Written by Dr. Stacey Ellender.

Bad news is any news that drastically and negatively alters the patient’s view of her or his future. For many years there was debate as to whether or not a physician should feel obligated to disclose information when the patient’s prognosis was particularly poor and no effective treatment was available. Continue Reading

Written by Dr. Peter Hollands.

When Louise Brown was born over 30 years ago, she resulted from one beautiful 8 cell embryo. In the subsequent years, the number of embryos transferred has varied with the general underlying thought that more embryos transferred lead to better overall results. Most of the early workers transferred 3 embryos, which then went up to 4 or even 5, as this seemed to give the greatest chance of pregnancy, especially in women over 40. As time went by, it became clear that multiple pregnancies were becoming routine in assisted conception and the complications, risks, and social and financial implications of these multiple pregnancies became matters of hot debate. As a result, the current trend, in patients under 35 with good prognosis, is to recommend elective single embryo transfer in fresh assisted conception cycles and much greater emphasis on embryo freezing followed by single
frozen embryo transfer. Continue Reading

In a retrospective study that reviewed 10 years of fertility care experience in HIV-seropositive men, researchers from Columbia University have added further credence to the safety and efficacy of ICSI in achieving pregnancy with minimal risk of viral transmission. The findings of the recent study have been published in the journal, Fertility and Sterility. Continue Reading

The practice of luteal phase support (LPS) following embryo transfer (ET) is widely accepted since it is known to substantially improve the embryo implantation, clinical pregnancy, and live birth rates. Although there is general consensus on the need for progesterone administration for LPS, only few studies have evaluated the optimal duration for progesterone support, with the evidence supporting periods ranging from ET until pregnancy confirmation and ET until 8-12 weeks of pregnancy. Now, a recent prospective randomized study reports that administering intramuscular progesterone (progesterione-in-oil) for up to 11 days after ET has comparable pregnancy and live birth rates to the traditional 6 weeks regimen. Continue Reading

Blastocyst transfer (BT), compared to the conventional cleavage-stage embryo transfer (ET), has been shown to improve uterine and embryonic synchronicity, thereby increasing the implantation rates. Now, a systematic review, published in the recent issue of Fertility and Sterility, reports an increase in the incidence of monozygotic twinning (MZT) and male:female ratio with blastocyst stage transfer compared to the cleavage-stage ET in fresh IVF cycles. Continue Reading

The correlation of antral follicle count (AFC), one of the sonographic parameters considered in ovarian reserve tests (ORTs), with the ovarian response to stimulation is quite well established. However, there is lack of consensus on the size as well as the minimum number of antral follicles required to reflect the optimal ovarian response with regard to successful ART outcome. But in a new, prospective study published online in Human Reproduction, it has been reported that assessing antral follicles using the sono-automatic volume calculation (SonoAVC™) algorithm may offer substantial independent predictive value for pregnancy after IVF. Continue Reading

Three-dimensional power Doppler ultrasound (3D PD-US) aids in more objective and reliable evaluation of the endometrial and subendometrial blood flow compared to the conventional Doppler study. However, there are contradictory findings regarding the role of this non-invasive technique as a predictor of ART outcome. In a recent prospective study published in Fertility and Sterility, researchers have provided new evidence supporting the prognostic value of endometrial blood flow parameters, determined using 3D PD-US, in predicting success after Intra Uterine Insemination (IUI). Continue Reading

Scientific studies have reported contradictory findings on the effect of stress on both, fertility and IVF outcomes. Since most of the earlier research focused on ART-related stress, the impact of naturally occurring, non-fertility-related stressors on the probability of achieving IVF pregnancy was unclear. Now, a prospective study published in the online edition of Human Reproduction reports that negative and stressful events up to 12 months before an IVF procedure can increase the chances of poor treatment outcomes. Continue Reading

The prediction of ovarian responsiveness holds considerable benefits in individualizing the stimulation protocol as well as in patient counseling. Several former studies have explored the prognostic value of diverse clinical, genetic and endocrine factors, including the levels of basal follicle-stimulating hormone (FSH), in predicting the ovarian stimulation outcome. In a recent, retrospective cohort study published in Reproductive BioMedicine Online, researchers have concluded that age-specific FSH level within the normal basal concentrations (bFSH of ≤9.5 IU/L), could be an effective predictor of ovarian response in women undergoing IVF. Continue Reading

Elevated levels of homocysteine (Hcy) in the ovarian follicular fluid has been implicated to adversely affect follicular development, oocyte maturity, and pregnancy outcomes. Now, a new study published in Human Reproduction has established a correlation between high follicular fluid Hcy concentrations and poor oocyte and embryo quality in polycystic ovary syndrome (PCOS) patients undergoing assisted reproductive techniques. With this association, the study suggests that the follicular fluid Hcy levels measured on the day of oocyte pick up (dOPU) can be used as a marker for assessing oocyte and embryo quality, and fertilization rates in PCOS patients. Continue Reading