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Biomedical subjects

Elizabeth S Ginsburg

Publications and source records attributed to Elizabeth S Ginsburg.

9 recordsLinked to original sources
PubMed2006

Should a patient's own IVF physician perform the embryo transfer?

PURPOSE: To compare pregnancy rates of embryo transfers performed by a patient's own IVF physician to pregnancy rates of embryo transfers performed by other physicians on the IVF team. METHODS: Retrospective cohort study; University hospital. RESULTS: A total of 3029 embryo transfers were included. 434 patients (14%) had an embryo transfer by their own IVF physician. There was no difference in pregnancy rates comparing patients who had embryos transferred by a different physician than their own IVF physician when all cycle attempts were analyzed [Odds ratio (OR) 1.1; Confidence interval (CI) 0.9-1.4]. There was no significant difference between the groups' population characteristics. A subset analysis of 1st cycle only embryo transfers (n=1416) also revealed no difference in pregnancy rates [OR 1.1; CI 0.8-1.5]. CONCLUSIONS: Patients can be reassured that their chances of pregnancy are the same whether their embryo transfer is performed by their own physician or another physician in the practice.

Embryo Transfer↗
PubMed2006

Rate of cell division and weight of neonates following IVF.

The present study tested the hypothesis that embryos with a lower number of cells on day 3 would be associated with infants born of lower weight. Singleton births (n = 447) were analysed to assess mean birth weight according to mean cell number in the transferred cohort. Mean birth weight increased with increasing average cell number. Each increase of one in average cell number was associated with a predicted increase in birth weight of 42.7 g (P = 0.01). This association was present only without assisted hatching, where an increase of one in average cell number was associated with a predicted increase of 79.1 g (P = 0.0005). Intracytoplasmic sperm injection was not associated with any change in birth weight. Demonstration of causality is limited because it is impossible to know which embryo in the transferred group implanted and grew into a fetus. Complete data were also lacking on some factors that influence birth weight. However, our data indicate that mean cell number on day 3 is positively associated with birth weight, but only without assisted hatching. Assisted hatching of slower-cleaving embryos may normalize birth weight distribution to that of faster-cleaving embryos.

Body Weight↗
PubMed2005

T-helper 2 and 3 type immunity to trophoblast in successful in vitro fertilization-embryo transfer.

OBJECTIVE: To determine whether peripheral blood mononuclear cell (PBMC) secretion of T-helper (Th)-1 type cytokines and Th-2 and Th-3 type cytokines in women undergoing in vitro fertilization-embryo transfer (IVF-ET) is associated with therapeutic failure and success, respectively. DESIGN: Cohort study. SETTING: Academic medical center. PATIENT(S): One hundred one women undergoing IVF-ET and 19 fertile controls. INTERVENTION(S): Peripheral blood was obtained from women undergoing IVF-ET before oocyte retrieval and from 19 nonpregnant fertile controls. The PBMCs were cultured in the presence or absence of a protein extract from either a trophoblast cell line or sperm membrane. MAIN OUTCOME MEASURE(S): Supernatants from PBMC cultures were tested by enzyme-linked immunoabsorbent assay (ELISA) for the Th-1 type cytokines tumor necrosis factor-alpha (TNF)-alpha) and interferon-gamma (IFN)-gamma), the Th-2 type cytokines interleukin (IL)-6 and IL-10, and the Th-3 type cytokine transforming growth factor (TGF)-beta1. RESULT(S): Levels of IL-6 and IL-10 were significantly higher in controls than in infertile women with endometriosis, and levels of IL-10 were higher in controls than in women with unexplained infertility. No differences were found in unstimulated levels of TNF-alpha, IFN-gamma, or TGF-beta1 between infertile patients and controls. In trophoblast-stimulated PBMC cultures, levels of TGF-beta1 were significantly lower in subjects who experienced failed compared with ongoing pregnancies. CONCLUSION(S): Baseline PBMC secretion of IL-6 and IL-10 is higher in fertile controls than in women with endometriosis, and IL-10 secretion is also higher than in women with unexplained infertility. Trophoblast-stimulated PBMC secretion of TGF-beta1 is positively associated with the establishment of successful pregnancy in women undergoing IVF-ET. Our study provides novel evidence to support a faciliatory role of Th-2 and Th-3 type responses to trophoblast in early pregnancy.

Analysis of Variance↗
PubMed2005

Optimum number of embryos to transfer in women more than 40 years of age undergoing treatment with assisted reproductive technologies.

OBJECTIVE: To determine whether increasing the number of embryos transferred beyond five increases pregnancy rates in women aged > 40 years. DESIGN: Retrospective analysis of cycles performed between January 1998 and July 2003. SETTING: University-affiliated teaching hospital. PATIENT(S): Women aged > 40 years undergoing a fresh cycle with a day-3 ET (n = 863). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Pregnancy, chemical pregnancy, miscarriage rates, number of viable fetuses at 12 weeks' gestation, live birth rates, and number of babies delivered. RESULT(S): Compared with patients with fewer than five embryos transferred, those having five or more embryos transferred had significantly increased pregnancy rates and live birth rates, more viable fetuses at 12 weeks, and significantly decreased miscarriage rates. None of these outcome variables differed between the five-embryo and more-than-five-embryo groups. There were no differences in outcome when only five embryos were transferred, regardless of whether five or more than five embryos were available. The number of embryos transferred did not significantly influence multiple birth rates. CONCLUSION(S): The present study demonstrates that in women aged > 40 years, five embryos is the optimum number to transfer, and transferring more than five does not confer any additional benefit to clinical outcome.

