Publications by authors named "Nigel Pereira"

101 Publications

Combined transvaginal and transabdominal oocyte retrieval in a patient with an ectopic ovary and unicornuate uterus.

Fertil Steril 2021 May;115(5):1347-1349

Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York.

Objective: To report the utility of combined transvaginal and transabdominal oocyte retrieval in a patient with an ectopic ovary and unicornuate uterus.

Design: Video case report with demonstration of oocyte retrieval technique.

Setting(s): University-affiliated fertility center.

Patient(s): A 35-year-old woman, gravida 0, with a 6-month history of infertility who presented to our center for fertility evaluation. Hysterosalpingography revealed a left unicornuate uterus and patent left fallopian tube magnetic resonance imaging and laparoscopy showed a right ectopic ovary located in the upper abdomen. Her partner was a 36-year-old male with isolated teratozoospermia. The couple did not conceive with intrauterine insemination.

Intervention(s): Ovarian stimulation for in vitro fertilization (IVF). Transvaginal retrieval of oocytes from the right ovary was not deemed possible due the anatomic location of the ovary, intervening blood vessels, and limited mobility of the ovary. Institutional review board approval was not required for this case report as per our institution's policy; patient consent was obtained for publication of the case.

Main Outcome Measure(s): Transabdominal retrieval of oocytes from the right ovary and transvaginal retrieval of oocytes from the left ovary.

Result(s): The couple underwent two IVF cycles. Nine oocytes were retrieved during the first IVF cycle: seven transabdominal (right ovary) and two transvaginal (left ovary). All oocytes were mature, and five blastocysts were cryopreserved. Eight oocytes were retrieved during the second IVF cycle, of which five oocytes were retrieved transabdominally from the right ovary, and three oocytes were retrieved transvaginally from the left ovary. All oocytes were mature, and four blastocysts were cryopreserved. A single thawed embryo was transferred in the natural menstrual cycle, which resulted in the live birth of a full-term baby boy weighing 2,410 grams.

Conclusion(s): The current case highlights the safety and feasibility of combined transvaginal and transabdominal oocyte retrieval in patients with an ectopic ovary located in the upper abdomen.
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http://dx.doi.org/10.1016/j.fertnstert.2020.12.006DOI Listing
May 2021

Laparoscopic management of a primary posterior cul-de-sac abdominal ectopic pregnancy.

Fertil Steril 2021 Apr 20. Epub 2021 Apr 20.

Department of Obstetrics and Gynecology, New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York. Electronic address:

Objective: To report a case of laparoscopic management of a primary posterior cul-de-sac abdominal ectopic pregnancy (AEP).

Design: Video article.

Setting: Academic medical center.

Patient(s): A 40-year-old G5P3013 woman at approximately 7 weeks of pregnancy was referred to our emergency department because of abnormally rising β-human chorionic gonadotropin levels. Transvaginal ultrasonography revealed a cystic structure measuring 2.8 × 1.6 ×1.9 cm in the posterior cul-de-sac distinct from the cervix. The mass was noted to have peripheral hypervascularity and a thickened wall. A moderate amount of complex free fluid was noted adjacent to the mass. The patient's baseline β-human chorionic gonadotropin level and hematocrit were 6,810.7 mIU/mL and 42.4%, respectively.

Intervention(s): Laparoscopy for suspected AEP.

Main Outcome Measure(s): Laparoscopic excision of a primary AEP.

Result(s): Diagnostic laparoscopy revealed a normal uterus, normal right ovary, normal left ovary with a corpus luteal cyst, and normal bilateral fallopian tubes without dilatation or hemorrhage. The AEP was noted in the right posterior cul-de-sac and was excised from the underlying peritoneum. The left lateral aspect of the AEP extended into the posterior vaginal wall. The patient was admitted for overnight observation, and her postoperative hematocrit was 35.1%.

Conclusion(s): AEPs are extremely rare and account for 1% of all ectopic pregnancies. Approximately 90% of AEPs require surgical management. Historically, AEPs were treated with laparotomy because of the high risk of hemorrhage and hemodynamic instability. However, as exemplified by the current case, laparoscopy is a safe and feasible option for surgical management of AEPs.
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http://dx.doi.org/10.1016/j.fertnstert.2021.03.042DOI Listing
April 2021

Laparoscopic ovarian surgery to induce follicular response in patients with premature ovarian insufficiency, diminished ovarian reserve, or resistant ovary syndrome.

