Growth hormone supplementation during ovarian stimulation improves oocyte and embryo outcomes in IVF/PGT-A cycles of women who are not poor responders.

PURPOSE: To determine the effect of human growth hormone (GH) supplementation during ovarian stimulation in women undergoing IVF/PGT-A cycles, who do not meet the Bologna criteria for poor ovarian response (POR). METHODS: This is a retrospective cohort study of 41 women with suboptimal outcomes in their first cycle of IVF/PGT-A including lower than expected number of MII oocytes, poor blastulation rate, and/or lower than expected number of euploid embryos for their age, who underwent a subsequent IVF/PGT-A cycle with the same fixed dose gonadotropin protocol and adjuvant GH treatment. Daily cotreatment with GH started with first gonadotrophin injection. The IVF cycle outcomes were compared between the control and GH cycle using the Wilcoxon-Signed Rank test. RESULTS: The total number of biopsied blastocysts (mean ± SD; 2.0 ± 1.6 vs 3.5 ± 3.2, p = 0.009) and euploid embryos (0.8 ± 1.0 vs 2.0 ± 2.8, p = 0.004) were significantly increased in the adjuvant GH cycle compared to the control cycle. The total number of MII oocytes also trended to be higher in the GH cycle (10.2 ± 6.3 vs 12.1 ± 8.3, p = 0.061). The overall blastulation and euploidy rate did not differ between the control and treatment cycle. CONCLUSION: Our study uniquely investigated the use of adjuvant GH in IVF/PGT-A cycles in women without POR and without a priori suspicion for poor outcome based on their clinical parameters. Our study presents preliminary evidence that GH supplementation in these women is beneficial and is associated with an increased number of blastocysts for biopsy and greater number of euploid embryos for transfer.

Follicle dynamics and global organization in the intact mouse ovary.

Quantitative analysis of tissues and organs can reveal large-scale patterning as well as the impact of perturbations and aging on biological architecture. Here we develop tools for imaging of single cells in intact organs and computational approaches to assess spatial relationships in 3D. In the mouse ovary, we use nuclear volume of the oocyte to read out quiescence or growth of oocyte-somatic cell units known as follicles. This in-ovary quantification of non-growing follicle dynamics from neonate to adult fits a mathematical function, which corroborates the model of fixed oocyte reserve. Mapping approaches show that radial organization of folliculogenesis established in the newborn ovary is preserved through adulthood. By contrast, inter-follicle clustering increases during aging with different dynamics depending on size. These broadly applicable tools can reveal high dimensional phenotypes and age-related architectural changes in other organs. In the adult mouse pancreas, we find stochastic radial organization of the islets of Langerhans but evidence for localized interactions among the smallest islets.

Oocyte donors' comprehension as assessed by the EDICT (Egg Donor Informed Consent Tool).

OBJECTIVE: To assess oocyte donors' comprehension of the process and potential risks of oocyte donation using the EDICT (Egg Donor Informed Consent Tool). DESIGN: Prospective cohort study. SETTING: University-based, tertiary reproductive health practice. PATIENT(S): Prospective oocyte donors. INTERVENTION(S): Donors (N = 65) participated in an audiovisual informational session, and met with a reproductive endocrinologist individually. Donors then completed the Subjective EDICT and Objective EDICT. MAIN OUTCOME MEASURE(S): We report scores on Subjective and Objective EDICT, scores stratified for demographic variables, relationship between Subjective and Objective EDICT scores, and the effect of counseling on scores. RESULT(S): In general, our cohort of oocyte donors performed well on both objective and subjective portions of the EDICT. We verified the effect of counseling on EDICT scores by comparing before and after counseling scores and demonstrating significant gains. There was no significant correlation between Subjective and Objective EDICT scores. CONCLUSION(S): For the first time, we report oocyte donors' comprehension of oocyte donation as assessed by the EDICT. Reassuringly, we demonstrate that oocyte donors have adequate subjective and objective comprehension of the process and risks associated with oocyte donation. We also demonstrate that oocyte donor comprehension is significantly impacted by physician counseling efforts. In addition, scores on perceived understanding (Subjective EDICT) did not predict scores on performance-based comprehension (Objective EDICT). The lack of correlation between the two scores further underscores the utility of a performance-based tool, as relying on a donor's self-report (e.g., simply signing a consent form to indicate understanding) may not reflect her actual understanding.

Egg Donor Informed Consent Tool (EDICT): development and validation of a new informed consent tool for oocyte donors.

OBJECTIVE: To develop and validate a novel tool to assess the objective and subjective understanding that oocyte donors have of the process and potential risks of oocyte donation. DESIGN: Prospective cohort study. SETTING: University-based tertiary reproductive health practice. PATIENT(S): Prospective oocyte donors. INTERVENTION(S): We developed an informed consent questionnaire specific to oocyte donors, the Egg Donor Informed Consent Tool (EDICT), using published informed consent guidelines and known egg donation risks. MAIN OUTCOME MEASURE(S): We assessed content validity, readability, and reliability after pilot testing of the EDICT. RESULT(S): The Subjective EDICT assesses donors' perceived understanding, and the Objective EDICT measures donors' actual knowledge. Questions cover the process of oocyte donation, potential risks, and legal and psychologic issues. We demonstrated good content validity, a readability level consistent with readability goal of informed consent documents, and good reliability on pilot testing. CONCLUSION(S): For the first time, we describe development of a valid and reliable new tool for assessing oocyte donors' understanding of the process and risks associated with oocyte donation.