Faculty Bibliography

OBJECTIVE: The overuse of intracytoplasmic sperm injection (ICSI) in non-male factor infertility is well documented. ICSI is associated with higher costs, increase workload on embryology staff, and concern for adverse outcomes to offspring. The use of ICSI in non-male factor preimplantation genetic testing - aneuploidy (PGT-A) cycles currently is recommended when there is a concern for paternal contamination. Our objective is to evaluate whether significant differences exist in number of embryos suitable for transfer and pregnancy outcomes from PGT-A cycles derived from oocytes fertilized by in vitro fertilization (IVF) compared to ICSI using the SART-CORS database. MATERIALS AND METHODS: This is a retrospective cohort study evaluating fresh and thawed linked frozen embryo transfer (FET) cycles reported to SART from 1/1/2014 to 12/31/2017 undergoing PGT-A. Exclusion criteria included male factor infertility, embryos tested for monogenic disorders, structural rearrangements, or HLA-typing, cryopreserved or donor oocytes, blastomere or polar body biopsy, in vitro maturation, rescue ICSI, split IVF/ICSI cycles, gestational carriers, and >1 embryo transferred. Patient demographics, cycle characteristics, number of embryos suitable for transfer, and pregnancy outcomes in FET cycles were collected. Primary outcomes were percentage of embryos suitable for transfer and live birth (LB) rates. Sub-analysis of embryos suitable for transfer were performed on cycles with < and R 6 oocytes and < 35 y/o and R 35 y/o. Chi-square or Fisher's exact test, as appropriate, were used for categorical variables. Mann-Whiney test was used for continuous variables. Relevant confounders and multiple cycles within a subject were accounted for in a generalized linear mixed model. Results were considered statistically significant with a p-value <0.05.
RESULT(S): A total of 4,867 IVF and 25,579 ICSI cycles met criteria to evaluate for embryos suitable for transfer. Significant difference between the IVF and ICSI cohort existed in age (35.8 y/o vs. 36.8 y/o, respectively, p=0.03). No significant differences in percentage of embryos suitable for transfer were found between IVF vs. ICSI (42.1% vs 42.7%, respectively, p=0.28), within the subgroup of patients R 35 y/o (35.8% vs. 36.5%, respectively, p=0.32), and within subgroup with % 6 oocytes retrieved (32.9% vs. 35.3%, respectively p=0.44). Total of 3,412 IVF and 16,358 ICSI cycles met criteria for pregnancy outcomes evaluation. No significant differences in LB/ongoing pregnancy rate between IVF vs. ICSI (53.2% vs 53.0%, respectively, p=0.51) and pregnancy loss (18.5% vs 17.3%, p=0.11) were found.
CONCLUSION(S): There were no significant differences in rate of embryos suitable for transfer or pregnancy outcomes in PGT-A cycles derived from IVF and ICSI insemination. ICSI in non-male factor infertility cycles undergoing PGT-A does not provide an advantage over IVF. IMPACT STATEMENT: ICSI insemination in non-male factor cycles undergoing PGT-A does not yield superior outcomes compared to IVF insemination. IVF in non-male factor PGT-A cycles provides the benefit of time and cost savings

OBJECTIVES/OBJECTIVE:To evaluate the utility of anti-Müllerian hormone (AMH) in predicting clinical pregnancy with intrauterine insemination (IUI) and compare it to other markers of quantitative ovarian reserve. METHODS:Retrospective cohort study of women undergoing natural and stimulated IUI cycles. All patients achieved a clinical pregnancy within three IUI cycles or completed three IUI cycles without pregnancy. Receiver operating curves were generated to determine the ability of AMH, antral follicle count, age, BMI, and day 3 FSH to predict clinical pregnancy with IUI. Characteristics of those with and without pregnancy were compared using Mann-Whitney U, chi-square, and Fisher exact tests. RESULTS:Of 209 women included, 49% achieved clinical pregnancy. Pregnant patients were more likely to have a higher AMH (2.76 vs. 1.55 ng/mL, P = 0.0004). The area under the curve was 0.642 in predicting clinical pregnancy within three IUI cycles using AMH (0.608 if excluding polycystic ovarian syndrome patients); 0.639 using antral follicle count; 0.549 using age; 0.599 using day 3 FSH; and 0.639 using BMI. CONCLUSION/CONCLUSIONS:Although serum AMH appears significantly higher in women achieving clinical pregnancy, the predictive value of AMH alone was no better than that for other markers of quantitative ovarian reserve in a patient who clinically qualifies for IUI.

OBJECTIVE:We sought to identify patients at risk of incomplete transvaginal oocyte retrieval, develop a risk assessment formula to identify patients who would benefit from a transabdominal approach, and compare complication and pregnancy rates between these two approaches. MATERIALS AND METHODS/METHODS:In this retrospective case control study in a private in vitro fertilization center, 95 cases of women undergoing transabdominal follicular aspiration for oocyte retrieval (15 transabdominal only and 80 transabdominal and vaginal combined) were compared with 278 controls of women undergoing the transvaginal aspiration only. Transabdominal oocyte retrieval was performed when one or more ovaries could not be retrieved via the transvaginal approach. Main study outcomes included need for transabdominal retrieval, pregnancy rates, and complications. RESULTS:A risk assessment scoring system was developed as follows: difficulty seeing ovaries on ultrasound (+4), history of pelvic surgery (+3), and body mass index of 30 kg/m(2) or greater (+2). With a cutoff score of 4 or greater, the overall sensitivity is 75%, specificity is 80%, positive predictive value is 57%, and negative predictive value is 90%. No statistically significant differences were found for pregnancy rates or complications. CONCLUSION/CONCLUSIONS:The transabdominal approach is an alternative option that would increase the total number of oocytes retrieved with no statistical difference in complication or pregnancy rates. We also developed a scoring system that can serve as a useful screening tool for identifying women at increased risk of transabdominal oocyte retrieval.