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Elective oocyte freezing for the preservation of fertility

Open Journal of Obstetrics and Gynecology 2012年第1期2卷 27-33页

作者： jason barritt Martha Luna Benjamin Sandler Marlena Duke Alan B. Copperman Reproductive Endocrinology Mount Sinai School of Medicine New York USA Reproductive Medicine Associates of New York New York USA

Oocyte cryopreservation has recently emerged as an option for women to preserve their fertility for medical (e.g. treatable malignancy) or elective indications (e.g. advancing age). This report describes an IRB-approved study of over 200 oocyte cryopreservation cycles at one center. Patients presenting for oocyte cryopreservation (January 2005 to 2010) were analyzed for day 3 follicle stimulating hormone (FSH), basal antral follicle count (BAFC), gonadotropin usage and the number of oocytes retrieved and cryopreserved. New patient consultations were performed on 516 women, of whom 175 (34%) proceeded to initiate a total of 233 cryopreservation cycles. Twenty-four cycles were cancelled (10%) after starting follicular stimulation due to poor ovarian response or self-withdrawal of the patients. Patients whose cycles were cancelled demonstrated a higher Day 3 FSH and a lower BAFC than patients who completed cycles (p < 0.01). In the 209 completed cycles, the most important predictors of a successful cycle included BAFC (r = 0.36), FSH (r = –0.25) and age (r = –0.18) with the mean number of oocytes cryopreserved at 13.6 ± 8.8. Information about long-term fertility preservation must reach both patients and health care providers so that more women can be educated about the benefits of proactive early physiological reproductive assessment and possible interventions available.

关键词： Human Oocyte Cryopreservation Fertility Preservation Oocyte Aging Ovarian Reserve Follicle Stimulating Hormone Basal Antral Follicle Count

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Preimplantation genetic diagnosis for gender selection: You don’t always get what you want

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Open Journal of Obstetrics and Gynecology 2012年第3期2卷 291-297页

作者： Tanmoy Mukherjee Eric Flisser Alan B. Copperman Lawrence Grunfeld Benjamin Sandler jason barritt Reproductive Medicine Associates of New York New York USA

Parenting children of opposite genders is a powerful motive for parents to seek “sex-selection” services. Medical beneficence and patient autonomy support making these services available. Our goals in this study included data to permit proper patient education, assess outcome, and evaluation of potential biases in this technology. IVF/PGD cases from August 2004 to December 2009 were studied (n = 122). FISH was used to analyze nuclear DNA of biopsied embryos. The variables analyzed were patient age, Day 3 Fluorescent In Situ Hybridization (FISH), the number of fertilized embryos, the number of embryos biopsied, Preimplantation Genetic Diagnosis (PGD) results, the number of embryos transferred, and the fate of remaining embryos. Female embryos were sought in 84 cycles, and male embryos desired in 38 cycles. Couples seeking female offspring had a reduced likelihood of a female-only transfer vs. those seeking males (p < 0.001). No transfer was performed in 32 cases for lack of normal embryos of desired gender. Clinical pregnancy rate per embryo transfer was 30.4%. PGD success rates for gender variety were lower than expected comparative to traditional IVF. In this report we present our clinical experience with IVF/PGD for gender selection. We attempt to analyze which patients seek this specialized treatment and to provide direct clinical and laboratory outcome data from our completed cycles.

关键词： IVF PGD Gender Preference Sex Selection Family Balancing

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Replacing liquid fyrite with digital to improve <i>in vitro</i>fertilization laboratory quality control procedures

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Open Journal of Obstetrics and Gynecology 2012年第1期2卷 7-10页

作者： Casey A. McDonald Zachary A. Haimowitz Andrea DeVenuta Charity Reeves Alan B. Copperman jason barritt Reproductive Endocrinology Mount Sinai School of Medicine New York USA Reproductive Medicine Associates of New York New York USA

In clinical in vitro fertilization (IVF), optimal culture conditions are required for production of high quality embryos and for achieving high pregnancy rates. Cell culture systems require vigilant attention to quality control and quality assurance, and upgrades to equipment and procedures require strenuous deliberation. During a 2-week maintenance period, we undertook an extensive analysis of incubator carbon dioxide (CO2) monitoring and the effect on culture media pH by comparing our traditional liquid Fyrite instruments to a certified and calibrated digital CO2 analyzer. The digital analyzer produced consistently lower CO2 readings and significantly greater precision than the liquid Fyrite. Media pH measurements showed significant variation depending on CO2 calibration device;however pH remained within manufacturers’ specifications. After superior performance by the digital analyzer, we incorporated this device into the incubator calibration and daily quality control procedures. A retrospective comparison of overall lab performance before and after this equipment switch demonstrated improved clinical pregnancy and implantation rates. This report illustrates the necessary caution when altering established laboratory procedures and equipment while highlighting the benefits of judiciously updating techniques and equipment in a laboratory setting that is often stubborn to change pre-existing, ingrained methodology.

关键词： IVF Incubator CO2 Laboratory Quality Control/Quality Assurance Liquid Fyrite Embryo Development Embryo Culture

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