Faculty Bibliography

OBJECTIVE: To compare rates of implantation, pregnancy, miscarriage, multiple gestation, and selective reduction between patients undergoing day 5 (d5) and day 3 (d3) ETs. DESIGN: Retrospective cohort study. SETTING: University-based IVF center. PATIENT(S): The first d5 ET cycle of patients 42 years of age from 2003 to 2006 was compared with a historical control of first cycle d3 ET patients 42 years of age from 1996 to 1999 who would have met current d5 ET criteria. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Rates of implantation, clinical pregnancy, miscarriage, live birth, high order multiple pregnancy (HOMP), and selective reduction. RESULT(S): D5 ET patients had higher implantation rates (39% vs. 30%), with no difference in the no-transfer rate. D5 ET patients had lower rates of HOMP (2.5% vs. 11%) and HOMP delivery (0.7% vs. 3.5%), multiple pregnancy (27% vs. 33%), multiple delivery (19% vs. 26%), and twin delivery (18% vs. 23%). There were fewer selective reductions of HOMP with d5 ET (1.7% vs. 3.8%). CONCLUSION(S): Extended culture improves embryo selection through increased implantation, facilitating fewer embryos per transfer, which lowers multiple gestation rates and the need for HOMP reduction

OBJECTIVE: To explore the use of oocyte cryopreservation as a fertility-conserving option. Cancer treatments administered during the reproductive and adolescent years can result in sterility. Previous fertility preservation efforts focused on embryo rather than oocyte storage because the latter was deemed inefficient. Recently, several large reports of healthy births resulting from the transfer of embryos derived from frozen/thawed oocytes have been published. We sought to establish an oocyte cryopreservation program at our center. DESIGN: Twenty-three oocyte cryopreservation cycles were performed. Collected oocytes were cryopreserved by either the slow or the vitrification method. Approximately 1-4 months later, a programmed cycle of thawing/warming, fertilization with intracytoplasmic sperm injection, and ET was performed; cycle and pregnancy outcomes were assessed. SETTING: University-based fertility center. PATIENT(S): Twenty-two infertile women. INTERVENTION(S): Oocyte cryopreservation. MAIN OUTCOME MEASURE(S): Oocyte survival, embryo development, pregnancy outcomes. RESULT(S): Oocyte survival, 2-pronuclei fertilization, and blastocyst formation rates were 92%, 79%, and 43%, respectively. Fourteen women became pregnant; one miscarried; 10 have delivered 13 viable infants, and three pregnancies are ongoing for an ongoing/delivered pregnancy rate of 57%. This result was not statistically different from cycles performed consecutively in age-matched controls using fresh, nonfrozen autologous or donor oocytes during a similar time period. CONCLUSION(S): Oocyte cryopreservation appears to be a viable option for fertility preservation in some centers

OBJECTIVE: To review a center's experience with cryopreserved embryos generated from donor eggs and to analyze their long-term disposition. DESIGN: Retrospective analysis of donor egg cycles with cryopreserved embryos. SETTING: University-based IVF program. PATIENT(S): Eight hundred twenty-nine women undergoing oocyte donation. INTERVENTION(S): N/A. MAIN OUTCOME MEASURE(S): Factors affecting the decision regarding disposition of donor frozen embryo transfer (dFET) and the association between fresh and dFET cycles. RESULT(S): From January 2000 to December 2004, donor egg recipients underwent 829 fresh embryo transfer cycles that resulted in a 54% live birth rate. Of the 444 recipients who delivered, 177 (40%) also cryopreserved embryos at transfer; however, only 37 (21%) returned for a dFET by August 2009 and only 18 women had children from fresh and frozen transfers. In contrast, 128 of the 385 recipients who failed the fresh transfer (33%) cryopreserved embryos and 111 (87%) returned for a dFET. Of these, 44 had children from the dFET. Frozen cycle success rates between these recipient groups did not depend on fresh cycle outcome or prior parity. CONCLUSION(S): Donor oocyte recipients often initiate treatment with a desire to cryopreserve embryos for future use and family expansion. However, our data demonstrates that most recipients with a child from the fresh transfer do not return to use their cryopreserved embryos. Although fresh transfer success correlated with embryo disposition, it did not correlate with the outcome of thawed embryo transfer

Annually, more than 50 000 cancer diagnoses are made in the USA in patients under the age of 35 years. Despite this staggering statistic, medical advancements have substantially improved survival rates. Thus, for both male and female patients with cancer, quality-of-life issues, such as fertility preservation and parenthood, have become an essential component of treatment. Unfortunately, many of the treatments to eradicate malignant processes can also compromise reproductive function. In these cases, fertility preservation should be discussed and initiated with early treatment planning, to allow the best chance for future parenthood, when appropriate. The effects of cancer and cancer treatments on fertility and future parenthood, including health risks for patients, their gametes, and offspring are discussed