Authors:
Nigel Pereira

Fertil Steril 2020 12;114(6):1197

The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.fertnstert.2020.09.168DOI Listing
December 2020

Optimal lead follicle size for human chorionic gonadotropin trigger in clomiphene citrate and intrauterine insemination cycles: an analysis of 1,676 treatment cycles.

Fertil Steril 2021 Apr 4;115(4):984-990. Epub 2020 Dec 4.

Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York.

Objective: To identify the optimal lead follicle size for hCG trigger in clomiphene citrate (CC)-intrauterine insemination (IUI) cycles.

Design: Retrospective cohort study.

Setting: University-affiliated center.

Patient(s): Patients <40 years of age with ovulatory dysfunction or unexplained infertility undergoing their first CC-IUI cycle.

Intervention(s): Ovulation induction, hCG trigger, and IUI.

Main Outcome Measure(s): Clinical pregnancy rate (CPR) was the primary outcome and was plotted against lead follicle size in increments of 1 mm. Odds ratios with 95% confidence intervals for associations between lead follicle size and CPR were calculated from a multivariable logistic regression model. A receiver operating characteristic (ROC) curve was generated for CPR as a function of lead follicle size.

Result(s): 1,676 cycles were included. The overall CPR was 13.8% (232/1,676). There was no difference in baseline demographics or ovulation induction parameters of patients who did or did not conceive. The odds of clinical pregnancy were 2.3 and 2.2 times higher with lead follicle sizes of 21.1-22.0 mm and >22.0 mm, respectively, compared with the referent category of 19.1-20.0 mm. Lead follicle size was an independent predictor of CPR, even after accounting for confounders. A lead follicle size of 22.1 mm corresponded to a sensitivity and specificity of 80.1% and 90.4% for clinical pregnancy, respectively, with an area under the ROC curve of 0.89.

Conclusion(s): hCG administration at a lead follicle size of 21.1-22.0 mm is associated with higher odds of clinical pregnancy in patients undergoing their first CC-IUI cycles for ovulatory dysfunction or unexplained infertility.
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http://dx.doi.org/10.1016/j.fertnstert.2020.10.026DOI Listing
April 2021

Chorionic bump in early pregnancy associated with first-trimester miscarriage.

BMJ Case Rep 2020 Jul 16;13(7). Epub 2020 Jul 16.

The Ronald O Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York, USA

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http://dx.doi.org/10.1136/bcr-2020-236624DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368479PMC
July 2020

Incarcerated Omental Hernia at a 5-mm Trocar Site after Laparoscopy.

J Minim Invasive Gynecol 2021 03 9;28(3):384-385. Epub 2020 Jul 9.

The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine (Drs. Pereira, Irani, Chung, and Rosenwaks, and Mr. Chung), Weill Cornell Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jmig.2020.07.003DOI Listing
March 2021

Monozygotic vanishing twin after single euploid blastocyst transfer.

BMJ Case Rep 2020 06 30;13(6). Epub 2020 Jun 30.

The Ronald O Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York, USA

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http://dx.doi.org/10.1136/bcr-2020-236015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328753PMC
June 2020

Tubal Ectopic Pregnancy with Undetectable Initial Serum β-Human Chorionic Gonadotropin Level.

J Minim Invasive Gynecol 2021 01 26;28(1):142-145. Epub 2020 Jun 26.

The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine (Drs. Pereira, Romanski, Kligman, Rosenwaks, and Ms. Wright), Weill Cornell Medicine, New York, New York.

We present a case of a tubal ectopic pregnancy (EP) in a patient with an initially undetectable serum β-human chorionic gonadotropin (β-hCG) level. A 33-year-old woman in a same-sex relationship underwent timed donor intrauterine insemination. Her serum β-hCG level was <5 mIU/mL 14 days after the intrauterine insemination. She reported menstrual bleeding 3 days after her negative pregnancy test and returned to the office 10 days later to begin a new treatment cycle. Her serum levels of estradiol, progesterone, and β-hCG were 119 pg/mL, 6.1 ng/mL and 1157 mIU/mL, respectively. Transvaginal ultrasonography did not show an intrauterine pregnancy. Her β-hCG level increased to 1420 mIU/mL the next day. She was diagnosed with a pregnancy of unknown location and treated with methotrexate. Her β-hCG levels continued to increase despite 3 methotrexate doses, necessitating laparoscopy. The diagnostic laparoscopy demonstrated approximately 100 mL of hemoperitoneum in the posterior cul-de-sac with an intact right fallopian tube that was dilated at its distal end by the EP. A total right salpingectomy was performed. Her β-hCG level was <5 mIU/mL 3 weeks later. The current case supports that although rare, an undetectable serum β-hCG level does not completely rule out the diagnosis of an EP.
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http://dx.doi.org/10.1016/j.jmig.2020.06.015DOI Listing
January 2021

