Faculty Bibliography

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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Objective: To determine the incidence of euploidy and implantation and delivery of Blastocysts derived from 0PN and 1PN compared with 2PN embryos.
Design(s): Single center retrospective review of PGT-A cases over a 4 year period (2015-2018) where a biopsy and ploidy determination was performed on blastocysts (blasts) derived from zygotes where pronuclei (PNs) were either not evident (0 PN) or only 1 pronucleus (1 PN) was evident at the time of fertilization check.
Material(s) and Method(s): At our center fertilization checks are routinely conducted ~18 hours post insemination or ICSI. The number of PN in each egg is recorded and zygotes cultured individually. Cases where < 50% of the mature eggs exhibit 2PN are routinely rechecked later on Day 1 and omitted from this study if additional PNs seen. In cases for PGT-A, all viable inseminated eggs excluding those with > 3 PN remain in culture to Day 6/7. Good quality blastocysts with a distinct Inner cell mass and cohesive trophectoderm are considered for PGT-A regardless of whether they were 0PN, 1PN or 2PN at fertilization check. PGT-A results are shown in Table 1 along with PGT-A sex of blasts derived from each group.
Result(s): [Figure presented]
Conclusion(s): Prior to utilization of PGT-A and/or timelapse zygotes not exhibiting 2PN at fertilization check were routinely discarded. However, it is now obvious that a percentage of these, albeit small, are fertilized normally and are euploid. Though they account for only a small percentage these may be the only euploid blasts available. Implantation rates and LB rates following transfer of these blasts are similar to those for 2PN blastocysts. Of interest, ratios of XX:XY blasts derived from 1PN and 0PN zygotes were skewed towards female while those from 2PN zygotes were ~1:1. It should be noted that NGS cannot detect pure haploidy (23, X) or triploidy (69, XXX) thereby possibly misdiagnosing these as euploid although our IR and LB results indicate otherwise. Support: None References: None
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Objective: Current data suggests that use of oral antibiotics and corticosteroids (AC) prior to embryo transfer (ET) does not improve ET outcomes. We hypothesized that patients with a history of chronic endometritis (CE) may be an exception to this finding. The objective was to investigate the utility of AC prior to single thawed euploid embryo transfer (STEET) in patients with CE.
Design(s): Retrospective cohort study.
Material(s) and Method(s): Patients who underwent STEET at an academic medical center from 1/2000 to 4/2019 were identified. Cycles prior to 1/2018 received 100 mg doxycycline bid and methylprednisolone 16 mg daily (Pre) prior to ET, and cycles performed after this date did not (Post). Cycles were evaluated for performance of endometrial biopsy (EMB) for CE, with CE defined as presence of plasma cell marker CD-138 (not by hematoxylin and eosin stain alone). Patients positive for CE were treated with 2-3 weeks antibiotics prior to ET cycle start. Outcomes were recorded as not pregnant (NP), biochemical pregnancy (BP), ectopic (E), or intrauterine pregnancy (IUP). Rates of IUP were compared to NP+E and BP. Chi-squared test was used for analysis (p<0.05).
Result(s): 2774 STEET cycles were included. There were 1870 Pre and 904 Post. 462 cycles had an EMB for CE performed. Of these, 238 were positive for CE and 224 were negative. Rates of IUP versus NP, BP, and E combined were not significantly different between all Pre (n=1247, 67%) and all Post (n=628, 68%) with X²(2, N=2765) =2.24 P>.05. Similarly, rates of IUP were not significantly different in patients who had not had an EMB (Untested), or in patients who were tested for CE and found to be negative. In patients with a history of CE there was a small but significant increase in IUP in Post (n=61, 54%) compared to Pre (n=46, 37%) X²(2, N=238) =9.31 P<0.05.
Conclusion(s): Overall, treatment with AC was not associated with higher IUP rates. The use of AC did not improve outcomes in patients with a history of CE, and unexpectedly resulted in lower IUP rates. [Figure presented]
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Objective: To determine the incidence of euploidy in Blastocysts derived from 0PN and 1PN compared with 2PN embryos.
Design(s): Single center retrospective review of PGT-A cases over a 4 year period (2015-2018) where a biopsy and ploidy determination was performed on blastocysts (blasts) derived from zygotes where pronuclei (PNs) were either not evident (0 PN) or only 1 pronucleus (1 PN) was evident at the time of fertilization check.
Material(s) and Method(s): At NYULMC fertilization checks are conducted ~18 hours post insemination or ICSI. The number of PN in each egg is recorded and zygotes are cultured individually. Cases where <=50% of the mature eggs exhibit 2PN are routinely rechecked later on Day 1. In cases for PGT-A, all viable inseminated eggs excluding those with >=3 PN remain in culture to Day 6/7. Good quality blastocysts with a distinct Inner cell mass and cohesive trophectoderm are considered for PGT-A regardless of whether they were 0PN, 1PN or 2PN at fertilization check. PGT-A results are shown in Table 1 along with PGT-A sex of blasts derived from each group.
Result(s): [Figure presented]
Conclusion(s): Prior to utilization of PGT-A and/or timelapse zygotes not exhibiting 2PN at fertilization check were routinely discarded. However, it is now obvious that a percentage of these, albeit small, are fertilized normally and are euploid. Though they account for only a small percentage these may be the only euploid blasts available. Implantation rates and LB rates following transfer of these blasts are similar to those for 2PN blastocysts. Of interest, ratios of XX:XY blasts derived from 1PN and 0PN zygotes were ~2:1 while those from 2PN zygotes were ~1:1. It should be noted that NGS cannot detect pure haploidy (23, XO) or triploidy (69, XXX thereby possibly misdiagnosing these as euploid although our IR and LB results indicate otherwise.
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