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IS TRANSABDOMINAL (TA) IMAGING AN ADEQUATE ALTERNATIVE TO TRANSVAGINAL (TV) IMAGING IN ART CYCLES? [Meeting Abstract]

Finning, S; Jain, N; Fino, M E; McCulloh, D H; Blakemore, J K
Objective: Several patient populations prefer to avoid TV monitoring for comfort or to prevent dysphoria. The purpose of this study is to compare TA and TV ultrasound as a means of determining cycle trigger timing and predicting oocyte maturity based on scans performed during ART cycles in this patient population.
Material(s) and Method(s): This was a retrospective cohort study of 59 patients who underwent >= 1 ART cycle at a single academic center. The study group consisted of patients who preferred TA monitoring based on any of 3 following inclusion criteria: 1) if they were virginal, 2) identified as transgender or 3) had a diagnosis of vaginismus. The control group included patients within this cohort that had no preference for TA imaging and thus underwent exclusive TV imaging. Demographics and variables included age, body mass index (BMI), antral follicle count (AFC) and anti-mullerian hormone (AMH), day 2 estradiol (D2 E2) and follicle-stimulating hormone (FSH) levels, # scans per cycle, # stimulation days per cycle, estimated # follicles and follicle sizes at trigger, # eggs retrieved, and oocyte maturity rate. Primary outcomes were 1) % difference between estimated # follicles at trigger and # oocytes retrieved, 2) # oocytes retrieved, and 3) % maturity. Secondary outcomes included % difference between AFC and # oocytes retrieved. Kolmogorov-Smirnov test was used to determine normality with independent sample t-tests and Mann Whitney U-Tests were used where appropriate with p<0.05 considered significant.
Result(s): 59 patients (n=18 TA; n= 41 TV) were included in the analysis. 27.1% (n=9 TA; 7 TV) were virginal, 50.8% (6 TA; 24 TV) had vaginismus and 37.3% (10 TA; 12 TV) identified as transgender. Some patients met 2 criteria (virginal + vaginismus, transgender + virginal, or transgender + vaginismus). Patients in the TA group were significantly younger than those in the TV group (26.2 TA v 37.8 years TV, p<0.001). Median BMI (22.4 TA v 23.7 kg/m2 TV, p=0.26) and AMH (2.9 TA v 2.7 ng/mL TV, p=0.99) were similar. There was no statistical significance in mean AFC (12.8 +/- 9.2 TA, 13.6 +/- 8.2 TV, p=0.18). Patients in both groups had similar median D2 E2 (32.0 TA v 41.1 TV pg/mL, p=0.23) and FSH (5.6 TA v 7.2 mIU/mL TV, p=0.23), # scans per cycle (5 TA v 5 TV, p=0.88), and # stimulation days (11 TA v 11 TV, p=0.74). The TA group had higher mean E2 at trigger (3488.5 +/- 1087.0 TA, 2566.1 +/- 1416.1 pg/mL TV, p<0.002). There was no significant difference between estimated # follicles at trigger and # oocytes retrieved (17.7 +/- 31.4% TA, 6.7 +/- 38.0% TV; p= 0.29). Mean # oocytes (21.3 +/- 10.8 TA, 15.9 +/- 8.8 TV, p= 0.05) and median % mature oocytes (0.89 TA, 0.83 TV; p= 0.12) were also similar. Median % difference between AFC and # oocytes retrieved was not significantly different (0.68 TA, 0.82 TV; p= 0.18).
Conclusion(s): TA and TV imaging do not differ in their ability to predict FP cycle characteristics, oocytes retrieved or oocyte maturity rate. TA imaging may offer an acceptable alternative for patients uncomfortable with TV imaging during FP. Impact Statement: TA monitoring for oocyte cryopreservation does not adversely affect oocyte yield in patients with preference against TV imaging.
Copyright
EMBASE:2020860454
ISSN: 1556-5653
CID: 5367282

