Faculty Bibliography

OBJECTIVE: To evaluate a cohort of patients who were referred to our center after failing IVF/ICSI elsewhere, but who did not meet our center's more stringent criteria for ICSI (<2 mil progressively motile sperm after prep +/- prior failed fert). DESIGN: Retrospective analysis. MATERIALS AND METHODS: 76IVF cycles at NYUFC, in which ICSI was deemed necessary for fert at another program, were fertilized by insemination-only (Grp 1; n=21) or 1/2 insemination-1/2 ICSI (Grp 2; n=55). Fert method was per program criteria. Fert (FR), implantation (IR), clinical pregnancy (PR) and live birth (LBR) rates were analyzed by chi + logistic regression. RESULTS: FR for MII oocytes was 70% in Grp 1 and 74% in Grp 2. Within Grp 2, 72% of inseminated and 83% of ICSI oocytes fertilized (p=.13). In no cycle was there complete fert failure, regardless of method used. Best quality embryos, regardless of fert method, were chosen for transfer (ET). In Grp 2, 17 cycles had ETof ICSI-only embryos, 16 insemination-only and 22 a mixed ET. Clinical outcomes by method of fert for transferred embryos were compared to inseminated ETs (Table). No statistically significant difference was found in PR or LBR, although ICSI oocytes demonstrated a higher IR. (Table presented). CONCLUSIONS: Our center's use of ICSI (27%) includes cycles chosen because of prior failed fert or poor semen parameters and is significantly lower than the national average (63%), with no compromise in PR. Reasonable fert can be achieved whether or not ICSI is performed if treatment is individualized to history or semen parameters. ICSI should only be used when clinically indicated

OBJECTIVE: To reevaluate clinical management of isolated teratozoospermia, in couples initiating IVF. DESIGN: Retrospective analysis of fertility indices in 535 cycles. SETTING: A large, university-based fertility center. PATIENT(S): Consecutive couples (n = 495) who had a semen analysis using Kruger/Tyberberg strict criteria at our center within 12 months before undergoing their first and/or second IVF cycle in 2002-2004 with >2 million postwash, motile sperm on the day of egg retrieval. INTERVENTION(S): Eggs were fertilized either by conventional IVF or ICSI. Semen analysis and gamete/embryo manipulation was standardized in all cases. MAIN OUTCOME MEASURE(S): Fertilization, fertilization failure, pregnancy, and live birth rates. RESULT(S): There was no statistical difference in fertilization, fertilization failure, pregnancy, and live birth rates in the first or second IVF cycle when comparing couples with isolated teratozoospermia (<5% normal morphology) to those with a normal semen analysis. Furthermore, no improvement in these outcomes was noted when ICSI was used to treat these teratozoospermic couples. CONCLUSION(S): Because isolated teratozoospermia generally does not impact on the major indices of IVF, these patients need not be subjected to the unnecessary cost and potential risks of ICSI. Future studies, however, should focus on different sperm morphologic and biochemical parameters to determine if they are important for clinical management in IVF

In a 6-year review of ectopic pregnancies (EPs) after fresh and frozen embryo transfers in IVF cycles conducted at a large university-based program, we report an overall 0.9% rate of EP that seems to have increased with the programmatic shift to routine blastocyst transfer, but remains lower than nationally reported rates. Aggressive management of tubal disease may contribute to low rates of EP, whereas blastocyst transfer may increase the rate

To assess whether the use of extended embryo culture can reduce the incidence of high-order multiple gestations, a retrospective analysis of 7,418 fresh ETs performed in a university-based IVF clinic from 1997-2003 was conducted, comparing program results before and after institution of a protocol to select patients for extended culture of in vitro fertilized embryos. The incidence of triplet pregnancies was significantly reduced in patients at highest risk for high-order multiple gestations, i.e., those at <35 years of age (16.8% versus 6.8%), those at 35-37 years of age (13.0% versus 5.6%), and recipients of donated oocytes (11.2% versus 4.5%)

We describe our experience of over 300 cycles of preimplantation genetic diagnosis (PGD) and report clinical pregnancy rates (35%-67%) that support using this technology to screen for genetic disorders and chromosomal abnormalities. In clinical practice for over ten years, PGD offers couples the earliest form of genetic screening and may help improve ongoing pregnancy rates in poor-prognosis patients