ASRM Brings Out the Researcher in Practitioners
Each year, the members of the American Society for Reproductive Medicine gather
in a different U.S. (or, sometimes, Canadian) city to share research findings
and experiences. With the constantly rapid development of reproductive medicine,
staying in touch with and on top of the science is a large part of a clinician's
job.
This year, a variety of IntegraMed physicians presented conclusions and
questions on several topics for consideration by their colleagues.
Listed below is a sample of the presentations and conclusion comments as pulled
from the meeting's abstracts:
Mandy Katz-Jaffe, William G. Kearns, David Gardner, William Schoolcraft
Relationship Between Embryonic Secretome And Chromosomal Abnormalities in Human
IVF
This is the first study to describe the differences in the secretome between
human blastocysts identified as eithe rnormal or aneupoloid for 10 chromosomes
tested. This study has also shown that degenerating aneuploid embryos exhibit a
significantly diffrent secretome profile to hatching aneuploid blastocysts. This
approach of protein analysis will further increase our understanding of human
blastocyst physiology and its association with chromosomal composition. This
work could lead to the development of a non-invasive assay to identify human
embryos with chromosomal abnormalities.
Sue Ellen Carpenter, Andre Denis, G. W. Bates Jr., Jim Toner, Lisa Hasty
Sequential Clomiphene Citrate and Letrozole Therapy Without Intervening Menses
Despite evidence of ovulation, women older than 35 had few pregnancies with
multiple doses or sequential therapy with clomiphene citrate or letrozole in the
same cycle. Women less than 35 years of age who were initially resistant to
ovulation induction had a statistically higher pregnancy rate with sequential
therapy of CC and letrozole when compared to those that received multiple doses
of the same medication. Sequential therapy with clomiphene citrate and letrozole
without an intervening menses is a good option for women who intially do not
respond to either therapy.
Angeline Beltsos, Aaron Lifchez, Jane Nani, Meike Uhler
BMI: Impact on IVF Success Appears Age Related
In younger patients undergoing IVF, BMI [body mass index] has a signifcant
impact, however as patients reach their mid thirties, the effects of age appear
to be stronger than those of BMI. For patients in the normal and elevated BMI
groups, BMI has a significant, age-dependent influence on fertility. It appears
to be appropriate to recommend pre-treatment weight loss to patients under 37,
whereas in patients over 37 a more aggressive and immediate approach to therapy
may be warranted.
Steven Nakajima, Henry C. Bohler, Diane Woodford, Michael Grossman, Lowell Ku
Effect of Body Mass Index (BMI) And/Or Weight Distribution On IVF Outcome
1) Although prior studies have suggested that obese women have decreased
fertility, there was no effect of BMI and/or weight distribution on IVF outcomes
in our population. 2) When ovulatory disorders are corrected, women had a higher
pregnancy rate than the general population over a wide range of BMI and weight
distributions.
Mark Leondires, Spencer Richlin, Ling Chi
Agonist Down-Regulation, Microdose Flare, and Antagonist Protocols and the Role
of Estradiol Supplementation In Improving Clinical Pregnancy Rates
Estradiol supplementation was seen to improve clinical pregnancy rates
regardless of stimulation protocol. The patients in the ANT group who are among
the oldest in this study achieved pregnancy rates equivalent to the youngest
found in the DR group when they received E2 supplementation. Curiously the
patients in the ANT group, in whom we expect a rapid resumption of pituitary
function, benefited significantly from full luteal support. In conclusion,
luteal estradiol supplementation was shown to be a beneficial yet simple
intervention that should be considered in all IVF patients.
K.E. Elkind-Hirch, Annette Lee, Richard T. Scott, Allison Styne-Gross
Adjunctive PGD Does Not Enhance Embryo Selection Beyond Any Improvement Provided
by Blastocyst Embryo Transfer
This study provides evidence that PGD techniques may not be detrimental to
embryo development but does not support the utilization of PGD as a tool to
improve embryo selection in non-indicated patients.
Anne Wold, Patricia McShane, Ron Carson, Isaac Glatstein, Shimon Segal
Outcome in Women < 35 Years of Age Undergoing Consecutive Cycles of In Vitro
Fertilization (IVF) Using the Gonadotropin-Releasing Hormone Antagonist Protocol
The GnRH-Agonist protocol is the current standard for IVF. GnRH-Antagonist
protocol is used only if the standard is unsuccessful. The results of this
prospective case series suggest that the GnRH-Antagonist protocol is a viable
alternative associated with high rates of implantation and clinical pregnancy.
The GnRH-Antagonist protocol may be particularly advantageous if used as
first-line ovarian stimulation for patents younger than or equivalent to 35
years old.
Nancy Klein, Angela Thyer, Mike Soules
The Decline in Ovarian Non-Growing Follicle Number from Birth to Menopause: A
New Model of Reproductive Aging
The development and implementation of modern stereology methods to the
determination of ovarian NGF count has provided a powerful new tool for the
investigation of fundamental aspects of ovarian aging. Unlike previous models of
ovarian follicle depletion which suggest a sudden increase in decay rate at ~38
years, our model predicts no sudden change in decay rate, but rather a
constantly increasing rate. This model not only agrees well with observed ages
of menopause in women, but also is more biologically plausible than previous
models.
Nancy Covington, William Kearns, Michael Levy, Michael Tucker, Eric Widra, Jeff
McKeeby, Paulette Brown, Robert Stillman
Single Embryo Transfer of Frozen-Thawed Blastocysts: Proportion of Cells
Surviving the Cryopreservation Process is Indicative of Implantation Potential
This study, the first to evaluate implantation potential in relation to
blastomere survival of cryopreserved blastocysts, demonstrates that the
percentage of cells in a blastocyst that survive the cryopreservation process as
assessed by experienced embryologists is a clinically valuable measure fo the
viability and implantation potential of that thawed blastocyst. Implantation
potential is relatively high when most or all cells survive, but drops steadily
as cell survival declines below 95 percent. Implantation potential appears to be
negligible when fewer than 80 percent of the cells survive the thawing process.
This information may be clinically useful in deciding which and/or how many
embryos to thaw and then transfer.
William Gibbons, Bobby Webster, Richard Cochran
Ovulation Induction (OI)/Intrauterine Insemination (IUI) Protocol Using a Novel,
Needleless Bioject(r) System for Gonadotropin Administration
Within a gentle OI protocol, utilizing a novel, needleless injection system,
adequate follicular development was seen in 23/24 subjects with a satisfactory,
singleton pregnancy rate, 25%/cycle. There was excellent patient acceptance.
This represents the first time that this delivery method has been employed to
administer gonadotropins within a treatment protocol.