Foreword: An Update in REI and ART.

Clin Obstet Gynecol 2019 06;62(2):215-216

The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York.

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http://dx.doi.org/10.1097/GRF.0000000000000454DOI Listing
June 2019

Postsurgical peritoneal inclusion cyst masquerading as a large pelvic mass.

Authors:
Nigel Pereira

BMJ Case Rep 2019 Apr 16;12(4). Epub 2019 Apr 16.

The Ronald O Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York City, New York, USA.

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http://dx.doi.org/10.1136/bcr-2019-230066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506023PMC
April 2019

Fresh or Frozen Embryo Transfer in In Vitro Fertilization: An Update.

Clin Obstet Gynecol 2019 06;62(2):293-299

The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York.

The past decade has witnessed a rapid increase in the number of frozen-thawed embryo transfer (FET) cycles. Several factors have contributed to the increase in FET cycles, including improvement in culture media, vitrification, and an increase in preimplantation genetic testing of embryos. However, the accelerated trend in FET cycles also suggests that FET may be preferred over fresh embryo transfer. The current review explores the factors that have influenced this practice shift toward preferential FET and why this shift may be premature.
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http://dx.doi.org/10.1097/GRF.0000000000000456DOI Listing
June 2019

Contemporary Management of Unexplained Infertility.

Clin Obstet Gynecol 2019 06;62(2):282-292

The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York.

Infertility is estimated to affect about 10% to 15% of couples. Most cases of infertility have etiologies that can be attributed to tubal factors, ovulatory dysfunction, endometriosis, uterine factor, male factor, or diminished ovarian reserve, while the remainder often do not have a known attributable cause, that is, unexplained infertility. The current manuscript summarizes the contemporary management of unexplained infertility.
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http://dx.doi.org/10.1097/GRF.0000000000000450DOI Listing
June 2019

Contemporary Management of Polycystic Ovarian Syndrome.

Clin Obstet Gynecol 2019 06;62(2):271-281

The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York.

PCOS remains one of the most intriguing endocrine disorders that physicians encounter even though it was first described over 80 years ago. Although the diagnostic criteria, nomenclature, and ideal therapeutic strategies are areas of active and ongoing debate, there is no doubt that we have made tremendous progress in improving the quality of life and reproductive outcomes of women who suffer from this wide-ranging disorder.
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http://dx.doi.org/10.1097/GRF.0000000000000449DOI Listing
June 2019

Total motile count as predictor of live birth in intrauterine insemination cycles.

Authors:
Nigel Pereira

Fertil Steril 2019 04;111(4):674

The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.fertnstert.2019.02.026DOI Listing
April 2019

Expanded genetic carrier screening in clinical practice: a current survey of patient impressions and attitudes.

J Assist Reprod Genet 2019 Apr 13;36(4):709-716. Epub 2019 Feb 13.

Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, 128 Apple Street, Suite 3800 Weber CHE, Dayton, OH, 45409, USA.

Purpose: Expanded genetic carrier screening (ECS) is an important part of gynecological practice and preconception planning. We evaluated the awareness and attitudes among women regarding ECS and factors that may influence decision-making in a family planning context.

Methods: A 32-question survey in an academic university practice was given to 521 women who were either currently pregnant (n = 108), undergoing gynecologic care who were considering future fertility (n = 308), and considering or receiving fertility treatment (n = 105). Data are reported descriptively.

