IN VITRO FERTILIZATION VS INTRACYTOPLASMIC SPERM INJECTION FOR NON-MALE FACTOR PREIMPLANTATION GENETIC TESTING-ANEUPLOIDY CYCLES: ARE THERE DIFFERENCES IN EMBRYOS SUITABLE FOR TRANSFER & PREGNANCY OUTCOMES? A SART CORS ANALYSIS [Meeting Abstract]
OBJECTIVE: The overuse of intracytoplasmic sperm injection (ICSI) in non-male factor infertility is well documented. ICSI is associated with higher costs, increase workload on embryology staff, and concern for adverse outcomes to offspring. The use of ICSI in non-male factor preimplantation genetic testing - aneuploidy (PGT-A) cycles currently is recommended when there is a concern for paternal contamination. Our objective is to evaluate whether significant differences exist in number of embryos suitable for transfer and pregnancy outcomes from PGT-A cycles derived from oocytes fertilized by in vitro fertilization (IVF) compared to ICSI using the SART-CORS database. MATERIALS AND METHODS: This is a retrospective cohort study evaluating fresh and thawed linked frozen embryo transfer (FET) cycles reported to SART from 1/1/2014 to 12/31/2017 undergoing PGT-A. Exclusion criteria included male factor infertility, embryos tested for monogenic disorders, structural rearrangements, or HLA-typing, cryopreserved or donor oocytes, blastomere or polar body biopsy, in vitro maturation, rescue ICSI, split IVF/ICSI cycles, gestational carriers, and >1 embryo transferred. Patient demographics, cycle characteristics, number of embryos suitable for transfer, and pregnancy outcomes in FET cycles were collected. Primary outcomes were percentage of embryos suitable for transfer and live birth (LB) rates. Sub-analysis of embryos suitable for transfer were performed on cycles with < and R 6 oocytes and < 35 y/o and R 35 y/o. Chi-square or Fisher's exact test, as appropriate, were used for categorical variables. Mann-Whiney test was used for continuous variables. Relevant confounders and multiple cycles within a subject were accounted for in a generalized linear mixed model. Results were considered statistically significant with a p-value <0.05.
RESULT(S): A total of 4,867 IVF and 25,579 ICSI cycles met criteria to evaluate for embryos suitable for transfer. Significant difference between the IVF and ICSI cohort existed in age (35.8 y/o vs. 36.8 y/o, respectively, p=0.03). No significant differences in percentage of embryos suitable for transfer were found between IVF vs. ICSI (42.1% vs 42.7%, respectively, p=0.28), within the subgroup of patients R 35 y/o (35.8% vs. 36.5%, respectively, p=0.32), and within subgroup with % 6 oocytes retrieved (32.9% vs. 35.3%, respectively p=0.44). Total of 3,412 IVF and 16,358 ICSI cycles met criteria for pregnancy outcomes evaluation. No significant differences in LB/ongoing pregnancy rate between IVF vs. ICSI (53.2% vs 53.0%, respectively, p=0.51) and pregnancy loss (18.5% vs 17.3%, p=0.11) were found.
CONCLUSION(S): There were no significant differences in rate of embryos suitable for transfer or pregnancy outcomes in PGT-A cycles derived from IVF and ICSI insemination. ICSI in non-male factor infertility cycles undergoing PGT-A does not provide an advantage over IVF. IMPACT STATEMENT: ICSI insemination in non-male factor cycles undergoing PGT-A does not yield superior outcomes compared to IVF insemination. IVF in non-male factor PGT-A cycles provides the benefit of time and cost savings
Dissociation of Pubertal Development Abnormality and Gonadal Dysfunction in Childhood Cancer Survivors
DOES INTRACYTOPLASMIC SPERM INJECTION (ICSI) PROVIDE ANY BENEFIT OVER IN VITRO FERTILIZATION (IVF) ON PREGNANCY OUTCOMES IN NON-MALE FACTOR INFERTILITY CYCLES UNDERGOING PRE-IMPLANTATION GENETIC TESTING FOR ANEUPLOIDY (PGT-A)?. [Meeting Abstract]
INTRACYTOPLASMIC SPERM INJECTION (ICSI) DOES NOT PROVIDE ANY BENEFIT OVER IN VITRO FERTILIZATION (IVF) ON PLOIDY RATES IN NON-MALE FACTOR INFERTILITY CYCLES UNDERGOING PRE-IMPLANTATION GENETIC TESTING FOR ANEUPLOIDY (PGT-A). [Meeting Abstract]
