Luteal phase estrogen is decreased in regularly menstruating older women compared with a reference population of younger women.

Objective: To compare daily reproductive hormone secretion in regularly menstruating older versus younger women.

Design: This was a prospective cohort study.

Results: Daily morning urine samples were obtained from 106 women, 28 of whom were aged between 20 and 34 years (mean: 27.

Preimplantation genetic screening in older women: a cost-effectiveness analysis.

Objective: To compare the strategy of traditional IVF with prenatal diagnosis versus IVF with preimplantation genetic screening (IVF/PGS) to prevent aneuploid births in women with advanced maternal age.

Design: A decision tree analytic model was created to compare IVF alone versus IVF/PGS to evaluate which strategy is the least costly per healthy (euploid) infant.

Setting: Outpatient IVF practices.

Patient willingness to participate in a clinical trial with preimplantation genetic diagnosis.

Objective: To investigate patients' interest in preimplantation genetic diagnosis (PGD) as a method for aneuploidy screening and their willingness to participate in a clinical trial using PGD.

Design: Anonymous questionnaire.

Setting: University infertility clinic.

Continuous quality improvement and assisted reproductive technology multiple gestations: some progress, some answers, more questions.

The past decade has seen a fall in the number of embryos transferred accompanied by a reduction in the rate of higher order multiple pregnancies occurring from U.S. assisted reproductive technology (ART) cycles, which is temporally related to voluntary adherence to embryo transfer guidelines.

Prevalence of celiac disease in a cohort of women with unexplained infertility.

Several European studies have suggested a higher prevalence of celiac disease (CD) among infertile women (4% to 8%) compared with the general population (<1%). We screened a cohort of women with unexplained infertility in Northern California for the serum markers of CD, tissue transglutaminase and endomysium antibodies (EMA). Given that only one woman out of 121 (0.

Methylenetetrahydrofolate reductase (MTHFR) is associated with ovarian follicular activity.

Objective: Polymorphisms in the MTHFR gene have been associated with decreased cell division and apoptosis. This finding led us to evaluate whether MTHFR polymorphisms were associated with follicular growth within the ovary. More specifically, we investigated the effect of the two common polymorphisms C677T and A1298C in our population of women undergoing ovarian stimulation.

Assisted reproductive technology practice patterns and the impact of embryo transfer guidelines in the United States.

Objective: [1] To evaluate trends in number of embryos transferred and resultant high-order multiple (HOM) pregnancy rates by Society for Assisted Reproductive Technology (SART)-member clinics between 1996 and 2003 and [2] to relate these practice patterns and outcomes to clinic compliance with SART-American Society for Reproductive Medicine (ASRM) embryo transfer guidelines.

Design: Retrospective.

Setting: Society for Assisted Reproductive Technology-member fertility centers in the United States.

Bed rest after embryo transfer: a randomized controlled trial.

Objective: To determine whether bed rest after embryo transfer leads to improved pregnancy rates (PR).

Design: Randomized controlled trial.

Setting: University reproductive health clinic.

Methylenetetrahydrofolate reductase C677T and A1298C variants do not affect ongoing pregnancy rates following IVF.

Background: There is concern that IVF could compromise normal imprinting and methylation of DNA. Methylenetetrahydrofolate reductase (MTHFR) regulates the flow of folic acid-derived, one-carbon moieties for methylation and is critical to early embryonic development. Therefore, we hypothesized that common polymorphisms in MTHFR could associate with IVF outcome.

Novel missense mutations of the Deleted-in-AZoospermia-Like (DAZL) gene in infertile women and men.

Background: The Deleted-in-AZoospermia-Like (DAZL) gene has homologs required for germ cell development in many organisms. Recently, we showed that there are several common polymorphisms within the DAZL gene that are associated with age at ovarian failure/menopause and sperm count.

Methods: Here we sought to identify rare mutations in DAZL and examine their phenotypes in men and women.

Day 2 transfer improves pregnancy outcome in in vitro fertilization cycles with few available embryos.

Objective: Delaying ET to day 3 to optimize embryo selection is well accepted. However, in cases where there are not enough embryos to perform selection, it is not clear whether there is a difference in clinical outcomes with the day of ET.

Design: Cohort study.

Gonadotropin stimulation demonstrates a ceiling effect on in vitro fertilization outcomes.

Objective: To determine the effect of number of oocytes retrieved and number of 2PN embryos developed on in vitro fertilization (IVF) outcomes.

Design: Retrospective data analysis.

Setting: University practice.

Oocyte degeneration after intracytoplasmic sperm injection: a multivariate analysis to assess its importance as a laboratory or clinical marker.

Objective: Oocyte degeneration has historically been associated with the intracytoplasmic (ICSI) technique. We sought to determine whether oocyte degeneration rates were associated with the technician performing the procedure, the baseline characteristics of the patient, and/or ovarian stimulation variables. We also evaluated whether the degeneration rate could serve as a surrogate marker for implantation potential.

Postmenopausal hormone therapy: new questions and the case for new clinical trials.