Results: Forty-seven percent (n = 246) of patients were aware of ECS. Though most reported feeling positive or neutral towards ECS, 51% (n = 263) reported no desire for testing. Fifty-eight percent (n = 303) felt it beneficial to know their carrier status, and 55% (n = 257) said it was their responsibility to undergo testing. Those considering future fertility were found to have a more positive attitude towards ECS (51.4%) than those considering or receiving fertility treatment (34%). For positive carriers of a genetic disorder, 228 (49%) of patients would proceed with having their partner screened, 58 (13%) would undergo prenatal screening only and 12 (2.6%) would continue with vitro fertilization (IVF). Related to cost for ECS, 53.5% (n = 191) would be willing to pay at least $50-100 for testing, while 29% (n = 146) would not pay anything out of pocket.

Conclusions: Despite patients' beliefs that it would be beneficial and their responsibility to undergo carrier status testing, the majority reported no desire for ECS and many were unwilling to pay out of pocket. Further education is necessary to reconcile the gap between technology and patient decision-making.
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http://dx.doi.org/10.1007/s10815-019-01414-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6505014PMC
April 2019

Fertility preservation with random-start controlled ovarian stimulation and embryo cryopreservation for early pregnancy-associated breast cancer.

Gynecol Endocrinol 2019 Mar 7;35(3):214-216. Epub 2018 Nov 7.

a The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine , Weill Cornell Medicine , New York , NY , USA.

We report a case of fertility preservation using random-start controlled ovarian stimulation (COS), intracytoplasmic sperm injection (ICSI) and embryo cryopreservation in a patient with early pregnancy-associated breast cancer. A 34-year-old nulliparous woman at 5 weeks of gestation was diagnosed with estrogen receptor (ER) positive, progesterone receptor (PR) positive and human epidermal growth factor receptor-2 (HER-2) negative infiltrating intraductal carcinoma. Urgent neoadjuvant chemotherapy was deemed necessary and the patient decided to terminate the pregnancy. Random-start COS was initiated 5 days after pregnancy termination using a letrozole-based protocol. The beta human chorionic gonadotropin level on the day of COS start was 119.8 mIU/mL. Twenty-nine oocytes were retrieved after 11 days of COS. Seventeen oocytes underwent successful fertilization and 10 blastocysts were cryopreserved. The patient subsequently initiated neoadjuvant chemotherapy with her oncologist. The current case highlights the feasibility of random-start COS and embryo cryopreservation for fertility preservation immediately after the termination of an early pregnancy in a patient with pregnancy-associated breast cancer.
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http://dx.doi.org/10.1080/09513590.2018.1522298DOI Listing
March 2019

Risk factors and human chorionic gonadotropin trends in patients with ruptured tubal ectopic pregnancies despite methotrexate treatment.

Gynecol Endocrinol 2019 Jan 15;35(1):49-52. Epub 2018 Oct 15.

b The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine , New York , NY , USA.

This retrospective cohort study investigates the risk factors and beta-human chorionic gonadotropin (β-hCG) trends in patients with ruptured tubal ectopic pregnancies (EPs) despite methotrexate (MTX) treatment. All patients receiving MTX for sonographically confirmed tubal EPs at our fertility center between 2004 and 2014 were included. Baseline demographics and β-hCG trends of patients with EP rupture after MTX were compared to patients with resolved EPs after MTX. One-hundred-thirty-seven patients with EPs were treated with MTX during the study duration; 27 experienced EP rupture and 110 EP resolution. There was no difference in the baseline demographics or β-hCG levels on the day of MTX between the groups. Patients with ruptured EPs after MTX had higher β-hCG levels on day-4 (1223.9 ± 243.5 vs. 1111.2 ± 179.7 mIU/mL; p < .001) and day-7 (1156.9 ± 206.2 vs. 872.4 ± 690.2 mIU/mL; p < .001). The odds of EP rupture compared to EP resolution was 6.2 (95% CI 2.1-19.1), 13.7 (95% CI 4.8-38.9), and 3.0 (95% CI 1.2-7.2) times higher when the change in β-hCG levels was <5% between day-7 vs. day of MTX, day-7 vs. day-4, and day-4 vs. day of MTX, respectively. Our results demonstrate that ruptured tubal EPs despite MTX have <5% change in β-hCG levels between the day of MTX and day-4 or day-7 after MTX.
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http://dx.doi.org/10.1080/09513590.2018.1490406DOI Listing
January 2019

Revisiting the relationship between vitamin D and ovarian reserve.

