Faculty Bibliography

Two of the many milestone developments in the field of assisted reproduction have been oocyte donation and preimplantation genetic testing for aneuploidy (PGT-A). Because it has been demonstrated that even young women produce a meaningful proportion of aneuploid embryos, screening out such abnormalities could potentially increase the efficacy of donor egg (DE) cycles. In this retrospective cohort study, we investigated the effect of PGT-A on DE cycle outcomes, including implantation rate (IR), spontaneous abortion rate (SABR), and ongoing pregnancy/live birth rate. We used fresh and frozen donor cycles not using PGT-A as comparison groups; all cases involved single embryo transfer. Data analysis revealed that PGT-A did not improve pregnancy outcome metrics in DE cycles, although there was a trend toward decreasing the SABR. There was a significant increase in IR with fresh cycles outperforming all frozen cycles. Overall, these results suggest that the benefits of performing PGT-A on embryos derived from young DEs may be limited and that there is an effect of the freezing process on pregnancy outcomes. These findings may provide useful insights into the science and practice of PGT-A across all of its applications.

Objective Improvements in oocyte cryopreservation(OC) have led to successful oocyte banking and more readily available cryopreserved donor oocytes(DO). Simultaneously, preimplantation genetic screening(PGS) has increased, even with DO. Using OC, DO, and PGS together is less common, but now occurs. Reservations include increased technological and financial cost ($1,100/oocyte). Our goal was to determine whether adding PGS increases implantation and live birth rates in DOT. Design Retrospective cohort study. Material and Methods We conducted a retrospective analysis of DOT performed 10/2004-1/2017 at a university-based fertility center. To remove bias, we conducted a sub-analysis of single embryo transfers(SET). Data was mined for: number of oocytes thawed/survived/fertilized, embryo development/transfer/implantation, and ongoing pregnancy/live birth. Mood's median and Fischer's exact tests were used for statistical analysis. Results Within the 130 non-PGS DOT (118 pts, median age:26y), 1138 oocytes (median:8/cycle) were thawed. Within the 15 PGS DOT (15 pts, median age:24y), 180 oocytes (median:11/cycle) were thawed a mean of 3 blastocysts(BL) were biopsied. Oocyte survival, 2-PN fertilization, BL formation, implantation, and ongoing pregnancy/live birth rates were not significantly different between the groups. The multiple birth rate in the non-PGS group was 6% (5/84 births). When controlling for SET, no differences were found in implantation or ongoing pregnancy/live birth rates with and without PGS (p>.1). When comparing embryo quality in the non-PGS group, a higher ongoing pregnancy/live birth rate was noted among SETs with excellent-quality Gardner's >2Bb (62% 50 births/81 transfers) when compared with SETs with poor-quality Gardner's <2Bb (35% 8 births/23 transfers p=.03). Conclusions Due to this study's small sample size, it is difficult to conclude whether PGS improves implantation/live birth rates in a young donor population. In DO cycles with excellent-quality BL for transfer, morphology alone predicts a high live birth rate. Given the financial and technological burden of PGS, larger studies are needed to determine whether the costs of PGS outweigh the benefits in DO cycles

Resident physicians' scores on the REI section of the CREOG exam are traditionally low, and nearly 40% of house staff nation-wide perceive their REI knowledge to be poor. We aimed to assess whether an interactive case-based group-learning curriculum would narrow the REI knowledge gap by improving understanding and retention of core REI concepts under the time constraints affecting residents. A three-hour case-based workshop was developed to address four primary CREOG objectives. A multiple-choice test was administered immediately before and after the intervention and 7 weeks post-workshop, to evaluate both knowledge and confidence. Following the intervention, residents self-reported increased confidence with counseling and treatment of PCOS, ovulation induction cycle monitoring, counseling and treatment of POI, and breaking bad news related to infertility (p < 0.05). The multiple-choice exam was re-administered 7 weeks post-intervention, and scores remained significantly improved compared to pre-workshop scores (p < 0.05). At that time, all residents either strongly agreed (91.7%) or agreed (8.3%) that the case-based interactive format was preferable to traditional lecture-based teaching. In conclusion, a nontraditional curriculum aimed at teaching core REI concepts to residents through interactive case-based learning can be successfully integrated into a residency curriculum, and significantly improves knowledge and confidence of critical concepts in REI.

OBJECTIVE: To demonstrate that oocyte cryopreservation is a feasible reproductive option for patients with cancer of childbearing age who require gonadotoxic therapies. METHODS: This study is a university-based retrospective review of reproductive-aged cancer patient treatment cycles that included ovarian stimulation, transvaginal oocyte retrieval, oocyte cryopreservation, and, in some cases, subsequent oocyte thaw, in vitro fertilization, and embryo transfer. Outcome measures included ovarian stimulation response, number of oocytes retrieved, cryopreserved, and thawed, and pregnancy data. RESULTS: From 2005 to 2014, 176 reproductive-aged patients with cancer (median age 31 years, interquartile range 24-36) completed 182 oocyte cryopreservation cycles. Median time between consult request and oocyte retrieval was 12 days (interquartile range 10-14). Median peak stimulation estradiol was 1,446 pg/mL (interquartile range 730-2,687); 15 (interquartile range 9-23) oocytes were retrieved and 10 (interquartile range 5-18) metaphase II oocytes were cryopreserved per cycle. Ten patients (11 cycles) have returned to attempt pregnancy with their cryopreserved oocytes. Among thawed oocytes, the cryopreservation survival rate was 86% (confidence interval [CI] 78-94%). Nine of 11 thaw cycles resulted in embryos suitable for transfer. The embryo implantation rate was 27% (CI 8-46%) and the live birth rate was 44% (CI 12-77%) per embryo transfer. Chance for live birth with embryos created from cryopreserved oocytes was similar between the patients with cancer in this study and noncancer patients who underwent the same treatment at our center (44% [CI 12-77%] compared with 33% [CI 22-44%] per embryo transfer). CONCLUSION: Oocyte cryopreservation is now a feasible fertility preservation option for reproductive-aged patients with cancer who require gonadotoxic therapies.