Adult↗
PubMed2005

Embryo quality based on ovulation induction: defining the differences.

Patients undergoing IVF, with or without intracytoplasmic sperm injection, were treated with either recombinant human FSH or urine-derived FSH. Response to ovarian stimulation was monitored by ultrasound examinations and measurement of serum oestradiol concentrations. To define any differences in embryo quality and hence assisted reproductive technology success rates, a retrospective analysis of 811 recombinant FSH versus 555 urinary FSH cycles was undertaken. Embryo quality was assessed as embryo cell number and degree of fragmentation. Implantation and ongoing pregnancy rates were also compared. Use of recombinant FSH resulted in a higher percentage of mature oocytes, improved embryo cleavage, with more embryos available for freezing and higher implantation rates compared with urinary FSH. Oocyte and embryo quality were superior when recombinant FSH was used for ovarian stimulation compared with urinary FSH.

Adult↗
PubMed2004

Persistent tubal pregnancy presenting with delayed hemorrhage from a second implantation of trophoblast on the ovary: a case report.

BACKGROUND: The use of conservative surgical techniques to treat ectopic pregnancies has been reported to increase the rate of incomplete trophoblastic tissue removal and subsequent regrowth. CASE: A persistent ectopic pregnancy occurred in a woman previously treated with laparoscopic linear salpingostomy for an ampullary ectopic pregnancy. Repeat laparoscopy was performed, and bleeding from an ovarian implantation site was treated with resection of the trophoblastic site and electrocautery. A repeat linear salpingostomy was also performed at the site of the prior salpingostomy, where trophoblastic tissue also persisted. CONCLUSION: This is the first known case of hemorrhage from the probable secondary ovarian implantation of persistent trophoblastic tissue. A repeat conservative surgical procedure to treat persistent ectopic pregnancies and maintain potential fertility is advocated. This case also serves as a reminder to diligently examine all areas of the pelvis for the possible secondary implantation of persistent trophoblastic tissue should reoperation be necessary.

Adult↗
PubMed2002

Early pregnancy loss in in vitro fertilization (IVF) is a positive predictor of subsequent IVF success.

OBJECTIVE: To determine the significance of biochemical pregnancy losses and clinical spontaneous abortion (SAB) on outcomes of future IVF cycles. DESIGN: Retrospective cohort study. SETTING: Academic IVF program. PATIENT(S): Women with a history of unsuccessful IVF attempts undergoing IVF. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate. RESULT(S): Patients with an early pregnancy loss had a greater ongoing clinical pregnancy rate in the immediate next cycle when compared with those women who had a negative pregnancy test (37.3% vs. 27.3%). Patients with a history of a biochemical pregnancy or a clinical spontaneous abortion had an ongoing clinical pregnancy rate in the next cycle of 38.4% and 42.3%, respectively, compared with 27.3% in women who had a history of a negative pregnancy test. The cumulative pregnancy rate after the first IVF attempt was 54.1% in patients with a previous biochemical pregnancy loss, 61.4% in those with a previous clinical SAB, and 46.5% in women with a previous negative pregnancy test. CONCLUSION(S): Women who experience an early pregnancy loss after IVF have a greater likelihood of success in subsequent IVF cycles when compared with patients who fail to conceive.

Abortion, Spontaneous↗
PubMed2002

Conversion of high-response gonadotropin intrauterine insemination cycles to in vitro fertilization results in excellent ongoing pregnancy rates.

OBJECTIVE: To determine whether conversion of gonadotropin/IUI cycles at high risk of high-order multiple pregnancies to IVF yields a pregnancy rate high enough to warrant the added intervention. DESIGN: Case-control study. SETTING: Brigham and Women's Hospital assisted reproductive technology program. PATIENT(S): Seventy-seven patients converted from gonadotropin/IUI to IVF, 77 consecutive age and attempt number-matched controls (sequential controls [SCs]), and 77 consecutive age-, attempt-, and E(2)-matched controls (E(2) controls [ECs]). INTERVENTION(S): Gonadotropin/IUI cycles with exuberant responses were converted to IVF (cases) to avoid cycle cancellation and high-order multiple pregnancies. MAIN OUTCOME MEASURE(S): Pregnancy rates, delivery rates, E(2) levels, follicle and oocyte number, and fertilization and implantation rates. RESULT(S): Compared with SCs and ECs, cases had more follicles (16.3 +/- 0.6 vs. 13.3 +/- 0.9 and 14.4 +/- 0.9) and higher E(2) at hCG administration (1,951 +/- 93 vs. 1,568 +/- 96 and 1,939 +/- 89 pg/mL). Delivery rates among the three groups (45.5% vs. 32.5% and 39.0%) did not differ significantly. Despite the transfer of fewer embryos in cases than in controls (2.5 +/- 0.1 vs. 3.1 +/- 0.1 and 2.9 +/- 0.1), three triplet pregnancies occurred in cases and three in controls. CONCLUSION(S): Conversion of high responder gonadotropin/IUI patients to IVF is an effective alternative to cycle cancellation and offers a delivery rate as high or higher per cycle than that of planned IVF. Sample size limited the statistical power of the study.

Adult↗