Faculty Bibliography

OBJECTIVE: The ongoing COVID-19 pandemic has disrupted the normal methods of communication used by physicians and patients, as well as the standard protocols and procedures by which medical clinics operate. Pandemic related stresses may have also influenced patient's fertility goals and/or their ovarian response.We questioned whether these changes resulted in any unanticipated effects in the treatments and outcomes of ART patients. DESIGN: Retrospective cohort. MATERIALS AND METHODS: Patients who underwent GnRH-antagonist IVF cycles from January 2020 through June 2020 at NYU Fertility Center, a period in New York City over which the COVID-19 pandemic escalated and life in the city drastically changed as a result of new social distancing measures, were separated by month of treatment and compared with patients from the corresponding month in the prior year (January 2019 through June 2019). Patient age, AMH, days gonadotropin, #oocytes retrieved, #oocytes matured, #fertilized, #blastocysts, and #euploid embryos were compared using Student's T-test.
RESULT(S): 1881 patients were compared over the parallel six-month periods. Clinic visits were markedly decreased over the months of March and April of 2020, when the pandemic was at its peak in NYC and treatments were suspended as per the ASRM pandemic guidelines. There were no differences in age, AMH, #oocytes retrieved, #mature oocytes, or #fertilized between the two years. In April of 2020 there were significantly more blastocysts per patient, as compared to April of 2019, however, in May and June of 2020 there were significantly fewer euploid embryos per patient, as compared to May and June of 2019 (see table).
CONCLUSION(S): In the months following the end of the COVID-19 treatment suspension, there were no apparent differences in patient characteristics or the quantitative responses to stimulation. However, there was a significant qualitative difference as expressed in the number of euploid embryos. It remains unclear if or how the pandemic is related to this difference

Objective: The efficacy and safety of use of the transvaginal ultrasound probe for percutaneous abdominal oocyte retrieval in patients with limited vaginal access has been established in prior studies,^1-2 but the technique has not been demonstrated widely. Methodology: This video uses a patient case to explain and demonstrate the technique of percutaneous transabdominal oocyte retrieval with the transvaginal ultrasound probe in a patient without vaginal access to her ovaries. Patient consent was obtained prior to creation of the video.
Conclusion(s): Abdominal oocyte aspiration using a high frequency transvaginal ultrasound probe should be considered in patients with ovaries inaccessible vaginally. It is safe, effective and an easily skill to acquire. References: 1. Baldini D, Lavopa C, Vizziello G, Sciancalepore AG, Malvasi A. The safe use of transvaginal ultrasound probe for transabdominal oocyte retrieval in patients with vaginally inaccessible ovaries. Front Womens Healt. 2018; 3(2):1-3. 2. Sekhon L, Said T, Del Valle A. Percutaneous transabdominal oocyte retrieval using vaginal ultrasound probe: A novel, effective and safe method for oocyte retrieval in patients with vaginally inaccessible ovaries. Fertil Steril. 2014; 101(2) Supplement.
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PURPOSE/OBJECTIVE:The objective of this study was to investigate stress levels among women undergoing elective oocyte cryopreservation by comparing their self-reported quality of life measures with women undergoing in vitro fertilization during the fertility treatment cycle. METHODS:Patients undergoing oocyte retrieval at a single institution were offered a voluntary, anonymous, and written questionnaire. The survey was adapted and validated from the Fertility Quality of Life tool to assess self-reported fertility treatment-related problems and was tested for construct validity and reliability. Based on exploratory factor analyses, three subscales were created as follows: fertility treatment-related stress, tolerability, and environment. Relationships between patient characteristics and fertility treatment-related measures were examined with Fisher's exact test, ANOVA, and multivariate regression with significance p < 0.05. RESULTS:A total of 461 patients (331 IVF, 130 egg freeze) were included in the analysis. Medically indicated egg freezing patients were excluded. Overall, both IVF and egg freeze patients reported stress during the current fertility cycle and there were no significant differences between IVF and egg freeze patients for any subscale scores. Three sets of generalized linear models were run and found age to be associated with fertility treatment-related stress and tolerability scores, with younger patients experiencing greater difficulties. Additionally, patients who underwent repeat cycles reported more fertility treatment-related stress. CONCLUSIONS:Patients undergoing egg freezing have similar responses to quality of life questions as patients undergoing IVF. Repeat cycles and younger age contribute to perceptions of stress. This information supports developing stress reduction strategies for all women undergoing egg freezing.

OBJECTIVE: An FSH boost on trigger-day may improve outcomes in fresh transfers by enhancing folliculogenesis and endometrial receptivity. As more patients are freezing all of their embryos, the endometrial effect is less of a concern, but folliculogenesis remains relevant. Recent reports1,2 conflict over the clinical effects of an FSH boost. We therefore examined the effect of an FSH boost on oocyte retrieval, quality, and development, specifically in patients undergoing PGT-A. DESIGN: Retrospective cohort. MATERIALS AND METHODS: Patients undergoing GnRH-antagonist IVF cycles from 1/2015 through 12/2018, were separated into two groups for comparison: those receiving only trigger injections on trigger day (NB), and those also receiving an FSH boost (B). Demographics, days of gonadotropin, #oocytes retrieved, #mature, #blastocysts, and #euploid embryos, were compared (Student's t-test or X2).
RESULT(S): Both groups were stratified into SART registry age groups . Initial comparisons between the groups, without matching for trigger day estradiol levels (E2Trig), revealed a selection bias. B patients had weaker responses, with lower estradiol levels and fewer eggs. In order to examine the effect of B in each age group, we created NB comparison groups with E2Trig values indistinguishable from the B's. This was done by randomly selecting NB patients from the same age group and E2Trig stratum as B. 1394 patients were included in this matched comparison. 697 received B, and 697 did not. B patients had significantly more days of gonadotropin administration (~1 day) than NB patients. There were no consistent differences for #oocytes retrieved, #mature, fertilization rate, #blastocysts, or #euploid embryos (see table). Overall, costs associated with B amounted to $276,923, or close to $400 per patient.
CONCLUSION(S): No benefit of B was found for #oocytes retrieved, #mature, fertilization rates, #blastocysts, or #euploid embryos. There are significant cost savings associated with NB