Two is not always greater than one: patients with one ovary have similar assisted reproductive technology (ART) outcomes compared to patients with two ovaries

Auran, Emily; Cascante, Sarah; Blakemore, Jennifer
PURPOSE/OBJECTIVE:To assess assisted reproductive technology (ART) outcomes in patients with one ovary compared to two ovaries. METHODS:We performed a retrospective cohort study of all patients with one ovary who underwent ≥ 1 ART cycle between 2012 and 2020 at a large university-affiliated fertility center. Patients were 3-to-1 matched with two ovary controls during the same period. Primary outcome was metaphase II oocytes (MIIs) retrieved per cycle. Secondary outcomes included ovarian reserve markers, laboratory outcomes, and live birth rates (LBRs). RESULTS:A total of 104 one ovary patients (158 cycles; median age 35.5 years) were matched to 312 two ovary patients (474 cycles; median age 35.0 years). In one ovary patients, anti-Mullerian hormone was lower (median 1.1 vs. 2.2, p < 0.01) and day 2 follicle-stimulating hormone was higher (median 7.4 vs. 6.2, p < 0.01). One ovary patients yielded median 7.5 MIIs and 10 oocytes per cycle, fewer than two ovary patients (11.0 and 14.5, respectively; p < 0.01). However, one ovary patients had ≥ 50% the MII and oocyte yield of two ovary patients (Z > 5.8, p < 0.01). Fertilization and blastocyst formation rates, euploidy rate, and rate of ≥ 1 embryo for transfer were equivalent between groups (p > 0.40). Among the one and two ovary groups, LBRs per transfer (45.8% vs. 46.6%, p = 1.00) and per patient who underwent transfer (68.3% vs. 73.9%, p = 0.55) were equivalent. CONCLUSION/CONCLUSIONS:One ovary patients yielded fewer MIIs and oocytes than two ovary patients, but had ≥ 50% the yield of two ovary patients, suggesting a compensatory mechanism in oocyte yield in the solitary ovary. One and two ovary patients had equivalent LBRs.
PMID: 35716337
ISSN: 1573-7330
CID: 5282872

Planned Oocyte Cryopreservation and the Black Obstetrician Gynecologist: Utilization and Perspectives

Wiltshire, Ashley; Ghidei, Luwam; Lantigua-Martinez, Meralis; Licciardi, Frederick; Blakemore, Jennifer
The objective of this study was to describe the opinions and attitudes toward planned oocyte cryopreservation (POC) among Black Obstetrician Gynecologists (BOG) and their experiences in counseling patients of color. A web-based, cross-sectional survey was distributed to BOGs. The survey consisted of questions pertaining to personal family building goals, fertility preservation, education and patient counseling experiences regarding POC. Of the 136 potential participants, the response rate was 50% (n = 68). Sixty-six percent of respondents felt the need to postpone childbearing due to medical training and 19% had already undergone POC or planned to in the future. A majority (70%) felt that all women planning to undergo medical training should consider POC, and a subgroup analysis showed this was more likely to be reported within BOG trainees (p < 0.01). Fifty-seven percent received education on POC and 25% felt "very comfortable" counseling patients on POC. Those age < 35 years were more likely to feel the need to postpone family building due to their medical training (p < 0.01). Generalist attendings who had not undergone POC were significantly more likely to report regret, compared to subspecialists (p < 0.03). Medical careers may have an unfavorable impact on family building, and our results highlight this effect in Black women. A better understanding of the mitigating factors is needed to develop culturally appropriate counseling and educational interventions for Black women and other women of color.
PMID: 35349117
ISSN: 1933-7205
CID: 5201032

Fifteen years of autologous oocyte thaw outcomes from a large university-based fertility center

Cascante, Sarah Druckenmiller; Blakemore, Jennifer K; DeVore, Shannon; Hodes-Wertz, Brooke; Fino, M Elizabeth; Berkeley, Alan S; Parra, Carlos M; McCaffrey, Caroline; Grifo, James A
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.
PMID: 35597614
ISSN: 1556-5653
CID: 5247762

