Faculty Bibliography

OBJECTIVE:To review the outcomes of patients who underwent autologous oocyte thaw after planned oocyte cryopreservation. DESIGN/METHODS:Retrospective cohort study. SETTING/METHODS:Large urban university-affiliated fertility center. PATIENT(S)/METHODS:All patients who underwent ≥1 autologous oocyte thaw before December 31, 2020. INTERVENTION(S)/METHODS:None. MAIN OUTCOME MEASURE(S)/METHODS:The primary outcome was the final live birth rate (FLBR) per patient, and only patients who had a live birth (LB) or consumed all remaining inventory (cryopreserved oocytes and resultant euploid/untested/no result embryos) were included. The secondary outcomes were laboratory outcomes and LB rates per transfer. RESULT(S)/RESULTS:A total of 543 patients underwent 800 oocyte cryopreservations, 605 thaws, and 436 transfers. The median age at the first cryopreservation was 38.3 years. The median time between the first cryopreservation and thaw was 4.2 years. The median numbers of oocytes and metaphase II oocytes (M2s) thawed per patient were 14 and 12, respectively. Overall survival of all thawed oocytes was 79%. Of all patients, 61% underwent ≥1 transfer. Among euploid (n = 262) and nonbiopsied (n = 158) transfers, the LB rates per transfer were 55% and 31%, respectively. The FLBR per patient was 39%. Age at cryopreservation and the number of M2s thawed were predictive of LB; the FLBR per patient was >50% for patients aged <38 years at cryopreservation or who thawed ≥20 M2s. A total of 173 patients (32%) have remaining inventory. CONCLUSION(S)/CONCLUSIONS:Autologous oocyte thaw resulted in a 39% FLBR per patient, which is comparable with age-matched in vitro fertilization outcomes. Studies with larger cohorts are necessary.

PURPOSE/OBJECTIVE:Characterize outcomes among adolescents and young adults (AYAs) with sex chromosome disorders (SCDs) after oocyte cryopreservation (OC) consultation. METHODS:Retrospective case series of all AYA (< 25 years) patients with SCDs seen for OC consultation from 2011 to 2019 at a large, urban, academic fertility center. All AYA patients with an SCD seen for OC consult in the study time period were reviewed and included. Data collected included patient age, SCD type, number of patients who attempted OC, number of cycles attempted, and cycle outcomes. RESULTS:Twenty-two patients were included: 9 with Turner syndrome, 12 with mosaic Turner syndrome, and 1 with 47,XXX. Mean age at consult was 14.7 ± 3.5 years. Fourteen patients elected for OC: 5 with Turner syndrome, 8 with mosaic Turner syndrome, and 1 47,XXX who pursued 31 OC cycles total. Of those 14 patients, 10 underwent retrieval, 9 froze oocytes, and 8 froze mature (MII) oocytes. Seven patients underwent > 1 cycle and 7 had ≥ 1 cancelation. 3/3 patients who pursued cycles after 1st cancelation never got to retrieval. Age, SCD type, and baseline FSH did not predict ability to freeze MIIs. One patient returned after OC and attempted 4 ovulation induction cycles and 2 IVF cycles; all were canceled for low response. CONCLUSIONS:AYA patients with SCDs have a high risk of poor response and cycle cancelation but the majority froze MIIs. Thus, setting expectations is important. A larger sample size is needed to evaluate possible clinical predictors of success.

PURPOSE/OBJECTIVE:To compare the racial and ethnic make-up of patients who accessed medically indicated fertility preservation services (MIFP) against the overall racial diversity (including Hispanic origin) across women of reproductive age diagnosed with cancer in New York City (NYC). METHODS:All patients who completed at least one MIFP between January 2017 and December 2018 were reviewed. Race was self-reported. A calculation of the expected racial distribution across women of reproductive age with cancer in NYC was determined using the most recent NYC census data. Statistical analysis included chi-square goodness of fit and test for independence and Kruskal-Wallis H test, with p < 0.05 considered significant. RESULTS:A total of 107 patients who accessed MIFP were included. A total of 55 (51.4%) identified as White, 3 (2.8%) as Black, 13 (12.2%) as Asian, 6 (5.6%) as Hispanic, 3 (2.8%) as other, and 27 (25.2%) did not report. A total of 78.5% of patients had insurance. There was no significant difference in racial distribution by cancer type (p = 0.255). A subgroup analysis excluding the BRCA+ patients and races not reported by the census (n = 69) was then performed, showing a statistically significant difference between observed (O) and expected (E) cases of fertility preservation (FP) by race at our center-White 47O/32E, Black 3O/15E, Asian 13O/7E, and Hispanic 6O/15E (p < 0.001). A statistically significant difference in racial distribution by FP type was observed. CONCLUSIONS:There is a difference in the observed vs expected racial distribution of patients accessing MIFP. Further studies are needed to identify modifiable factors to better ensure equal opportunity to all patients.

