Faculty Bibliography

BACKGROUND To minimize the potential for harmful inheritable conditions, donors are rigorously screened according to standard guidelines, yet such guidelines may not be sufficient to exclude egg donors with certain known inheritable conditions. We compared universal screening of oocyte donors with Tay-Sachs, Fragile X, karyotype and Minnesota Multiphasic Personality Inventory-2 (MMPI-2) versus standard American Society of Reproductive Medicine (ASRM) guidelines that do not include such testing. METHODS In this 12 year retrospective cohort study, results of enhanced universal screening of all anonymous oocyte donor candidates from 1997 to 2008 at a university hospital oocyte donation program were reviewed. Primary outcomes were the frequency of oocyte donor candidates excluded as a result of enhanced universal screening (Tay-Sachs, Fragile X, karyotypic analysis and MMPI-2) versus basic screening according to ASRM guidelines. RESULTS Of 1303 candidates who underwent on-site evaluation, 47% passed the screening process, 23% were lost to follow-up and 31% were excluded. Genetic and psychological factors accounted for the most common reasons for candidate exclusion. Enhanced genetic screening excluded an additional 25 candidates (19% of all genetic exclusions) and enhanced psychological screening excluded an additional 15 candidates (12% of all psychological exclusions). Altogether enhanced screening accounted for 40 candidates (10%) of the total pool of excluded candidates. CONCLUSIONS Although our study is limited by its retrospective nature and center-specific conclusions, we show that enhanced comprehensive screening can exclude a significant number of candidates from an oocyte donor program and should be encouraged to assure optimal short-term and long-term outcomes for pregnancies achieved through oocyte donation

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

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

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.

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

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

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%)