OBJECTIVE: To report the use of previously cryopreserved oocytes for the treatment of secondary infertility. DESIGN: Case report. SETTING: University-based IVF program. PATIENT(S): A 41-year-old woman with 18 months of secondary infertility and a previous history (age 38) of elective oocyte cryopreservation. INTERVENTION(S): Previously cryopreserved oocytes. MAIN OUTCOME MEASURE(S): Fertilization, embryo development, pregnancy, and outcome. RESULT(S): The patient achieved pregnancy and delivery following thaw of oocytes electively cryopreserved 39 months before use. Before thawing the oocyte, the patient attempted pregnancy naturally for 12 months, followed by two unsuccessful clomiphene citrate ovulation induction cycles with intrauterine insemination and one fresh IVF cycle resulting in a chromosomally abnormal twin gestation that aborted. CONCLUSION(S): Although oocyte cryopreservation is still labeled an experimental procedure, this case demonstrates that oocyte cryopreservation used for electively deferred reproduction can subsequently serve in the treatment for secondary infertility when the patient becomes her own oocyte donor

Background: Early detection programs combined with improved treatment protocols have allowed cancer patients (CP) to live substantially longer lives. Therefore, quality-of-life issues, such as fertility preservation (FP), have become increasingly important. Previously, time constraints and poor success limited the effectiveness of such procedures. However, recent advancements in oocyte cryopreservation (OC) technology have made this a viable option. OC not only eliminates the need for donor gametes but also the ethical, personal and religious constraints associated with embryo freezing. The novelty of OC has limited its universality; only recently have oncologists begun to refer CP for OC with even fewer yet returning to use these oocytes. To ensure feasibility, we compared OC outcomes of CP to all women without cancer who have completed oocyte thaw (n=32). Methods: CP referred for FP underwent extensive counseling in compliance with the ASRM (2009); those electing OC were included. Ovarian stimulation was achieved with injectable gonadotropins. OC was performed using slow cooling and vitrification methods. Results: 50 CP completed an OC cycle (baseline ovarian reserve testing was normal for all CP); 6 had 1 child already. Malignant diagnoses included 22 gyn, 12 breast, 8 hematologic, 2 GI, 2 CNS and 4 other; 7/9 pts >= age 38 had breast cancer. FP treatment was completed on average in 12 +/-0.3 days. Outcome data are shown in the Table. Conclusions: OC is a novel and potentially successful FP option offering desired reproductive choice. With a dedicated team, OC can be performed expeditiously and successfully, minimizing interference with cancer treatment. As future parenthood greatly impacts quality-of-life, OC should be an integral component of FP counseling in young cancer patients. (Table presented)

Background: Objectives - 1) Establish a prospective registry with long-term follow-up of female cancer patients (CP) who presented for initial consultation for FP; 2) Introduce the FACT-B QOL survey for novel use in a FP population. Methods: All consenting female CP completed the registry survey/FACT-B and agreed to yearly follow-up. Results: From 3/2008 to 1/2010, 22 CP enrolled in the registry, 2 declined, and 1 was lost to follow-up. Cancer diagnoses included 6 cervical, 4 breast, 3 endometrial, 2 ovarian, 2 Hodgkin's, 1 childhood neuroblastoma + renal cell carcinoma, 1 Ewing's sarcoma, 1 thymic carcinoma, 1 AML, 1 papillary mesothelioma. The average age at enrollment was 33.1+/-5 (range 23 - 44) y. Sixteen patients sought FP with oocyte (OC) and/or embryo cryopreservation (EC), and 5 underwent in vitro fertilization (IVF). 15/22 were referred from their medical or surgical oncologists. Thirteen patients sought treatment prior to cancer surgery and/or chemo and began FP treatment an average of 12 (range 1 - 22) days from initial consult. Twenty patients completed 30 cycles; 14 used OC and/or EC, 5 IVF and 1 oocyte donation (OD), of which 7 patients underwent embryo transfers resulting in 1 delivery, 1 ongoing (in 8^th month) and 1 miscarried pregnancy. One year follow-up is ongoing. By survery, most patients (12/22) felt having a child was most important in their life (scale 1 - 7; mean 6.1), and 14/22 were most concerned with the impact of their cancer treatment on fertility (mean 6.1). IVF and OD were the most and least preferred treatments, respectively. Recognizing the limited data on the long-term risks for FP patients, most (14/22) were unsure regarding the risk they would undertake to pursue fertility treatment. Most patients reported high baseline QOL scores across all categories of physical, social, emotional, and functional well being. Conclusions: Fertility after cancer remains a significant issue, yet most patients are unsure of their risk tolerance. We introduce the FACT-B QOL survey for novel use in a FP population and aim to determine the long-term safety, effectiveness, and QOL impact of FP treatment in female CP

PURPOSE: To compare oocyte cryopreservation cycles performed in cancer patients to those of infertile women. METHODS: Cancer patients referred for fertility preservation underwent counseling in compliance with the ASRM; those electing oocyte cryopreservation were included. Ovarian stimulation was achieved with injectable gonadotropins and freezing was performed using slow-cooling and vitrification methods. RESULTS: Fifty cancer patients (mean age 31 y) underwent oocyte cryopreservation; adequate ovarian stimulation was achieved in 10 +/- 0.3 days. The outcome from these cycles included a mean peak estradiol of 2,376 pg/ml and an average of 19 oocytes retrieved (15 mature oocytes were cryopreserved/cycle). All patients tolerated ovarian hyperstimulation. There were no significant differences noted between cryopreservation cycles performed in cancer patients and in women without malignancy. CONCLUSIONS: Oocyte cryopreservation appears to be a feasible fertility preservation method for reproductive-age women diagnosed with cancer. This modality is not only effective but also, providing a multidiscipline effort, can be completed in timely fashion