S) All women undergoing OT cycles in the United States. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Absolute numbers of oocyte cryopreservation (OC) and OT cycles over time. Among OT cycles, patient and cycle characteristics, the ratio of the total number of oocytes thawed to the number of live births by maternal age at the time of cryopreservation (ATOC), and outcomes including pregnancy, miscarriage, live birth, and good perinatal outcome (GPO) by age ATOC. RESULT(S) From 2012 to 2018, 54,675 OC and 6,413 OT cycles were performed; the absolute numbers increased from 2,719 to 13,824 and from 348 to 1,810, respectively. The ratio of the total number of oocytes thawed to the number of live births increased significantly with increasing age ATOC, from 41.4 (age <35 years) to 122.4 (age >41 years). Among OT cycles resulting in embryo transfer, the live birth rate decreased with increasing age ATOC from 42.8% (age <35 years) to 10.8% (age >42 years). The live birth rate was higher when calculated per transfer (42.8% in women aged <35 years ATOC) rather than per thaw cycle (31.5% in women aged <35 years ATOC) because of the number of patients with no transfer. Among 1,124 cycles resulting in pregnancy, the chance of a GPO was highest among women aged <35 years ATOC (65.8%) and decreased as age at ATOC increased. CONCLUSION(S) Among reported OT cycles, the rates of pregnancy and live birth decreased as age ATOC increased. The number of oocytes thawed to achieve one live birth increased significantly with increasing age ATOC. In addition, among the resulting pregnancies, the rate of GPO decreased as age ATOC increased.
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Research Interests: Obstetrics, Obesity, Fertility, Infertility, Medicine, and 15 moreBirth Weight, Pregnancy, Humans, Female, Assisted Reproductive Technology, Body Mass Index, Clinical Sciences, Adult, Odds ratio, Fertilization in Vitro, Gestational Age, Elsevier, Miscarriage, Live birth, and Paediatrics and reproductive medicine
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INTRODUCTION AND OBJECTIVE:Men at risk for subfertility should undergo further evaluation by a urologist, ideally with specialization in male reproduction. We investigated patient access to reprodu...
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OBJECTIVE: To determine if there is an increased risk of first trimester pregnancy loss in frozen embryo transfer cycles as compared to fresh cycles following in vitro fertilization (IVF). DESIGN: Retrospective cohort study using data... more
OBJECTIVE: To determine if there is an increased risk of first trimester pregnancy loss in frozen embryo transfer cycles as compared to fresh cycles following in vitro fertilization (IVF). DESIGN: Retrospective cohort study using data from Centers for Disease Control and Prevention National ART Surveillance System for 2007-2012. MATERIALS AND METHODS: Multivariable log binomial regression, stratified by maternal age (< 30, 30-34, 35-37, 38-40, >40 years), was performed to compare agespecific risk of first trimester pregnancy loss between fresh and frozen embryo transfers. The main analysis included fresh cycles (n1⁄4203,970) and frozen cycles for which maternal age at oocyte retrieval could be ascertained (n1⁄445,660) that resulted in a pregnancy. A subgroup analysis was performed to compare miscarriage risks of similar quality embryos between fresh (n1⁄4203,970) and frozen cycles (n1⁄47,885). Frozen cycles for the subgroup analysis were restricted to those for which their originating fresh cycle had not had an embryo transfer (i.e. the embryo(s) transferred during the frozen cycle were the first embryos transferred from the originating retrieval). RESULTS: There was an increased risk of first trimester loss in pregnancies achieved after frozen embryo transfers versus fresh cycles and the adjusted relative risk remained significant among women less than 37 years of age: <30 years: 14.9% vs. 8.2%, aRR1⁄41.37, 95% CI1⁄41.29-1.44; 30-34 years: 16.1% vs. 10.0%, aRR1⁄41.23, 95% CI1⁄41.18-1.27; 35-37 years: 19.3% vs. 13.7%, aRR1⁄41.14, 95% CI1⁄41.09-1.19. In the sub-analysis, the risk of miscarriage was significantly higher in frozen cycles only among women less than 30 years of age: 12.0% vs. 8.2%, aRR1⁄41.16, 95% CI1⁄41.04-1.32. CONCLUSIONS: There was an increased risk of first trimester loss in frozen cycles compared to fresh cycles in younger women. This risk, however, which could be ascribed to lower embryo quality in frozen cycles, was reduced in the subgroup analysis that compared similar quality embryos from fresh and frozen cycles.
