Objective To assess the impact of endometriosis alone, or in combination with other infertility diagnoses, on IVF outcomes Design Population-based retrospective cohort study of cycles from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database. Setting Not applicable. Patients 347,185 autologous fresh and frozen ART cycles from 2008-2010. Interventions None. Main Outcome Measure(s) oocyte yield, implantation rate, live birth rate (LBR) Results While cycles of patients with endometriosis comprised 11% of the study sample, the majority (64%) reported a concomitant diagnosis with male factor (42%), tubal factor (29%) and diminished ovarian reserve (22%) being the most common. Endometriosis, when isolated or with concomitant diagnoses, was associated with lower oocyte yield compared to those with unexplained infertility, tubal factor, and all other infertility diagnoses combined. Women with isolated endometriosis had similar or higher live birth rates compared to those in other diagnostic groups. However, women with endometriosis with concomitant diagnoses had lower implantation rates, and live birth rates compared to unexplained infertility, tubal factor, and all other diagnostic groups. Conclusions Endometriosis is associated with lower oocyte yield, lower implantation rates, and lower pregnancy rates after IVF. However the association of endometriosis and IVF outcomes is confounded by other infertility diagnoses. Endometriosis, when associated with other alterations in the reproductive tract has the lowest chance of live birth. In contrast, for the minority of women who have endometriosis in isolation, the live birth rate is similar or slightly higher compared to other infertility diagnoses.

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Objective: To evaluate predictors of undergoing fertility preservation treatment (FPT) in women with breast cancer. Design: Secondary analysis of a clinical database. Setting: Three academic fertility preservation centers. Patient(s): One hundred and eight patients with breast cancer undergoing FPT and 77 patients with breast cancer not undergoing FPT from 2005-2010. Intervention(s): None. Main Outcome Measure(s): Patients’ demographic and medical information. Result(s): Women who had FPT were older, wealthier, and had lower cancer stage compared to women who did not have FPT. The rate of the administration of neoadjuvant chemotherapy (NAC) was significantly lower in women who underwent FPT. After adjusting for age, BMI, income, cancer stage, and center, a negative correlation persisted between NAC and FPT (OR=0.091, 95 % CI 0.009-0.904). When we stratified the women by center, women at Center-1 had a significantly lower FPT rate, lower parity, higher BMI, more advanced cancer stage, and lower income compared to Centers-2 and -3. The rates of NAC were significantly higher in Center-1. Conclusion(s): While age, BMI, income, cancer stage, center and NAC appear to be associated with undergoing FPT, NAC is the only modifiable variable. Since NAC restricts the time available for FPT, oncologists may consider offering adjuvant chemotherapy, except in cases where NAC clearly improves survival, in women who are interested in FPT.

Objective To determine the exact nature and timing of alterations in thyroid function throughout controlled ovarian hyperstimulation (COH). Design Prospective cohort study. Setting University fertility clinic. Patient(s) Fifty-seven women undergoing COH as part of planned in vitro fertilization. Intervention(s) None. Main Outcome Measure(s) Timing and magnitude of change in serum thyroid hormones, including TSH, total and free T4, E2, and thyroxine-binding globulin (TBG), measured at six time points from before stimulation to 2 weeks after serum pregnancy test. Result(s) Geometric mean serum TSH increased during stimulation, peaking 1 week after hCG administration compared with baseline (2.44 vs. 1.42 mIU/L), as did free T4 (1.52 vs. 1.38 ng/dL) and TBG (32.86 vs. 21.52 μg/mL). Estradiol levels increased, peaking at hCG administration (1743.21 vs. 71.37 pg/mL). Of 50 women with baseline TSH ≤2.5 mIU/L, 22 (44.0%) had a subsequent rise in TSH to >2.5 during or after COH. The pattern of change over time in TSH concentrations was significantly influenced by baseline hypothyroidism and whether pregnancy was achieved. Conclusion(s) COH led to significant elevations in TSH, often above pregnancy appropriate targets. These findings were particularly evident in women with preexisting hypothyroidism and may have important clinical implications for screening and thyroid hormone supplementation.

Objective To investigate the accuracy of serial hCG to predict outcome of a pregnancy of unknown location in an ethnically and geographically diverse setting. Design Multi-site cohort study Setting University hospital Patients Women with a pregnancy of unknown location Interventions None Main outcome measures Patients were followed until diagnosed with ectopic pregnancy (EP), intrauterine pregnancy (IUP), or miscarriage. To predict outcome, observed hCG was compared to recommended thresholds to assess deviation from defined normal curves. Predicted outcome was compared to standard of care. Sensitivity, specificity, predictive value, and accuracy were calculated, stratified by diagnosis. Results The final diagnosis 1,005 patients included 179 EPs, 259 IUPs, and 567 miscarriages. The optimal balance in sensitivity and specificity used the minimal expected two-day rise in hCG of 35%, and the minimal two-day decline in hCG of 36–47% (depending on the level) achieving 83.2% sensitivity, 70.8% specificity to predict EP. However 16.8% of EPs and 7.7% of IUPs would be misclassified solely using serial hCGs. Consideration of a third hCG and early ultrasound decreased IUP misclassification to 2.7%. Conclusion Solely using serial hCG values can result in misclassification. Clinical judgment should trump prediction rules and continued surveillance with a third hCG may be prudent, especially when initial values are low or when values are near suggested thresholds.