Impact of a prior cesarean delivery on embryo transfer: a prospective study.

Objective: To determine whether a history of prior cesarean delivery (CD) makes ET more difficult and impacts pregnancy outcomes.

Design: Prospective cohort study.

Setting: Tertiary care military facility.

Natural cycle IVF reduces the risk of low birthweight infants compared with conventional stimulated IVF.

Study Question: Are perinatal outcomes improved in singleton pregnancies resulting from fresh embryo transfers performed following unstimulated/natural cycle IVF (NCIVF) compared with stimulated IVF?

Summary Answer: Infants conceived by unstimulated/NCIVF have a lower risk of being low birthweight than infants conceived by stimulated IVF; however, this risk did not remain significant after adjusting for gestation age.

What Is Already Known: Previous studies have shown that infants born after modified NCIVF have a higher average birthweight and are less likely to be low birthweight than those infants conceived with conventional stimulated IVF.

Study Design, Size And Duration: Retrospective cohort study of singleton live births in non-smoking women undergoing fresh IVF-embryo transfer cycles from 2007 to 2013 in a single IVF center.

Live births achieved via IVF are increased by improvements in air quality and laboratory environment.

Infertility is a common disease, which causes many couples to seek treatment with assisted reproduction techniques. Many factors contribute to successful assisted reproduction technique outcomes. One important factor is laboratory environment and air quality.

Proteomics of the human endometrial glandular epithelium and stroma from the proliferative and secretory phases of the menstrual cycle.

Despite its importance in reproductive biology and women's health, a detailed molecular-level understanding of the human endometrium is lacking. Indeed, no comprehensive studies have been undertaken to elucidate the important protein expression differences between the endometrial glandular epithelium and surrounding stroma during the proliferative and midsecretory phases of the menstrual cycle. We utilized laser microdissection to harvest epithelial cells and stromal compartments from proliferative and secretory premenopausal endometrial tissue and performed a global, quantitative mass spectrometry-based proteomics analysis.

Follicular and estradiol parameters that improve success with natural cycle in vitro fertilization.

Objective: To describe clinical thresholds for follicle size and estradiol levels to optimize success with natural cycle in vitro fertilization (NCIVF).

Study Design: Descriptive cohort of candidates for stimulated IVF, < 43 years old, with regular menstrual cycles, regardless of ovarian reserve or fertility treatment history. Patients underwent NCIVF, defined as oocyte retrieval, fertilization and embryo transfer after human chorionic gonadotropin (hCG) trigger without luteinizing hormone (LH) suppression or ovarian stimulation medications.

Falling estradiol levels on day after human chorionic gonadotropin administration in assisted reproductive technology cycles are not predictive of decreasing oocyte maturity or pregnancy rates.

Objective: To determine whether a fall in serum estradiol levels the day after human chorionic gonadotropin (hCG) administration correlated with the incidence of a positive serum hCG in fresh, nondonor assisted reproductive technology (ART) cycles.

Study Design: A total of 1,969 women undergoing fresh, nondonor ART cycles at a tertiary referral fertility clinic between January 1, 2003, and January 31, 2010, were included and retrospectively analyzed. Primary outcome measures were oocyte maturity and positive serum beta-hCG.

Utilization and success rates of unstimulated in vitro fertilization in the United States: an analysis of the Society for Assisted Reproductive Technology database.

Objective: To examine the utilization and outcomes of natural cycle (unstimulated) IVF as reported to the Society of Assisted Reproductive Technology (SART) in 2006 and 2007.

Design: Retrospective analysis.

Setting: Dataset analysis from the SART Clinical Outcome Reporting System national database.

GnRH antagonist rescue in high responders at risk for OHSS results in excellent assisted reproduction outcomes.

Gonadotrophin-releasing hormone (GnRH) antagonist rescue is performed by replacing a GnRH agonist with a GnRH antagonist in patients with rapidly rising serum oestradiol who are at risk of ovarian hyperstimulation syndrome (OHSS) during stimulation. It results in a rapid reduction in serum oestradiol, allowing for the avoidance of cycle cancellation and the continuation of exogenous gonadotrophin administration. A total of 387 patients who underwent GnRH antagonist rescue for ovarian hyperresponse were compared with 271 patients who did not receive GnRH antagonist rescue and had oestradiol concentrations >4000 pg/ml on the day of human chorionic gonadotrophin (HCG) administration.