The use of oocyte cryopreservation for fertility preservation in patients with sex chromosome disorders: a case series describing outcomes

Martel, Rachel A; Blakemore, Jennifer K; Fino, M Elizabeth
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.
PMID: 35320443
ISSN: 1573-7330
CID: 5206692

Sociodemographic differences in utilization of fertility services among reproductive age women diagnosed with cancer in the USA

Voigt, Paxton; Persily, Jesse; Blakemore, Jennifer K; Licciardi, Frederick; Thakker, Sameer; Najari, Bobby
PURPOSE/OBJECTIVE:To determine whether sociodemographic differences exist among female patients accessing fertility services post-cancer diagnosis in a representative sample of the United States population. METHODS:All women ages 15-45 with a history of cancer who responded to the National Survey for Family Growth (NSFG) from 2011 to 2017 were included. The population was then stratified into 2 groups, defined as those who did and did not seek infertility services. The demographic characteristics of age, legal marital status, education, race, religion, insurance status, access to healthcare, and self-perceived health were compared between the two groups. The primary outcome measure was the utilization of fertility services. The complex sample analysis using the provided sample weights required by the NSFG survey design was used. RESULTS:Five hundred forty-five women reported a history of cancer and were included in this study. Forty-three (7.89%) pursued fertility services after their cancer diagnosis. Using the NSFG sample weights, this equates to a population of 161,500.7 female cancer survivors in the USA who did utilize fertility services and 1,811,955.3 women who did not. Using multivariable analysis, household income, marital status, and race were significantly associated with women utilizing fertility services following a cancer diagnosis. CONCLUSIONS:In this nationally representative cohort of reproductive age women diagnosed with cancer, there are marital, socioeconomic, and racial differences between those who utilized fertility services and those who did not. This difference did not appear to be due to insurance coverage, access to healthcare, or perceived health status.
PMID: 35316438
ISSN: 1573-7330
CID: 5200472

Counseling, risks, and ethical considerations of planned oocyte cryopreservation

Reich, Jenna A; Caplan, Arthur; Quinn, Gwendolyn P; Blakemore, Jennifer K
The use of planned oocyte cryopreservation for nonmedical need has been steadily increasing, especially since the experimental label on this procedure was lifted nearly 10 years ago. With this rise, patients' desires to postpone or conserve their reproductive potential have become increasingly nuanced, and the need for complex individualized counseling has grown. In addition, there are several ethical considerations, including risks, access, and patient comprehension that must be discussed with patients who are considering this procedure. In this review, we provide an in-depth discussion of these concepts, highlighting the need for individualized and comprehensive counseling that recognizes the gaps in knowledge that remains in this somewhat novel domain.
PMID: 35105448
ISSN: 1556-5653
CID: 5153552

Fertility Preservation for Adolescent and Young Adult Transmen: A Case Series and Insights on Oocyte Cryopreservation