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PURPOSE To evaluate fertility clinic management of male factor infertility, including website educational content as well as factors associated with referral for urologic evaluation and care. MATERIALS AND METHODS Using 2015-2018 CDC... more
PURPOSE To evaluate fertility clinic management of male factor infertility, including website educational content as well as factors associated with referral for urologic evaluation and care. MATERIALS AND METHODS Using 2015-2018 CDC Fertility Clinic Success Rates Reports, 480 operative fertility clinics in the United States (U.S.) were identified. Clinic websites were systematically reviewed for content regarding male infertility. Structured telephone interviews of clinic representatives were performed to determine clinic-specific practices for management of male factor infertility. Multivariable logistic regression models were used to predict how clinic characteristics (geographic region, practice size, practice setting, proximity to urologist, in-state andrology fellowship, state-mandated fertility coverage, annual in vitro fertilization (IVF) cycles, and percentage of IVF cycles for male factor infertility) were associated with patient referral to a urologist for male infertility care. RESULTS We interviewed 477 fertility clinics and analyzed available websites (n=474). The majority of websites (77%) discussed male infertility evaluation while 46% discussed treatment. Fifty clinics (11%) had an on-site urologist. Clinics with on-site urologists were more likely to be larger practices, academically affiliated, and discuss male infertility treatment on their website (all p≤0.05). For clinics without an on-site urologist, practice size and presence of an in-state andrology fellowship program were the strongest predictors of urologic referral (p<0.02). CONCLUSION Variability in patient-facing education and infertility practice setting and size influence access to urologic care for couples with male factor infertility.
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PurposeTo characterize national oocyte donation practice patterns from the perspective of individual donors rather than of recipients.MethodsRetrospective cohort including all donor oocyte retrievals and transfers reported to SARTCORS in... more
PurposeTo characterize national oocyte donation practice patterns from the perspective of individual donors rather than of recipients.MethodsRetrospective cohort including all donor oocyte retrievals and transfers reported to SARTCORS in 2016 and 2017 in the USA. Primary outcomes include characteristics of oocyte donors and of donor oocyte cycles. Secondary outcomes include overall pregnancy rates, elective single embryo transfer (eSET) rates, and perinatal outcomes among donor oocyte recipient transfers.ResultsDuring the study period, 49,193 donor oocyte retrievals were performed, of which the largest proportion were in the Western US. For all reported retrievals, there were 17,099 unique donors, each of whom underwent an average of 2.4 retrievals (range 1–22). Average donor age was 26.3 years (range 18–48). On average, 24.6 oocytes (SD 12.4) were retrieved each cycle, ranging from 0 to 102. Among 37,657 donor oocyte recipient transfers, 20,159 (53.5%) involved eSET, and 17,725 (47.1%) resulted in live birth. Miscarriage rates were 17.5%, and good perinatal outcome (GPO), defined as full-term normal birthweight delivery, was more likely among singleton (75.7%) than multiple (23.8%) pregnancies.ConclusionThe average number of retrievals that donors underwent and oocyte yield mirrored national guidelines; however outliers, exist that may unnecessarily increase donor risk. Additionally, among resultant donor transfers, 46.5% transferred more than one embryo despite national recommendations for eSET. The significantly higher likelihood of GPO among singleton pregnancies points to the need to further increase donor recipient eSET rates.