Authors:
Nigel Pereira

Fertil Steril 2018 09;110(4):643

The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.fertnstert.2018.07.001DOI Listing
September 2018

Expanded carrier screening: a current survey of physician utilization and attitudes.

J Assist Reprod Genet 2018 Sep 1;35(9):1631-1640. Epub 2018 Aug 1.

Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, 128 Apple Street, Suite 3800 Weber CHE, Dayton, OH, 45409, USA.

Purpose: Expanded carrier screening (ECS) is an available component of preconception and prenatal care. There is complexity around offering, administering, and following-up test results. The goal of this study is to evaluate current physicians' utilization and attitudes towards ECS in current practice.

Methods: This was a prospective qualitative survey study. A 32-question electronic survey was distributed during a 1-year period to obstetricians-gynecologists who were identified using a Qualtrics listserv database.

Results: While more than 90% of physicians offered ethnic-based carrier screening (CS), ECS was offered significantly less (2010, 20.6%, and 2016, 27.1%). Physicians who were not fellowship-trained in reproductive endocrinology and infertility (REI) preferred ethnic-based carrier screening (95.9 vs 16.8%; P < 0.001). REI subspecialists were more likely to offer ECS (80%) compared to 70% of maternal fetal medicine physicians (MFM). Physicians were comfortable discussing negative results (53.6%) compared to positive results (48.4%). Most physicians (56%) believed that ECS should not be offered until the significance of each disease is understood; 52% believed that testing should be restricted to those conditions important to couples; while 26% felt that testing should be done regardless of the clinical significance.

Conclusions: Discussion and application of ECS has increased in clinical practice. However, lack of comfort with counseling and varying beliefs surrounding ECS continue to hinder its utilization. Further education and training programs, and subsequent evaluation are warranted.
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http://dx.doi.org/10.1007/s10815-018-1272-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6133809PMC
September 2018

Reproductive medicine: Walk, don't run: a case study of frozen embryo transfers.

Nat Rev Urol 2018 May 13;15(5):266-268. Epub 2018 Mar 13.

The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA.

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http://dx.doi.org/10.1038/nrurol.2018.31DOI Listing
May 2018

Exogenous progesterone hypersensitivity associated with recurrent pregnancy loss.

J Allergy Clin Immunol Pract 2018 Jul - Aug;6(4):1412-1413. Epub 2018 Jan 12.

Cornell Center for Reproductive Medicine, New York, NY.

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http://dx.doi.org/10.1016/j.jaip.2017.11.041DOI Listing
November 2019

CGG repeat length and AGG interruptions as indicators of fragile X-associated diminished ovarian reserve.

Genet Med 2018 09 21;20(9):957-964. Epub 2017 Dec 21.

The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York, USA.

Purpose: Fragile X premutation (PM) carriers may experience difficulties conceiving a child probably due to fragile X-associated diminished ovarian reserve (FXDOR). We investigated which subgroups of carriers with a PM are at higher risk of FXDOR, and whether the number of AGG interruptions within the repeat sequence further ameliorates the risk.

Methods: We compared markers of ovarian reserve, including anti-Müllerian hormone, antral follicle count, and number of oocytes retrieved between different subgroups of patients with a PM.

Results: We found that carriers with midrange repeats size (70-90 CGG) demonstrate significantly lower ovarian reserve. Additionally, the number of AGG interruptions directly correlated with parameters of ovarian reserve. Patients with longer uninterrupted CGG repeats post-AGG interruptions had the lowest ovarian reserve.

Conclusion: This study connects AGG interruptions and certain CGG repeat length to reduced ovarian reserve in carriers with a PM. A possible explanation for our findings is the proposed gonadotoxicity of the FMR1 transcripts. Reduction of AGG interruptions could increase the likelihood that secondary RNA structures in the FMR1 messenger RNA are formed, which could cause cell dysfunction within the ovaries. These findings may provide women with guidance regarding their fertility potential and accordingly assist with their family planning.
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http://dx.doi.org/10.1038/gim.2017.220DOI Listing
September 2018

Definitive Management of Persistent Vaginal Discharge Caused by Leiomyoma-endometrial Fistulas after Uterine Artery Embolization.

J Minim Invasive Gynecol 2018 Sep - Oct;25(6):944-945. Epub 2017 Dec 6.

Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jmig.2017.12.001DOI Listing
December 2017

Transarterial Embolization of a Bartholin Cyst before Resection.