Experience with a patient-friendly, mandatory, single-blastocyst transfer policy: the power of one.

Objective: To determine whether a mandatory single-blastocyst transfer (mSBT) algorithm reduced multiple gestation rates without sacrificing clinical pregnancy rates.

Design: Retrospective review.

Setting: U.

Proficiency in oocyte retrieval: how many procedures are necessary for training?

Objective: To determine a minimum number of procedures required for proficiency in oocyte retrieval and to characterize skill acquisition.

Design: Retrospective analysis.

Setting: Reproductive endocrinology and infertility fellowship training program.

Enough is enough! Patients who do not conceive on 600 IU/d of gonadotropins show no improvement from an additional 150 IU of LH activity.

Studies have suggested that supplemental LH improves outcomes in assisted reproductive technology (ART) cycles. In this retrospective review, an additional 150 IU of LH activity did not improve ART outcomes in women undergoing a second round of IVF/ intracytoplasmic sperm injection (ICSI) after an initial failed cycle using 600 IU of gonadotropins.

Are there ethnic differences in pregnancy rates in African-American versus white women undergoing frozen blastocyst transfers?

Objective: To determine whether frozen-thawed blastocyst transfer pregnancy rates (PR) are lower in African-American compared with white women.

Design: Retrospective review of frozen blastocyst cycles.

Setting: University-based assisted reproductive technology (ART) program.

The pathophysiology of ovarian hyperstimulation syndrome: an unrecognized compartment syndrome.

Objective: To compare and contrast the pathophysiology of ovarian hyperstimualtion syndrome (OHSS) with known syndromes of increased intraabdominal pressure (IAP), and to explore the relationship of increased IAP with symptom severity in OHSS.

Design: Literature review.

Main Outcome Measure(s): Correlation of OHSS symptoms with IAP; effects of paracentesis on IAP in patients with OHSS.

Balloon fluoroscopy as treatment for intrauterine adhesions: a novel approach.

Objective: To report a unique fluoroscopically guided approach to treat severe intrauterine adhesions and cervical stenosis using balloon hysteroplasty.

Design: Case report.

Setting: Military-based fertility center.

Activating transcription factor 3 gene expression suggests that tissue stress plays a role in leiomyoma development.

Objective: To determine whether expression of the stress response gene ATF3 and related members of activator protein complex-1, cJun and cFos, were altered in leiomyoma compared with myometrium, and whether this difference might correlate with leiomyoma size or race.

Design: Laboratory study.

Setting: University hospital.

Ovarian follicular flushing among low-responding patients undergoing assisted reproductive technology.

A randomized comparison trial was performed to evaluate whether follicular reaspiration with use of a double-lumen retrieval needle improves oocyte recovery when compared with direct follicular aspiration among low-responding patients undergoing ART. There were no differences observed in the number of oocytes retrieved (single lumen: 6.5 +/- 2.

Curcumin, a nutritional supplement with antineoplastic activity, enhances leiomyoma cell apoptosis and decreases fibronectin expression.

Objective: To determine if curcumin has an antiproliferative effect on leiomyoma cells via apoptosis induction and whether curcumin impacts extracellular matrix (ECM) production by assessing the fibronectin expression in leiomyoma cells treated with curcumin.

Design: Tissue culture study of immortalized human leiomyoma and patient-matched myometrial cells treated with curcumin.

Setting: University hospital.

Epidemiology of myomas.

Fibroids are a prevalent disorder occurring in at least half of American reproductive-age women. In general, the incidence and size increases with age. Most women never attribute or report any symptoms from their fibroids, and because of this the actual contribution of disease to symptoms of pelvic pain,menstrual symptoms, and infertility is poorly understood.

Strategy for elucidating differentially expressed genes in leiomyomata identified by microarray technology.

Objective: cDNA microarray technology identifies genes that are differentially expressed between tissues. Our previous study identified several genes that might contribute to the fibroid phenotype. We therefore sought to confirm genes involved in three distinct signal transduction pathways.