Faculty Bibliography

OBJECTIVE: To determine whether there is a difference in pregnancy outcomes, stratified by age, between women undergoing elective single blastocyst transfer (eSBT) versus those undergoing double blastocyst transfer (2BT). DESIGN: Retrospective analysis. SETTING: University IVF center. PATIENT(S): A total of 1,141 nondonor IVF cycles in women aged <40 years from January 2004-March 2007. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Eggs retrieved, embryos cryopreserved, implantation rates, clinical pregnancy rates (PR), live birth rates (LBR), spontaneous abortion rates (SAB). RESULT(S): Pregnancy outcomes in 52 cycles of women <40 years of age who underwent eSBT were compared with 1,086 cycles of women who underwent 2BT in fresh IVF cycles from January 2004-March 2007. Overall, the eSBT was associated with a statistically significant 92% reduction in the twinning rate (from 25%-2%) while maintaining a high clinical PR (63% in the eSBT group vs. 61% in the 2BT group). CONCLUSION(S): Women who are <40 years of age undergoing nondonor fresh IVF cycles can electively choose to transfer a single blastocyst for the purpose of significantly reducing their risk of multiples without compromising their PR

OBJECTIVE: To determine whether there is a difference in pregnancy outcomes between women undergoing a shared versus exclusive donor oocyte cycle. DESIGN: Retrospective analysis. SETTING: University IVF center. PATIENT(S): Women undergoing either a shared (n=656 cycles), exclusive (n=225 cycles), or shared converted to exclusive (n=22 cycles) donor oocyte cycle from January 2000-December 2005. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Number of eggs retrieved, eggs fertilized, embryos transferred, embryos cryopreserved, clinical pregnancy rates (PR), live birth rates, spontaneous abortion rates. RESULT(S): Pregnancy outcomes in 656 shared cycles were compared with 225 exclusive cycles and 22 shared converted to exclusive donor oocyte cycles. Overall, there was no difference in the clinical PR among the three groups; however, the exclusive group did have a significantly greater number of embryos cryopreserved and this event occurred more frequently in such a cycle. CONCLUSION(S): Women undergoing a donor oocyte IVF cycle can choose to share the donor's oocytes with another recipient without compromising their PR; however, the probability of cryopreservation in such a shared donor oocyte cycle is significantly reduced. Therefore, the recipient must weigh the financial burden of an exclusive cycle with the desires for cryopreservation in an IVF cycle

In an 8-year review of ectopic pregnancy (EP) rates in donor egg recipients and standard patients undergoing in vitro fertilization-embryo transfer (IVF-ET) at a large university-based program, we report an EP rate of 0.6% in donor egg recipients and 0.9% in standard IVF patients, a difference that is not statistically significant. Donor egg recipients were found to have a significantly lower incidence of tubal disease compared with standard IVF patients; however, tubal disease was not found to be an independent risk factor for EP in our practice, perhaps owing to aggressive management of tubal disease

Cancer patients produce similar numbers of oocytes after ovarian hyperstimulation compared with age-matched infertile controls, suggesting that malignancy does not adversely affect ovarian response

Many studies cite infertility as highly stressful, yet women's responses to infertility are quite variable. Lazarus and Folkman's cognitive phenomenological theory of stress, coping, and appraisal may explain this variability. Gender role identity, career role salience, and societal pressure for motherhood are variables hypothesized to affect a woman's cognitive appraisal of infertility, thus influencing distress level. Female participants (N = 119) were recruited through the NYU Fertility Clinic and Resolve, a support organization for individuals faced with infertility. Participants completed questionnaires assessing gender characteristics, career role salience, social pressure for motherhood, cognitive appraisal, and distress. Many respondents (42%) reported clinically significant levels of distress. A path analysis assessed the effects of gender-role identity, career role salience, social pressure for motherhood, and cognitive appraisal on distress. The model accounted for 32% of the variance in distress. Women experiencing social pressure for motherhood viewed infertility as more stressful, women identifying with more positively valued instrumental gender role traits reported less distress, and women who endorsed more negatively valued instrumental gender role traits and cognitively appraised infertility as stressful reported greater distress.

OBJECTIVE: To determine if there is a difference between clinical outcomes with respect to inter-cycle time period. DESIGN: Retrospective analysis MATERIALS AND METHODS: We analyzed the clinical outcomes of 168 patients who underwent 2 consecutive fresh IVF cycles with various intercycle time duration from 1/2001-3/2009. Inclusion criteria were 2 consecutive IVF cycles in which the first cycle did not result in a pregnancy. All poor prognostic patients, whose medical history was characterized by high FSH levels on day 2 (D2) or a prior poor response to gonadotropins, were excluded. Patients were grouped according to time interval between cycles (grp 0: back to back cycles, grp 1: 35-59 days, grp 2: 60-89 days). Analysis included age, D2 FSH, D2 estradiol (E2), total gonadotropin dose (IU), # of eggs retrieved (ER), # embryos transferred (ET), cancellation rate (CR), no start cycle rate, clinical pregnancy rate (PR) and twin pregnancy rate. CR reflected those patients who did not undergo egg retrieval. No Starts patients did not start a cycle secondary to elevated D2 bloodwork or ovarian cysts. PR included patients with a fetal heartbeat(s) activity on ultrasound. Outcomes of the second IVF cycle were analyzed by chi square and ANOVA. RESULTS: Comparisons of Clinical Outcomes. (Table presented). CONCLUSIONS: Patients opting for back-to-back cycles (grp 0) had a significantly higher likelihood of not starting the second cycle when compared to patients who took a 1 month reprieve. This may be due to a high prevalence of residual ovarian cysts. However, if patients were eligible to start a subsequent cycle and completed the cycle, then there was no statistical difference in PR