Faculty Bibliography

OBJECTIVE: To determine any beneficial effects of preimplantation genetic screening (PGS) of all chromosomes by array comparative genomic hybridization (aCGH), with either day 3 or blastocyst biopsy, for idiopathic recurrent pregnancy loss (RPL) patients compared with their expected loss rate. DESIGN: Case series report. SETTING: Multiple fertility centers. PATIENT(S): A total of 287 cycles of couples with idiopathic RPL (defined as two or more losses). INTERVENTION(S): PGS was done with day 3 biopsy (n = 193) or blastocyst biopsy (n = 94), followed by analysis with aCGH. MAIN OUTCOME MEASURE(S): Spontaneous abortion rate, euploidy rate. RESULT(S): A total of 2,282 embryos were analyzed, of which 35% were euploid and 60% were aneuploid. There were 181 embryo transfer cycles, of which 100 (55%) became pregnant with an implantation rate of 45% (136 sacs/299 replaced embryos) and 94 pregnancies (92%) were ongoing (past second trimester) or delivered. The miscarriage rate was found to be only 6.9% (7/102), compared with the expected rate of 33.5% in an RPL control population and 23.7% in an infertile control population. CONCLUSION(S): Current PGS results with aCGH indicate a significant decrease in the miscarriage rate of idiopathic RPL patients and high pregnancy rates. Furthermore, this suggests that idiopathic recurrent miscarriage is mostly caused by chromosomal abnormalities in embryos.

PURPOSE: We determined whether the use of intracytoplasmic sperm injection in couples who previously underwent intracytoplasmic sperm injection cycles elsewhere could be decreased without compromising the pregnancy rate. MATERIALS AND METHODS: At our university in vitro fertilization-embryo transfer center we retrospectively analyzed the records of 149 fresh, in vitro fertilization-embryo transfer cycles in patients who underwent intracytoplasmic sperm injection elsewhere and subsequent fertilization by insemination only (all insemination group) or half insemination and half intracytoplasmic sperm injection at our center. We compared fertilization, implantation, clinical pregnancy and live birth rates. RESULTS: The fertilization rate was 74% and 73% for the all insemination and the half intracytoplasmic sperm injection groups, respectively. In the latter group 69% of inseminated and 78% of intracytoplasmic sperm injected oocytes were fertilized. No cycle showed complete fertilization failure. No statistically significant difference in the live birth rate was found between the 2 groups. CONCLUSIONS: More stringent criteria for intracytoplasmic sperm injection do not compromise the clinical outcome and reasonable fertilization can be achieved whether or not intracytoplasmic sperm injection is performed. Thus, although intracytoplasmic sperm injection is one of the greatest advances in our field, it is overused and should only be done for clinically proven indications

Oocyte cryopreservation still bears the experimental label. Remarkable innovation in this field has led to immense improvement in clinical outcomes and has even resulted in outcomes comparable to those achieved following fresh embryo transfers. Such success has prompted this centre to investigate outcomes of cryopreservation options (oocyte versus pronuclear zygote versus supernumerary day-5 blastocyst after fresh embryo transfer). This study retrospectively analysed 200 cryopreservation cycles which were divided into three groups according to cryopreservation option, which were all cultured to blastocyst-stage post thaw/warming from January 2005 to December 2008, and compared them with 400 fresh embryo transfer cycles from the same time period. When compared with fresh embryo transfer, frozen embryo transfers originating from previously cryopreserved oocytes or pronuclear zygotes resulted in similar implantation, pregnancy and live-birth rates; however, frozen embryo transfers originating from supernumerary day-5 blastocysts resulted in lower outcomes. Thus, oocyte and/or pronuclear zygote cryopreservation appear to be the most viable options for women desiring fertility preservation. Cryopreservation of supernumerary blastocysts may lead to a slightly lower live-birth rate since the best-quality blastocysts are generally transferred during the fresh embryo transfer attempt. Despite substantial advancements in oocyte freeze-thaw methods, allowing for much improved clinical outcomes, including live birth rates comparable to those achieved following fresh embryo transfer cycles, oocyte cryopreservation still bears the experimental label. Such recent reported success with cryopreservation has prompted us to investigate the clinical outcomes of our institution's currently available cryopreservation options (oocyte versus pronuclear zygote versus supernumerary day-5 blastocyst remaining after a fresh transfer). A total of 200 cryopreservation cycles were reviewed and subdivided according to cryopreservation optioninto three groups (oocyte versus pronuclear zygote versus day-5 blastocyst cryopreservation that were remaining after a fresh transfer), and compared with 400 fresh embryo transfer cycles from January 2005 to December 2008. When compared with fresh embryo transfer cycles, frozen embryo transfers originating from previously cryopreserved oocytes or pronuclear zygotes resulted in similar implantation, pregnancy and live birth rates. However, frozen embryo transfers originating from supernumerary day-5 blastocysts resulted in lower implantation and pregnancy rates when compared with controls. Thus, oocyte and/or pronuclear zygote cryopreservation appear to be the most viable options for women desiring fertility preservation as the outcomes from these treatments were comparable to those of fresh embryo transfer treatments. In addition, cryopreservation of supernumerary day-5 blastocysts may lead to a slightly lower live birth rate since the best-quality blastocysts are generally transferred during the fresh embryo transfer attempt

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