Is transferring a lower-quality embryo with a good-quality blastocyst detrimental to the likelihood of live birth?

Objective: To determine if transferring a lower-quality embryo with a good-quality blastocyst is detrimental, given that evidence suggests that embryos can signal the endometrium and that embryo quality may affect negatively endometrial receptivity.

Design: Retrospective cohort study.

Setting: In vitro fertilization center.

Revisiting the progesterone to oocyte ratio.

Objective: To critically evaluate the P to oocyte (O) ratio (P/O) in the prediction of live birth in assisted reproductive technology (ART) cycles.

Design: Retrospective cohort study.

Setting: Not applicable.

Is FMR1 CGG repeat length a predictor of in vitro fertilization stimulation response or outcome?

Objective: To study a broad range of FMR1 CGG repeat lengths and assisted reproduction technology (ART) outcomes.

Design: Retrospective cohort study.

Setting: Private ART practice.

Are good patient and embryo characteristics protective against the negative effect of elevated progesterone level on the day of oocyte maturation?

Objective: To evaluate if an elevated progesterone (P) level on the day of human chorionic gonadotropin (hCG) administration is associated with a decrease in live-birth rate in patients with a good prognosis.

Design: Retrospective cohort study.

Setting: Large, private, assisted reproductive technology (ART) practice.

Single vitrified blastocyst transfer maximizes liveborn children per embryo while minimizing preterm birth.

Objective: To compare live-birth rates, blastocyst to live-birth efficiency, gestational age, and birth weights in a large cohort of patients undergoing single versus double thawed blastocyst transfer.

Design: Retrospective cohort study.

Setting: Assisted reproduction technology (ART) practice.

Optimal oocyte retrieval and embryo transfer techniques: where we are and how we got here.

Oocyte retrieval is most safely accomplished with conscious sedation via a transvaginal approach under ultrasound guidance with low-pressure aspiration. Follicle flushing has not been shown to improve outcomes. The type of vaginal surgical preparation and the use of antibiotics have not been demonstrated to affect outcomes.

Single-donor and double-donor sperm intrauterine insemination cycles: does double intrauterine insemination increase clinical pregnancy rates?

Objective: To compare the pregnancy outcomes in the setting of a single- vs. double-donor sperm intrauterine insemination (IUI) treatment cycle.

Design: Retrospective cohort study.

Ovarian reserve and subsequent assisted reproduction outcomes after methotrexate therapy for ectopic pregnancy or pregnancy of unknown location.

Objective: To assess ovarian reserve after methotrexate treatment for ectopic pregnancy or pregnancy of unknown location after assisted reproductive technology (ART).

Design: Retrospective cohort study.

Setting: Large ART practice.

Progesterone luteal support after ovulation induction and intrauterine insemination: a systematic review and meta-analysis.

Objective: To evaluate the effect of luteal phase P support after ovulation induction IUI.

Design: A systematic review and meta-analysis.

Setting: Not applicable.

Money-back guarantees.

As fertility rates among women of advanced reproductive age have steadily increased, so has the utilization of fertility services. National health policies provide infertility treatment coverage in several developed countries; however, in the United States infertility treatment is largely privately funded, resulting in limited access to care. In response to the lack of insurance coverage, many practices offer fertility treatment on a risk-sharing or contingency fee basis.

Trophectoderm grade predicts outcomes of single-blastocyst transfers.

Objective: To estimate the effect of the embryo stage, trophectoderm (TE) morphology grade, and inner cell mass (ICM) morphology grade on live birth in single-blastocyst transfers.

Design: Retrospective cohort study.

Setting: Large private assisted reproductive technologies (ART) practice.

The use of follicle flushing during oocyte retrieval in assisted reproductive technologies: a systematic review and meta-analysis.

Study Question: Does follicular flushing during assisted reproductive technologies (ART) improve the number of oocytes retrieved?

Summary Answer: Follicular flushing during ART does not result in a greater number of oocytes in normal responders.

What Is Known Already: Despite limited evidence supporting the use of follicular flushing, it continues to be a common procedure in many ART clinics. Prior studies have provided conflicting results regarding the routine use of flushing during oocyte retrieval.

The use of recombinant luteinizing hormone in patients undergoing assisted reproductive techniques with advanced reproductive age: a systematic review and meta-analysis.

