Testosterone concentrations in early pregnancy: relation to method of conception in an infertile population.

This prospective cohort study of infertility patients compared testosterone concentrations in early pregnancy in infertility patients who conceived naturally or after treatment. Although all groups demonstrated some increase in pregnancy testosterone from baseline concentrations, subjects who conceived following ovulation induction showed a significantly increased rise in testosterone as compared with controls (P<0.01).

Laparoscopy in women with unexplained infertility: a cost-effectiveness analysis.

OBJECTIVE: To evaluate the cost effectiveness of laparoscopy for unexplained infertility. DESIGN: We performed a cost-effectiveness analysis using a computer-generated decision analysis tree. Data used to construct the mathematical model were extracted from the literature or obtained from our practice. We compared outcomes following four treatment strategies: [1] no treatment, [2] standard infertility treatment algorithm (SITA), [3] laparoscopy with expectant management (LSC/EM), and [4] laparoscopy with infertility therapy (LSC/IT). The incremental cost-effectiveness ratio (ICER) was calculated, and one-way sensitivity analyses assessed the impact of varying base-case estimates. SETTING: Academic in vitro fertilization practice. PATIENT(S): Computer-simulated patients assigned to one of four treatments. INTERVENTION(S): Fertility treatment or laparoscopy. MAIN OUTCOME MEASURE(S): Incremental cost-effectiveness ratios. RESULT(S): Using base-case assumptions, LSC/EM was preferred (ICER =$128,400 per live-birth in U.S. dollars). Changing the following did not alter results: rates and costs of multiple gestations, penalty for high-order multiples, infertility treatment costs, and endometriosis prevalence. Outcomes were most affected by patient dropout from infertility treatments-SITA was preferred when dropout was less than 9% per cycle. Less important factors included surgical costs, acceptability of twins, and the effects of untreated endometriosis on fecundity. CONCLUSION(S): Laparoscopy is cost effective in the initial management of young women with infertility, particularly when infertility treatment dropout rates exceed 9% per cycle.

Day-3 embryo morphology predicts euploidy among older subjects.

OBJECTIVE: To evaluate whether day-3 embryo morphology predicts euploidy. DESIGN: Retrospective. SETTING: Private IVF center. PATIENT(S): Subjects (n = 144) undergoing in vitro fertilization and preimplantation genetic diagnosis (PGD). INTERVENTION(S): Translate day-3 embryo characteristics into a standardized score. MAIN OUTCOME MEASURE(S): Day-3 embryo morphology score and PGD fluorescence in situ hybridization results for chromosomes: 13, 15, 16, 17, 18, 21, 22, X, and Y. RESULT(S): Of 1,043 biopsied blastomeres, 67% (n = 696) were chromosomally abnormal. Women with advanced maternal age (AMA) were 1.3 times more likely to have chromosomal errors (95% CI 1.1-1.4) than younger subjects (<38 years old). Morphology predicted PGD results in the AMA group (n = 553), but not in younger women. Fragmentation predicted euploidy in both the younger and the AMA group, but cell number did not. CONCLUSION(S): Day-3 embryo morphology selects for euploidy among AMA subjects but not among younger women who may have other factors responsible for embryo dysmorphism. However, cellular fragmentation is a sensitive proxy for selecting chromosomally normal embryos in both age groups. It is unclear that PGD-aneuploidy screening is a better tool for selecting which embryos to transfer than the standard approach of using day-3 embryo features, particularly among older women, a group for whom this technology is targeted.

Von Willebrand disease presenting as recurrent hemorrhage after transvaginal oocyte retrieval.

A 34-year-old nulligravid woman experienced hemorrhage after each of 2 oocyte retrievals. Initial coagulopathy screening was negative. Treatments used during in vitro fertilization likely interfered with assay performance. Reevaluation remote from medications confirmed the diagnosis of von Willebrand disease. Treatments used during in vitro fertilization may increase bleeding risk and confound coagulopathy evaluation.

Risk of monozygotic twinning with blastocyst transfer decreases over time: an 8-year experience.

OBJECTIVE: The purpose of our study is to compare the occurrence of monozygotic twinning (MZT) from blastocyst transfer (BT) in our program between an earlier and more recent time period. DESIGN: Retrospective. SETTING: Academic IVF practice. PATIENT(S): All pregnancies conceived between March 2002 and December 2005 (N = 932) in our program were compared to pregnancies conceived before March 2002 (N = 554), which were the subject of a previous study. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The incidence of MZT with day 3 embryo transfer and BT were compared between the study and control groups. RESULT(S): During the study period, the rate of MZT was not significantly different for BT at 2.3% (9/385) compared to day 3 embryo transfer at 1.8% (10/547). This rate of 2.3% for BT was significantly lower than the rate of 5.6% (11/197) reported at our institution for BT before March 2002. CONCLUSION(S): Our study suggests that the risk of MZT with BT is significantly lower in the more recent time period and is in the range of what is seen with cleavage stage transfer. It is likely that improvements in culture systems as experience is gained with BT played a role.