Objective: To review outcomes of all STEET procedures based on PGT-A platform used to determine Ploidy status.
Design(s): Retrospective review of all STEET procedures over an 8 year period at a single center.
Material(s) and Method(s): More than 3200 STEET procedures performed over an 8 year period (2011 to 2018) at a single center were reviewed based on the PGT-A platform (NGS, aCGH or SNP) utilized. Our main outcome measures were: Implantation Rate (IR), Clinical Preg rate (FH) and Live Birth (LB) rate. Only embryos reported as euploid were included in the analysis- embryos reported as mosaic or those not yielding a result were omitted. Statistical significance was determined using contingency X² with 1 degree of freedom.
Result(s): TABLE 1. Comparison of STEET outcomes depending on PGT-A Platform [Figure presented] STEET following PGT-A via NGS resulted in a significantly higher IR compared to aCGH /SNP combined (70.1% vs 62.4%). Similarly, ongoing Pregnancy rates and LB rates were significantly improved when NGS was utilized vs aCGH or SNP. SAB rates were not significantly different between platforms but all methods reduced SAB rates compared to age matched controls without PGS (18% ) (Ref 1).
Conclusion(s): STEET results in high IR, high clinical pregnancy rates and high LB rates across all age groups. However, with advances in PGT-A platforms we can continue to improve outcomes and increase safety of ART by maximizing the potential of every ET procedure. With continuing development of PGT-A platforms and interpretation methods used to determine ploidy we can further improve outcomes and safety by transferring a single embryo with the highest implantation potential every time. Reference: Harton et al (2013) Fert & Ster Vol. 100 (6) 1695-1703.
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Objective: In the era of personalized medicine and the simultaneously increasing use of frozen embryo transfer (FET), assays of the endometrium's receptivity prior to transfer has gained popularity, especially among patients. However, the optimal timing for single thawed euploid embryo transfers (STEET) in a programmed FET has yet to be determined¹. We sought to examine the outcomes of euploid FETs by length of progesterone (P4) exposure at our clinic.
Design(s): Prospective cohort study of all programmed FETs of single euploid embryos between 6/1/2018 and 12/18/2018 at our center.
Material(s) and Method(s): All patients undergoing FET in the inclusion time period were asked to write down the exact time of P4 initiation and then report the start time on the day of P4 serum level check (2 days later) prior to embryo transfer. All FETs were then reviewed. Programmed FET cycles were defined as treatment of oral estradiol daily followed by either 50-75mg intramuscular P4 in oil or vaginal P4 suppository with transfer of a euploid embryo (tested by either array comparative genomic hybridization or Next Generation Sequencing). Programmed FETs with untested, mosaic or double embryo transfers, as well as natural cycles, were excluded. Cycles where exact timing data could not be determined were also excluded. Statistical analysis included ANOVA, receiver operating characteristic curve, and Spearman's Rho correlation where appropriate, with p<0.05 considered significant.
Result(s): 253 programmed STEET cycles met criteria and were included in the analysis. The average patient age at time of ET was 38.0+/-4.5 years. 3 cycles utilized an assay for endometrial receptivity for adjusted timing. The mean duration of P4 exposure was 112.8+/-2.9 hours with a range from 98.25-124.5 hours for all unadjusted cycles. Overall, 166 women had an ongoing pregnancy (OP), 25 had a spontaneous loss (SAB), 12 a biochemical pregnancy (BP) and 50 a negative pregnancy (NP) test, for a 65.6% ongoing pregnancy rate. There was no significant difference in P4 duration between outcome groups (112.8+/-3.1 OP, 112.4+/-4.4 SAB, 111.6+/-1.7 BP, 113.9+/-5.7 NP, F 1.76, df 3, p = 0.156). An ROC curve assessing the ability of P4 duration to predict ongoing pregnancy (OP) had an area under the curve of 0.467 (p=0.38). Furthermore, there was no correlation in the day 28 serum hcg value based on the duration of P4 exposure (rs = 0.058, p = 0.399)
Conclusion(s): Duration of P4 is critical to the success of a programmed FET. At our center, duration of P4 was not associated with FET outcomes. 65.6% of cycles resulted in ongoing pregnancy with our center's standard instructions, which may vary from other centers who have equivalent euploid embryo implantation rates. With growing popularity for individualized testing, these results provide evidence for patient counseling of the high likelihood of desired outcome (ongoing pregnancy) without need for personalized testing. These results also support the need for further prospective or randomized controlled study of optimal FET cycle across clinics and protocols. References: 1. Mackens S, Santos-Ribeiro S, van de Vijver A, Racca A, Van Landuyt L, Tournaye H, Blockeel C. Frozen embryo transfer: a review on the optimal endometrial preparation and timing. Hum Reprod. 2017; 32(11):2234-2242.
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The process of gender affirmation may have an impact on fertility. Counseling on the impact of affirmation and opportunities for fertility, future family building, and reproductive health is an important first step in the affirmation process. This article discusses the options for fertility preservation for transmen. The barriers and outcomes in this unique population are also considered. In addition, insights are provided on the future of fertility preservation and suggestions are made for how to build a comprehensive team for male transgender patients.