Objective: To evaluate the effect of recombinant LH in assisted reproduction technology (ART) cycles in patients of advanced reproductive age.

Design: A systematic review and meta-analysis.

Setting: Published randomized controlled clinical trials comparing recombinant LH plus recombinant FSH versus recombinant FSH only in patients of advanced reproductive age.

Does exogenous LH in ovarian stimulation improve assisted reproduction success? An appraisal of the literature.

A review of the scientific literature on the use of exogenous LH in assisted reproductive technology was performed by searching the MEDLINE, PubMed and Cochrane online databases. Scientific evidence was reviewed comparing recombinant FSH-only protocols to protocols supplemented with exogenous LH activity: human menopausal gonadotrophin (HMG), recombinant LH and mid-follicular human chorionic gonadotrophin (HCG). Studies were further compared based on pituitary suppression with gonadotrophin- releasing hormone (GnRH) antagonist and agonist protocols.

Favorable response to antigonadal therapy for a benign metastasizing leiomyoma.

Background: Benign metastasizing leiomyoma and lymphangioleiomyomatosis (LAM) both are characterized by abnormal proliferation of smooth muscle-like cells in the lung.

Case: A 32-year-old African woman with a diagnosis of LAM underwent myomectomy for uterine leiomyomas. An alternative diagnosis of benign metastasizing leiomyoma was made on repeat lung biopsy.

Ethical application of Shared Risk programs in assisted reproductive technology.

Shared Risk programs require adherence to core principles: transparency, patient autonomy, and appropriate medical care. These programs improve utilization of and perseverance with fertility treatment, receiving strong patient endorsements.

Indian Hedgehog and its targets in human endometrium: menstrual cycle expression and response to CDB-2914.

Context: Progesterone is critical for secretory endometrial differentiation in women, but its downstream mediators are poorly understood.

Objective: Our objective was to investigate endometrial expression of Indian Hedgehog (IHH) and genes involved in its signaling [smoothened (SMO), patched-1 (PTCH1), glioma-associated oncogene homolog 1 (GLI1), and GLI2] during the menstrual cycle and the effects of the selective progesterone receptor modulator CDB-2914 on its expression.

Design And Setting: Comparisons between normally cycling volunteers and women with symptomatic fibroids who received CDB-2914 or placebo were made at a clinical research center.

Methylation patterns of Brahma during spermatogenesis and oogenesis: potential implications.

To compare methylation profiles and expression levels of Brahma at different stages of spermatogenesis, and to identify the methylation pattern during oogenesis, we analyzed gene expression and methylation patterns in murine germ cells at various developmental stages. The methylation levels of CpG islands within Brahma increased during spermatogenesis and decreased during oogenesis. This change in methylation pattern correlates with the change in expression of Brahma during spermatogenesis.

Contribution of male age to outcomes in assisted reproductive technologies.

Objective: To evaluate the relationship between male age and pregnancy outcome in donor oocyte assisted reproductive technology cycles.

Design: Retrospective cohort.

Setting: Private IVF center.

Conversion from assisted reproductive technology to intrauterine insemination in low responders: is it advantageous?

Objective: To examine cycle outcomes among patients demonstrating an attenuated ovarian response that proceeded to oocyte retrieval to those converted to intrauterine insemination (IUI).

Design: Retrospective cohort study.

Setting: Large private fertility center.

Is there a benefit in follicular flushing in assisted reproductive technology?

Purpose Of Review: Follicular flushing utilizing double-lumen retrieval needles attempts to increase oocyte yield during transvaginal retrieval. The original work on this topic, now more than 2 decades old, examined its utility in normal-responding assisted reproductive technologies (ART) patients. Newer studies examining its utility have focused on special populations expected to demonstrate benefit: poor responders, natural cycle and minimal stimulation ART, and in-vitro maturation cycles.

Recruitment and retention of women for clinical leiomyoma trials.

Background: Subject recruitment and retention in clinical leiomyoma trials is challenging. We evaluated strategies to increase patient enrollment and completion in leiomyoma trials.

Materials And Methods: Randomized trials for treatment of symptomatic leiomyoma published from 2000 through 2008 were evaluated and thirteen trials were selected.