Observational studies suggest that postmenopausal hormone therapy (HT) prevents coronary heart disease, whereas randomized clinical trials have not confirmed a cardioprotective effect. Although observational studies may have overestimated the coronary benefit conferred by postmenopausal hormone use, there are other plausible explanations for the apparent discrepancy between previous results and the less favorable findings from clinical trials such as the large Women's Health Initiative. There is now a critical mass of data to support the hypothesis that age or time since menopause may importantly influence the benefit-risk ratio associated with HT, especially with respect to cardiovascular outcomes, and that the method of administration, dose, and formulation of exogenous hormones may also be relevant.

Triploidy formation after intracytoplasmic sperm injection may be a surrogate marker for implantation.

Objective: Triploidy after intracytoplasmic sperm injection (ICSI) is due mostly to retention of the second polar body. Our interest was to determine the predictors of triploidy and to determine whether the presence of triploidy can serve as a surrogate marker of implantation for the remaining cohort of zygotes.

Design: Cohort study.

Preimplantation genetic diagnosis does not increase pregnancy rates in patients at risk for aneuploidy.

Objective: To investigate the use of preimplantation genetic diagnosis (PGD) as a method for increasing pregnancy success rates in patients at high risk for aneuploidy.

Design: Literature review and discussion of current evidence.

Conclusion(s): Preimplantation genetic diagnosis selects euploid embryos for transfer in assisted reproduction.

Variants in Deleted in AZoospermia-Like (DAZL) are correlated with reproductive parameters in men and women.

Qualitative and quantitative defects in human germ cell production that result in infertility are common and determined at least in part by genetic factors [Matzuk and Lamb, Nat Cell Biol 4(Suppl):s41-s49, 2002]. Yet, very few genes that are associated with germ cell defects in humans have been identified. In this study, we examined whether variants of the Deleted in AZoospermia-Like (DAZL) gene are associated with measures of germ cell production in three distinct populations of men and women.

A new era in the ethics of human embryonic stem cell research.

Scientific progress in human embryonic stem cell (hESC) research and increased funding make it imperative to look ahead to the ethical issues generated by the expected use of hESCs for transplantation. Several issues should be addressed now, even though phase I clinical trials of hESC transplantation are still in the future. To minimize the risk of hESC transplantation, donors of materials used to derive hESC lines will need to be recontacted to update their medical history and screening.

KEEPS: The Kronos Early Estrogen Prevention Study.

Observational studies have indicated that hormone therapy given at or after menopause is linked to substantial reduction in cardiovascular disease and its risk factors. Recent findings from the Women's Health Initiative (WHI) clinical trial, however, indicate that combined estrogen plus progestin hormone therapy, as well as estrogen-alone hormone therapy (given to women without a uterus), is ineffective in preventing the new onset of cardiac events in previously healthy late menopausal women. Further, the secondary prevention trial, the Heart and Estrogen/progestin Replacement Study (HERS), also failed to demonstrate any benefit of initiation of hormone therapy in women with established coronary heart disease.

A short study in the treatment of hot flashes with buccal administration of 17-beta estradiol.

Objective: To assess the efficacy and safety of 17-beta estradiol buccal tablets in reducing hot flush frequency (HFF) in postmenopausal women.

Methods: Estradiol buccal tablets containing 0.05, 0.

Plasma homocysteine levels after hormone therapy with and without folic acid supplementation: a randomized study.

Sequential transdermal estrogen-progestin therapy induced a significant reduction in fasting serum homocysteine levels in postmenopausal women. The addition of folic acid supplementation for 6 months did not further lower the homocysteine concentrations.

Informed consent in human oocyte, embryo, and embryonic stem cell research.

Research with human oocytes, embryos, and additional embryonic stem cell lines is needed to address important scientific questions and to fulfill the promise of stem cell transplantation for degenerative diseases. Proponents need to develop guidelines for the appropriate conduct of embryonic stem cell research. Such guidelines will help build public trust and acceptance for this research.

Manipulation of the pill-free interval in oral contraceptive pill users: the effect on follicular suppression.

Objective: The purpose of this study was to compare follicular suppression that was produced by 3 different oral contraceptive regimens that differ by treatment in the pill-free interval.

Study Design: In a university setting, 54 women were assigned randomly to receive either 20 microg ethinyl estradiol+100 microg levonorgestrel followed by 7 pill-free days, 20 microg ethinyl estradiol+150 microg desogestrel followed by 2 days of placebo then 10 microg ethinyl estradiol for 5 days, or 28 days of 20 microg ethinyl estradiol plus 150 microg desogestrel. Follicular suppression was evaluated by serial ultrasound scans and by serum and urinary hormone levels during a 2-month study period.

Human STELLAR, NANOG, and GDF3 genes are expressed in pluripotent cells and map to chromosome 12p13, a hotspot for teratocarcinoma.

Genes required to maintain pluripotency in human embryonic stem (hES) cells are largely unknown, with the exception of OCT-4, a homolog of mouse Oct-4, which is critical for the establishment of the embryonic inner cell mass and the generation of totipotent mouse embryonic stem (mES) cell lines. In the current study, we identified two genes with expression similar to OCT-4, in that they are largely restricted to pluripotent hES cells, premeiotic germ lineage cells, and testicular germ cell tumor cells. Furthermore, we determined that upon hES cell differentiation, their expression is downregulated.