Clinical utility of the endometrial receptivity analysis in women with prior failed transfers.

PURPOSE: To determine the utility of the endometrial receptivity analysis (ERA) in women with prior failed embryo transfers (ET). METHODS: This was a retrospective study of patients who underwent an ERA test with a subsequent frozen ET. Women were classified based on their indication for an ERA test: (1) ≥ 1 prior failed ET (cases), or (2) as a prophylactic measure (controls). A subset analysis of women with ≥ 3 prior failed transfers was performed. Pregnancy outcomes of the subsequent cycle were examined, including conception, clinical pregnancy, and ongoing pregnancy/live birth. RESULTS: A total of 222 women were included, 131 (59%) women with ≥ 1 prior failed ET and 91 (41%) controls. Among the 131 women with ≥ 1 prior failed ET, 20 women (9%) had ≥ 3 prior failed ETs. The proportion of non-receptive ERA tests in the three groups were the following: 45% (≥ 1 prior failed ET), 40% (≥ 3 prior failed ETs), and 52% (controls). The results did not differ between cases and controls. The pregnancy outcomes did not differ between women with ≥ 1 prior failed ET and controls. In women with ≥ 3 prior failed ETs, there was a lower ongoing pregnancy/live birth rate (28% vs 54%, P = 0.046). CONCLUSION: Women with ≥ 1 prior failed ET and ≥ 3 prior failed ETs had a similar prevalence of non-receptive endometrium compared to controls. Women with ≥ 3 prior failed ETs had a lower ongoing pregnancy/live birth rate despite a personalized FET, suggesting that there are additional factors in implantation failure beyond an adjustment in progesterone exposure.

Effect of bilateral oophorectomy on adrenocortical function in women with polycystic ovary syndrome.

OBJECTIVE: To determine the impact of ovary-secreted products on adrenocortical function in women with PCOS by studying the adrenocortical response to acute adrenocorticotropic-stimulating hormone (ACTH) stimulation before and after bilateral oophorectomy. DESIGN: Prospective study. SETTING: Tertiary care medical center. PATIENT(S): Fourteen women with PCOS, scheduled for bilateral oophorectomy for benign indications, on postoperative transdermal estradiol (E(2)). INTERVENTION(S): Physical examination, blood sampling before and after oophorectomy, measurement of hormone levels; assessment of basal (Steroid(0)), maximum stimulated (Steroid(60)), and net increment (ΔSteroid) levels of androstenedione (A4), dehydroepiandrosterone (DHEA), and cortisol (F) before and after ACTH 1-24 stimulation. MAIN OUTCOME MEASURE(S): Preoperative and postoperative basal and ACTH (1-24) stimulated hormone levels. RESULT(S): Total testosterone, free testosterone, and estrone levels decreased, and follicle-stimulating hormone levels statistically significantly increased after oophorectomy. No statistically significant differences in E(2), DHEA sulfate (DHEAS), or sex hormone-binding globulin levels were detected. Basal and ACTH-stimulated A4 levels statistically significantly decreased after oophorectomy, and ΔA4 was statistically significantly increased. No statistically significant differences in DHEA(0), DHEA(60), or F(0) levels were detected. The F(60) and ΔF levels tended to increase after oophorectomy, but the differences did not reach statistical significance. CONCLUSION(S): Ovarian factors do not appear to contribute significantly to the adrenocortical dysfunction of PCOS.

Phenotypic spectrum of polycystic ovary syndrome: clinical and biochemical characterization of the three major clinical subgroups.

OBJECTIVE: We tested the hypothesis that the three clinical phenotypes of polycystic ovary syndrome (PCOS) represent forms of the same metabolic disorder. DESIGN: Prospective cohort analysis. SETTING: University-based tertiary care. PATIENT(S): Three-hundred sixteen untreated consecutive women diagnosed as having PCOS. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Each subject underwent an evaluation of ovulatory function, body habitus, acne, and hirsutism; serum free and total testosterone (T), 17-hydroxyprogesterone (17-HP), and DHEAS; and fasting plasma glucose and insulin levels. Insulin resistance and beta-cell function were assessed using the homeostatic assessment model equation (HOMA-IR and HOMA-beta-cell, respectively). RESULT(S): The Oligo+HA+Hirsutism phenotype was present in 48% of subjects, Oligo+HA in 29%, and Oligo+Hirsutism in 23%. The three phenotypes did not differ in mean body mass index, waist-to-hip ratio, racial composition, degree of oligo-ovulation, prevalence of acne, or family history of hyperandrogenic symptomatology. However, subjects demonstrating the Oligo+HA+Hirsutism phenotype were the youngest and had the greatest degrees of hyperandrogenemia, hyperinsulinemia, and beta-cell function; patients with the Oligo+Hirsutism phenotype where the oldest and had the mildest degrees of hyperandrogenemia, hyperinsulinemia, and beta-cell function. Subjects with the Oligo+HA phenotype demonstrated intermediate degrees of hyperandrogenemia and metabolic dysfunction. CONCLUSION(S): We conclude that the three clinical phenotypes of PCOS do not represent forms of the same metabolic disorder and may be the result of varying degrees of metabolic dysfunction; greater degrees of beta-cell function and circulating insulin levels favored the development of hirsutism and frank hyperandrogenemia.

History of regulation of assisted reproductive technology (ART) in the USA: a work in progress.

The advent of human assisted reproductive technology (ART) has engendered much legal and ethical debate. This article examines the evolution of regulation in ART in the USA and discusses the impetus for, and repercussions of, the Human Fertilisation and Embryology Authority in the UK. Key differences in government legislation between the UK and USA have driven the evolution of a distinct regulatory body that oversees ART in the USA. The National Advisory Board on Ethics in Reproduction (NABER) serves as an unofficial advisory body that addresses ethical issues in reproduction. The Society for Assisted Reproductive Technology (SART) maintains a registry that collects, reports and verifies data for individual ART clinics. Clinic-specific success rates are readily available through annual reports published through a collaboration of SART, the American Society of Reproductive Medicine (ASRM), the Center for Disease Control (CDC), and the National Infertility Association (RESOLVE). The ASRM has assumed a strong advisory role in addressing ethical issues and practice guidelines in assisted reproduction. Thus, although there is no central body to regulate ART in the USA, basic legislation, standards and guidelines that drive the provision of these services do exist in the USA.