STUDY QUESTION Do donor oocyte recipients benefit from preimplantation genetic testing for aneuploidy (PGT-A)? SUMMARY ANSWER PGT-A did not improve the likelihood of live birth for recipients of vitrified donor oocytes, but it did avoid embryo transfer in cycles with no euploid embryos. WHAT IS KNOWN ALREADY Relative to slow freeze, oocyte vitrification has led to increased live birth from cryopreserved oocytes and has led to widespread use of this technology in donor egg IVF programs. However, oocyte cryopreservation has the potential to disrupt the meiotic spindle leading to abnormal segregation of chromosome during meiosis II and ultimately increased aneuploidy in resultant embryos. Therefore, PGT-A might have benefits in vitrified donor egg cycles. In contrast, embryos derived from young donor oocytes are expected to be predominantly euploid, and trophectoderm biopsy may have a negative effect relative to transfer without biopsy. STUDY DESIGN, SIZE, DURATION This is a paired cohort study analyzing donor oocyte-recipient cycles with or without PGT-A performed from 2012 to 2018 at 47 US IVF centers. PARTICIPANTS/MATERIALS, SETTING, METHODS Vitrified donor oocyte cycles were analyzed for live birth as the main outcome measure. Outcomes from donors whose oocytes were used by at least two separate recipient couples, one couple using PGT-A (study group) and one using embryos without PGT-A (control group), were compared. Generalized estimating equation models controlled for confounders and nested for individual donors contributing to both PGT-A and non-PGT-A cohorts, enabling a single donor to serve as her own control. MAIN RESULTS AND THE ROLE OF CHANCE In total, 1291 initiated recipient cycles from 223 donors were analyzed, including 262 cycles with and 1029 without PGT-A. The median aneuploidy rate per recipient was 25%. Forty-three percent of PGT-A cycles had only euploid embryos, whereas only 12.7% of cycles had no euploid embryos. On average 1.09 embryos were transferred in the PGT-A group compared to 1.38 in the group without PGT-A (P < 0.01). Live birth occurred in 53.8% of cycles with PGT-A versus 55.8% without PGT-A (P = 0.44). Similar findings persisted in cumulative live birth from per recipient cycle. LIMITATIONS, REASONS FOR CAUTION Pooled clinical data from 47 IVF clinics introduced PGT-A heterogeneity as genetic testing were performed using different embryology laboratories, PGT-A companies and testing platforms. WIDER IMPLICATIONS OF THE FINDINGS PGT-A testing in donor oocyte-recipient cycles does not improve the chance for live birth nor decrease the risk for miscarriage in the first transfer cycle but does increase cost and time for the patient. Further studies are required to test if our findings can be applied to the young infertility patient population using autologous oocytes. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used for this study. There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
Pelvic masses can pose a diagnostic dilemma with a broad differential to include both gynecological and non-gynecologic etiologies. While the initial instinct may be to search for gynecologic causes for the female patient, non-gynecologic etiologies must be considered as well. The presentation can be similar amongst many different causes of pelvic masses and imaging is generally required for further assessment to determine if the mass is intra- or extraperitoneal. The etiology of adnexal masses covers several subspecialties: gynecology, urology, gastroenterology, neurology, and oncology. For this reason, it is important for all to be aware of the differential diagnosis for pelvic masses.
Background: Herpes Simplex Virus Type (HSV) affects >90% of the adult population of the United States. Eye involvement can result in progressive scarring and permanent visual impairment.Case: An 81 years old female with a high grade ovarian adenocarcinoma underwent one cycle of chemotherapy before complaining of left red eye and tearing not relieved with olopatadine hydrochloride eye drops. Prompt optometry consult led to diagnosis of herpetic keratitis. She was given ganciclovir ophthalmic gel and oral valacyclovir with complete resolution of symptoms and impaired visual acuity. To date, this patient has normal vision with mild transparent stromal corneal scarring. Conclusion:Herpetic keratitis can have significant consequences including permanent corneal scarring, damage of nerves, and vision loss. Early diagnosis and prompt treatment are required to prevent serious long-lasting sequelae.
A chi-squared analysis was performed.RESULTS: A total of 465 embryos were included from 81 patients between 2017-2018. The average age of patients was 35.2 years (range 22-44), BMI was 23.6 kg/m2, and average CD3 FSH was 6.2 miU/mL. The overall aneuploidy rate in this cohort of embryos was 44%. The male-to-female ratio of blastocysts was (258/207) 55%/45% (p¼0.03). The euploid rate was 55% vs 57% among male and female embryos, respectively. 60% of embryos were euploid on day 5 compared to 50% on day 6 (p¼0.03). Male embryos were more likely to be euploid on day 5 versus day 6 (63% vs 41%, p <0.05) compared to female embryos which had a similar euploid rate on day 5 versus day 6 (55% vs 60%, p¼0.48).CONCLUSIONS: To our knowledge, this is the first study to assess sex imbalances and ploidy in IVF-PGT-A cycles as it relates to blastocyst expansion on day 5 versus day 6 at an individual center. We observed a sex-ratio imbalance among blastocysts undergoing PGT-A, in favor of males. Similar to other studies, we found a higher euploid rate among day 5 blastocysts versus day 6, in both male and female embryo cohorts. Overall, the euploid rate was higher in day 5 male embryos versus day 6 male embryos, while in female embryos the euploid rates were similar. These results might suggest differences in morphokinetics and blastocyst expansion of male and female embryos as it relates to ploidy status.
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