Barrett, Francesca; Shaw, Jacquelyn; Blakemore, Jennifer K; Fino, Mary Elizabeth
Background/UNASSIGNED:The opportunity for fertility preservation in adolescent and young adult (AYA) transmen is growing. Many AYA transmen desire future biologic children and are interested in ways to preserve fertility through oocyte cryopreservation prior to full gender affirmation, yet utilization of oocyte cryopreservation remains low. Additionally, standard practice guidelines currently do not exist for the provision of oocyte cryopreservation to AYA transmen. Our objective was to review our experience with oocyte cryopreservation in adolescent and young adult transmen in order to synthesize lessons regarding referral patterns, utilization, and oocyte cryopreservation outcomes as well as best practices to establish treatment guidance. Methods/UNASSIGNED:This is a case series of all AYA transmen (aged 10 to 25 years) who contacted, consulted or underwent oocyte cryopreservation at a single high volume New York City based academic fertility center between 2009 and 2021. Results/UNASSIGNED:Forty-four adolescent and young adult transmen made contact to the fertility center over the study period. Eighty percent (35/44) had a consultation with a Reproductive and Endocrinology specialist, with a median age of 16 years (range 10 to 24 years) at consultation. The majority were testosterone-naive (71%, 25/35), and had not pursued gender affirming surgery (86%, 30/35). Expedited initiation of testosterone remained the most commonly cited goal (86%, 30/35). Fifty-seven percent (20/35) pursued oocyte cryopreservation. Ninety-five percent (19/20) underwent successful transvaginal oocyte aspiration, with a median of 22 oocytes retrieved and 15 mature oocytes cryopreserved. There were no significant adverse events. At time of review, no patient has returned to utilize their cryopreserved oocytes. Conclusions/UNASSIGNED:Oocyte cryopreservation is a safe fertility preservation option in AYA transmen and is an important aspect of providing comprehensive transgender care. Insights from referral patterns, utilization, and oocyte cryopreservation outcomes from a single center's experience with adolescent and young adult transmen can be integrated to identify lessons learned with the goal of providing transparency surrounding the oocyte cryopreservation process, improving the education and comfort of patients and providers with fertility preservation, and easing the decision to pursue an oocyte cryopreservation cycle in parallel to gender-affirmatory care.
PMCID:9171925
PMID: 35685214
ISSN: 1664-2392
CID: 5261342

EXPERIENCES AND INTENTIONS OF PATIENTS WHO UNDERWENT MEDICALLY INDICATED ()OCYTE OR EMBRYO CRYOPRESERVATION: A QUALITATIVE STUDY [Meeting Abstract]

Bayefsky, Michelle J.; Sampson, Amain; Blakemore, Jennifer K.; Fino, Mary Elizabeth; Quinn, Gwendolyn P.
ISI:000891804600225
ISSN: 0015-0282
CID: 5439702

Evaluation of clinical parameters as predictors of monozygotic twins after single frozen embryo transfer

Kelly, Amelia G; Blakemore, Jennifer K; McCaffrey, Caroline; Grifo, James A
Objective/UNASSIGNED:To determine if recent evolutions in laboratory protocols, including the increased use of natural cycles and the use of a hyaluronan-containing transfer medium, affected the rate of monozygotic twin (MZT) pregnancies after single frozen embryo transfer (FET). Design/UNASSIGNED:Retrospective cohort study. Setting/UNASSIGNED:Urban university-based fertility center. Patients/UNASSIGNED:Patients who underwent single FET between January 2016 and December 2018 resulting in an intrauterine pregnancy. Interventions/UNASSIGNED:Transition to a transfer protocol with a hyaluronan-containing transfer medium in July 2017. Main Outcome Measures/UNASSIGNED:Number of MZT pregnancies. Results/UNASSIGNED:There were 1,619 cycles that met the inclusion criteria and 31 (1.9%) resulted in MZT pregnancies. A hyaluronan-containing transfer medium was used in 875 (54.1%) cycles. Programmed cycles were used for 1,385 (85.5%) FETs and 234 (14.5%) cycles were natural. The mean age at FET, oocyte age, endometrial echo thickness, inner cell mass grade, trophectoderm grade, expansion, and day of blastocyst vitrification were similar between the groups. The use of a hyaluronan-containing transfer medium resulted in fewer MZTs. After controlling potential confounders with a multivariate regression, the use of the hyaluronan-containing medium still resulted in fewer MZTs. Monozygotic twins were colinear with preimplantation genetic testing (PGT), so PGT was excluded as a variable in our regression. A regression of PGT only cycles showed that the use of the hyaluronan-containing medium was still associated with a reduction in MZT pregnancies. Conclusions/UNASSIGNED:The use of a hyaluronan-containing transfer medium was associated with a lower rate of MZTs. Other clinical parameters, including cycle type, were not associated with changes in the number of MZTs. The use of PGT needs to be further investigated as a risk factor for MZTs.
PMCID:8655405
PMID: 34934983
ISSN: 2666-3341
CID: 5108852