J Minim Invasive Gynecol 2018 Sep - Oct;25(6):938-940. Epub 2017 Nov 28.

Department of Radiology, Division of Interventional Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.

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http://dx.doi.org/10.1016/j.jmig.2017.11.016DOI Listing
November 2017

Arabian Peninsula ethnicity is associated with lower ovarian reserve and ovarian response in women undergoing fresh ICSI cycles.

J Assist Reprod Genet 2018 Feb 23;35(2):331-337. Epub 2017 Oct 23.

The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Ave., New York, NY, 10021, USA.

Purpose: Recent studies have demonstrated that ethnicity can be an independent determinant of assisted reproductive technology (ART) outcomes. In this context, we investigate whether ART outcomes differ between Arabian Peninsula and Caucasian women.

Methods: This is a retrospective cohort study of women undergoing fresh intracytoplasmic sperm injection (ICSI)-embryo transfer (ET) cycles for male factor infertility. The study cohort was divided into 2 groups based on ethnicity-Arabian Peninsula or Caucasian. Ovarian reserve, ovarian response, and pregnancy outcomes were compared between the groups. A sub-analysis was performed between individual Arabian Peninsula nationalities for the same outcomes. A multiple linear regression model was used to assess the independent effect of ethnicity on ovarian response.

Results: Seven hundred sixty-three patients were included-217 (28.4%) Arabian Peninsula and 546 (71.6%) Caucasian. There was no difference in the mean age of the two groups; however, the former had a higher body mass index (28.5 ± 7.5 vs. 23.3 ± 5.7; P < 0.001). Although follicle stimulating hormone (FSH) levels and antral follicle counts (AFC) were within the normal range in both groups, Arabian Peninsula women had higher FSH levels (5.7 ± 2.5 vs. 4.9 ± 2.8; P = 0.001) and lower AFC (13.9 ± 4.7 vs. 16.5 ± 4.3; P < 0.001) when compared to Caucasian women. Women from the Arabian Peninsula also had a statistically lower number of mature oocytes retrieved (15.6 ± 6.8 vs. 14.1 ± 8.4; P = 0.01), despite requiring higher gonadotropin doses. Multiple linear regression reveled that Arabian Peninsula women had 2.5 (95% CI 2.1-3.9) less mature oocytes, even after controlling for confounders. A sub-analysis within the Arab cohort demonstrated that Qatari women had a higher yield of mature oocytes when compared to Emirati, Kuwaiti, and Saudi women. There was no difference in the rates of implantation, clinical pregnancy, or live birth when comparing individual Arabian Peninsula nationalities with each other or to Caucasians.

Conclusions: Arabian Peninsula ethnicity is associated with lower ovarian reserve and ovarian response parameters in women undergoing their first ICSI-ET cycle.
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http://dx.doi.org/10.1007/s10815-017-1071-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5845040PMC
February 2018

The pioneering of intracytoplasmic sperm injection: historical perspectives.

Reproduction 2017 Dec 18;154(6):F71-F77. Epub 2017 Oct 18.

Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medical College, New York, New York, USA.

Intracytoplasmic sperm injection (ICSI) has often been heralded as a ground-breaking technique that has transformed the treatment of couples with infertility. By injecting a single spermatozoon into the cytoplasm of the oocyte, ICSI bypasses the zona pellucida and increases the chances of fertilization and subsequent embryo development, independent of semen parameters. Ever since the first live births using ICSI were reported in 1992, ICSI has become the mainstay of treating male factor infertility as well as overcoming fertilization failure associated with conventional insemination. Today, ICSI is utilized in nearly 66% of all assisted reproductive treatments worldwide and has resulted in the birth of millions of babies. The primary goal of this review is to provide historical perspectives about the pioneering of ICSI. We begin by highlighting the scientific work of early investigators who elucidated the mechanisms central to mammalian fertilization. Furthermore, we briefly discuss how these findings contributed to the development of IVF for the treatment of infertility. We then emphasize the shortcomings of IVF in treating severe forms of male factor infertility and enumerate the micromanipulation techniques that were developed to circumvent these shortcomings. Finally, we indicate how the inadequacies of these micromanipulation techniques lead to the inception, application and popularity of ICSI.
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http://dx.doi.org/10.1530/REP-17-0308DOI Listing
December 2017

Association between ABO blood type and live-birth outcomes in single-embryo transfer cycles.

