Search

Objective: To identify the incidence, risk factors, and obstetric/perinatal outcomes associated with monozygotic twins (MZTs) after IVF. Design: Nested case-control. Setting: University-based center. Patient(s): The IVF cycles eventuating in pregnancy from 2000–2009. Intervention(s): None. Main Outcome Measure(s): The MZT incidence, chorionicity/zygosity, pregnancy/neonatal outcome. Result(s): Of 6,223 gestations, 131 MZTs were diagnosed (2.1% incidence; 2.0% in autologous and 2.7% in donor IVF cycles), 10 were dichorionic, and 121 were monochorionic. Controlling for all risk factors, young oocyte age, extended culture (noncleavage embryos transferred on/after day 4), and year of IVF treatment cycle were significantly associated with MZT. When assessing factors associated with specific MZT placentation, day 3 assisted hatching correlated more with dichorionic MZT, whereas extended culture and advanced day 5 embryonic stage correlated with monochorionic MZT. Comparing monozygotic to dizygotic multigestation outcomes, MZT fared worse; however, once controlling for triplet gestation, only gestational age at delivery remained significantly compromised in the monozygotic group. Conclusion(s): After IVF the incidence of MZT is high, with young oocyte age, year of treatment, and extended culture (or embryo stage at transfer) conferring greatest risk. Regarding MZT type, assisted reproductive technology (ART) procedures may influence the timing of embryonic splitting (i.e., division in early embryonic development may be influenced by zona pellucida [ZP] manipulation whereas later splitting may occur during delayed implantation). Poor obstetric/perinatal outcome is significantly impacted by the presence of an “extra” fetus, as high-order multiple gestation concurrent with an MZT conveyed the worst prognosis. [ABSTRACT FROM AUTHOR]

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 ooctyte 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. [Copyright &y& Elsevier]

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. [Copyright &y& Elsevier]

Objective: To report the use of previously cryopreserved oocytes for the treatment of secondary infertility. Design: Case report. Setting: University-based IVF program. Patient(s): A 41-year-old woman with 18 months of secondary infertility and a previous history (age 38) of elective oocyte cryopreservation. Intervention(s): Previously cryopreserved oocytes. Main Outcome Measure(s): Fertilization, embryo development, pregnancy, and outcome. Result(s): The patient achieved pregnancy and delivery following thaw of oocytes electively cryopreserved 39 months before use. Before thawing the oocyte, the patient attempted pregnancy naturally for 12 months, followed by two unsuccessful clomiphene citrate ovulation induction cycles with intrauterine insemination and one fresh IVF cycle resulting in a chromosomally abnormal twin gestation that aborted. Conclusion(s): Although oocyte cryopreservation is still labeled an experimental procedure, this case demonstrates that oocyte cryopreservation used for electively deferred reproduction can subsequently serve in the treatment for secondary infertility when the patient becomes her own oocyte donor. [Copyright &y& Elsevier]

Objective: To report a case of a heterotopic primary abdominal pregnancy after two-blastocyst IVF-ET. Design: Case report. Setting: University-based IVF program. Patient(s): A woman with a heterotopic abdominal pregnancy after IVF-ET. Intervention(s): Pituitary down-regulation with luteal antagon, ovulation induction with menotropins, IVF-ET, progesterone in oil for luteal support, dilation and curettage for missed abortion, laparoscopy, and resection of abdominal gestation. Main Outcome Measure(s): Human chorionic gonadotropin levels, pelvic ultrasound examinations, and laparoscopic and pathologic findings. Result(s): A heterotopic abdominal pregnancy occurred after a two-blastocyst IVF-ET. The concurrent intrauterine gestation resulted in a miscarriage. Conclusion(s): The number of embryos transferred has been identified as a powerful risk factor for heterotopic pregnancy; however, heterotopic pregnancy can occur following a two-embryo, blastocyst stage transfer. [Copyright &y& Elsevier]

Objective: To compare the efficiency of oocyte cryopreservation (OC) and IVF using the metric “live births per mature oocyte retrieved.” Design: Retrospective analysis. Setting: University-based fertility center. Patient(s): Forty women who underwent OC with thaw attempt between 2004 and 2010; 25 autologous and 15 donor-oocyte treatments were included. One thousand nine hundred eight women underwent their first, fresh conventional IVF treatment between 2004 and 2010; 1,392 used autologous oocytes, and 516 used donor oocytes. Autologous and donor-oocyte cycles were analyzed separately. All oocytes were obtained from women