Identification and characterization of RSIY-11, a novel seminal peptide derived from semenogelin-1, which acts as a neutral endopeptidase inhibitor modulating sperm motility
PURPOSE/OBJECTIVE:Based on prior reports demonstrating that neutral endopeptidase (NEP) inhibitors increase sperm motility, the goal of our studies was to identify endogenous seminal peptides that inhibit NEP and investigate their potential effect on sperm motility. METHODS:Peptidomic analysis was performed on human seminal fluid, identifying 22 novel peptides. One peptide, named RSIY-11, derived from semenogelin-1, was predicted through sequence analysis to be a substrate and/or potential inhibitor of NEP. Enzymatic analysis was conducted to determine the inhibitory constant (Ki) of RSIY-11 as an inhibitor of NEP. Total and progressive sperm motility was determined at baseline and 30 and 60Â min following addition of RSIY-11 to seminal fluid in 59 patients undergoing an infertility workup at an urban medical center. Additionally, the effects of RSIY-11 on sperm motility were evaluated in 15 of the 59 patients that met criteria for asthenospermia. RESULTS:RSIY-11 was shown to act as a competitive inhibitor of NEP with a Ki of 18.4â€‰Â±â€‰1.6Â Î¼M. Addition of RSIY-11 at concentrations of 0.75Â Î¼M, 7.5Â Î¼M, and 75Â Î¼M significantly increased sperm motility at all time points investigated, with increases of 6.1%, 6.9%, and 9.2% at 60Â min, respectively. Additionally, within the subgroup of patients with asthenospermia, RSIY-11 at concentrations of 0.75Â Î¼M, 7.5Â Î¼M, and 75Â Î¼M significantly increased sperm motility at all time points investigated, with increases of 7.6%, 8.8%, and 10.6% at 60Â min, respectively. CONCLUSIONS:RSIY-11 is a newly identified semenogelin-1-derived peptide present in seminal fluid. RSIY-11 acts as a potent competitive inhibitor of NEP, which when added to seminal fluid significantly increases sperm motility. RSIY-11 could play a potential role in the treatment for male factor infertility related to asthenospermia and improve intrauterine insemination outcomes.
The impact of using donor sperm in assisted reproductive technology cycles on perinatal outcomes
OBJECTIVE:To assess the impact of using donor sperm in assisted reproductive technology (ART) cycles on perinatal outcomes. DESIGN:Historical cohort study. SETTING:US national database from the Society of Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) from 2012 toÂ 2013. PATIENT(S):Patients undergoing the first fresh autologous ART cycle using either donor or partner sperm. INTERVENTION(S):None. MAIN OUTCOME MEASURE(S):Miscarriage, preterm birth, low birthweight rates. RESULTS:A total of 134,710 fresh autologous ART cycles were evaluated from the SART CORS database. Following exclusion criteria and after restricting to the first cycle, 2,123 donor sperm and 42,799 partner sperm ART cycles were included in the final analyses. After adjusting for all confounding variables (including maternal age, race, body mass index, smoking status, gravidity, history of preterm birth, highest follicle stimulating hormone count, blastocyst transfer percentage, total embryo transferred, and etiology of infertility), no statistically significant differences in miscarriage rates, preterm births, very preterm births, low birthweight, and very low birthweight were observed. Birthweight was significantly lower in the partner sperm group than in the donor sperm group (3,292 Â± 601 and 3,233 Â± 592Â g in donor and partner sperm groups, respectively, adjusted P value 0.003); however, this small absolute difference (adjusted effect estimate 42Â g, 95% CI 14.7-70.9) does not carry clinical significance. CONCLUSIONS:The use of donor sperm in fresh autologous ART cycles was not associated with increased miscarriage, preterm births, or low birthweights, as compared to cycles using partner sperm. This information can be used in patient counseling to reassure patients using donor sperm in ART cycles.