Fertil Steril 2017 11 15;108(5):791-797. Epub 2017 Sep 15.

The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York.

Objective: To investigate the association between ABO blood type and live-birth outcomes in patients undergoing IVF with day 5 single-embryo transfer (SET).

Design: Retrospective cohort study.

Setting: University-affiliated center.

Patient(s): Normal responders, <40 years old, undergoing their first IVF cycle with fresh SET.

Intervention(s): None.

Main Outcome Measure(s): Live-birth rate was the primary outcome. Secondary outcomes were birth weight and gestational age at delivery. Univariate and multivariable logistic regression was used to examine the association between blood type and live birth, while controlling for confounders. Odds ratios (OR) with 95% confidence intervals (CI) for live birth were estimated.

Result(s): A total of 2,329 patients were included. The mean age of the study cohort was 34.6 ± 4.78 years. The distribution of blood types was as follows: A = 897 (38.5%); B = 397 (17.0%); AB = 120 (5.2%); and, O = 1,915 (39.3%) patients. There was no difference in the baseline demographics, ovarian stimulation, or embryo quality parameters between the blood types. The unadjusted ORs for live birth when comparing blood type A (referent) with blood types B, AB, and O were 0.96 (95% CI, 0.6-1.7), 0.72 (95% CI, 0.4-1.2), and 0.96 (95% CI. 0.6-1.7), respectively. The adjusted ORs for live birth remained not significant when comparing blood type A to blood types B, AB, and O individually. No difference in birth weight or gestational age at delivery was noted among the four blood types.

Conclusion(s): Our findings suggest that ABO blood type is not associated with live-birth rate, birth weight, or gestational age at delivery in patients undergoing IVF with day 5 SET.
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http://dx.doi.org/10.1016/j.fertnstert.2017.08.019DOI Listing
November 2017

Gonadotropin-releasing hormone agonist trigger increases the number of oocytes and embryos available for cryopreservation in cancer patients undergoing ovarian stimulation for fertility preservation.

Fertil Steril 2017 09;108(3):532-538

The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York.

Objective: To compare the oocyte and embryo yield associated with GnRH-agonist triggers vs. hCG triggers in cancer patients undergoing controlled ovarian stimulation (COS) for fertilization preservation.

Design: Retrospective cohort study.

Setting: Academic center.

Patient(s): Cancer patients undergoing COS with letrozole and gonadotropins or gonadotropin-only protocols for oocyte or embryo cryopreservation.

Intervention(s): Gonadotropin-releasing hormone agonist or hCG trigger.

Main Outcome Measure(s): Number of metaphase II (MII) oocytes or two-pronuclei (2PN) embryos available for cryopreservation were primary outcomes. Separate multivariate linear regression models were used to assess the effect of trigger type on the primary outcomes, after controlling for confounders of interest.

Result(s): A total of 341 patients were included, 99 (29.0%) in the GnRH-agonist group and 242 (71%) in the hCG group. There was no difference in the baseline demographics of patients receiving GnRH-agonist or hCG triggers. Within the letrozole and gonadotropins group (n = 269), the number (mean ± SD, 11.8 ± 5.8 vs. 9.9 ± 6.0) and percentage of MII oocytes (89.6% vs. 73.0%) available for cryopreservation was higher with GnRH-agonist triggers compared with hCG triggers. Similar results were noted with GnRH-agonist triggers in the gonadotropin-only group (n = 72) (i.e., a higher number [13.3 ± 7.9 vs. 9.3 ± 6.0] and percentage of MII oocytes [85.7% vs. 72.8%] available for cryopreservation). Multivariate linear regression demonstrated approximately three more MII oocytes and 2PN embryos available for cryopreservation in the GnRH-agonist trigger group, irrespective of cancer and COS protocol type.

Conclusion(s): Utilization of a GnRH-agonist trigger increases the number of MII oocytes and 2PN embryos available for cryopreservation in cancer patients undergoing COS for fertility preservation.
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http://dx.doi.org/10.1016/j.fertnstert.2017.06.027DOI Listing
September 2017

Author's Reply.

Authors:
Nigel Pereira

J Minim Invasive Gynecol 2018 01 24;25(1):189. Epub 2017 Aug 24.

The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jmig.2017.08.652DOI Listing
January 2018