Comparison of perinatal outcomes following frozen embryo transfer cycles using autologous versus donor oocytes in women 40 to 43Â yearsÂ old: analysis of SART CORS data
OBJECTIVE:To study the differences in perinatal outcomes after frozen embryo transfer cycles using autologous or donor oocytes in women of advanced maternal age. DESIGN/METHODS:Historical cohort study. SETTING/METHODS:US national database from the Society of Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) from 2009 to 2013. PATIENT(S)/METHODS:Women at 40-43Â years of age undergoing autologous frozen embryo transfers (a-FET) or donor oocyte frozen embryo transfers (d-FET) resulting in singleton pregnancies that were entered in the SART CORS database from 2009 to 2013. RESULTS:a-FET resulted in 4402 singleton live births whereas d-FET resulted in 2703 singleton live births. d-FET resulted in a higher risk of preterm births (<â€‰37Â weeks), with adjusted odds ratio (aOR) 1.33 (95% CI 1.02-1.75), but similar risk of small for gestational age (SGA), with aOR 1.75 (95% CI 0.85-3.7), when compared to a-FET. However, when only single blastocyst transfer cycles are considered, d-FET and a-FET showed no difference in preterm births or other adverse perinatal outcomes. CONCLUSIONS:Singletons resulting from d-FET are at increased risk for perinatal morbidity. However, the risk was diminished in single blastocyst transfer cycles. Our study supports the current American Society for Reproductive Medicine (ASRM) guidelines of transferring a single blastocyst in d-FET cycles.
Counseling patients on reproductive aging and elective fertility preservation-a survey of obstetricians and gynecologists' experience, approach, and knowledge
PURPOSE/OBJECTIVE:What are the experience, approach, and knowledge of US Obstetricians and Gynecologists' (ob-gyn) towards counseling patients on reproductive aging (RA) and elective fertility preservation (EFP). METHODS:A cross-sectional survey emailed by the American College of Obstetricians and Gynecologists (ACOG) to 5000 ACOG fellows consisting of 9 demographic and 28 questions relating to counseling patients on RA and EFP. RESULTS:Seven hundred and eighty-four responders completed the survey. Although 82.8% agreed that conversations relating to RA should take place with patients desiring future childbearing and delaying due to social reasons, only 27.6% stated that they frequently counsel these women aged 18-34Â years old, compared to 75.8% aged 35-44Â years old (Pâ€‰<â€‰0.01). Limited time (75.8%) and limited knowledge (41.4%) were amongst the most frequent reported barriers towards counseling patients on RA. Fifty-eight percent stated that they have been asked about EFP by patients. Although 74.8% agreed that conversations should take place related to EFP in women desiring future childbearing and delaying due to social reasons, only 27.6% stated that they frequently counsel these patients on EFP (Pâ€‰<â€‰0.01). Limited time (75%) and limited knowledge (59.9%) were amongst the most frequent barriers towards counseling on EFP. CONCLUSIONS:In the USA, methods to improve patient counseling and provider knowledge on RA and EFP are warranted and further studies are needed to address optimal methods to improve counseling and knowledge related to these topics.
Reproductive aging and elective fertility preservation
Reproductive aging is a natural process that occurs in all women, eventually leading to reproductive senescence and menopause. Over the past half century there has been a trend towards delayed motherhood. Postponing reproduction can increase the chance of a woman remaining involuntarily childless as well as an increase in pregnancy complications in those that do achieve pregnancy at advanced maternal age. Despite the well-documented decrease in fecundity that occurs as a woman ages, reproductive aged women frequently overestimate the age at which a significant decline in fertility occurs and overestimate the success of assisted reproductive technologies (ART) to circumvent infertility. Oocyte cryopreservation enables women to achieve genetically related offspring in the event that they desire to postpone their childbearing to an age after which a significant decline in fertility occurs or in circumstances in which their reproductive potential is compromised due to medical pathology. Available success rates and safety data following oocyte cryopreservation have been reassuring and is not considered experimental according to the American Society for Reproductive Medicine and the European Society for Human Reproduction and Embryology. This review article will focus on an evidence-based discussion relating to reproductive aging and oocyte cryopreservation.
Elevated serum estradiol levels in artificial autologous frozen embryo transfer cycles negatively impact ongoing pregnancy and live birth rates
PURPOSE/OBJECTIVE:) levels during artificial autologous frozen embryo transfer (FET) cycles and ongoing pregnancy/live birth rates (OP/LB). METHODS:A historical cohort study was conducted in an academic setting in order to correlate peak and average estradiol levels with ongoing pregnancy/live birth rates for all autologous artificial frozen embryo transfer cycles performed from 1/2011 to 12/2014. RESULTS:levels. CONCLUSIONS:levels in artificial autologous FET cycles are associated with lower OP/LB rates. Estradiol levels should be monitored during artificial FET cycles.