Nov 7, 2008
Leading fertility experts at NewYork-Presbyterian Hospital/Columbia University Medical Center are presenting new research findings at the 64th annual American Society of Reproductive Medicine (ASRM) meeting in San Francisco, Nov. 8–12. Highlights include the following:
- Dr. Mark V. Sauer is chairing the invited symposia, "Management of the HIV-Discordant Couple Seeking Fertility Care." He will speak on "Clinical Paradigms Gained From 10 Years of Experience.
- Dr. Rogerio A. Lobo is chairing a plenary session on infertility in polycystic ovary syndrome (PCOS). He will speak on "Management of Infertility in PCOS."
- Successful Fertility Treatment for HIV Women. "A Systematic, Multidisciplinary Approach to Address the Reproductive Needs of HIV-Seropositive Women" by Drs. Nataki C. Douglas, Bo Yu, Jeffrey Wang, Sreedhar Gaddipati, Michael Guarnaccia and Mark V. Sauer.
Nearly 130,000 American women are HIV-positive. Most are of reproductive age and many desire children. The researchers sought to establish a comprehensive program to address their fertility needs in order to minimize infectious, medical and reproductive risks to prospective patients. They found that by using a multidisciplinary approach to care, HIV-seropositive women may be successfully managed in a program of assisted reproduction. Of 17 HIV-positive women undergoing IVF, there were seven pregnancies, and five singletons and two sets of twins were delivered by Caesarean section. Throughout the pregnancies, maternal HIV-1 RNA levels remained undetectable and CD4 counts were stable. All infants, tested at birth and at 3 and 6 months of age, remained HIV-negative.
- SC Ovidrel® Can Be Reliably Used for Egg-Cell Donation. "Lower Serum hCG Levels After Ovidrel® Administration Do Not Reflect Compromised Oocyte Maturation in Donor Oocyte IVF Cycles," by Drs. Nataki C. Douglas, Bo Yu, Jeffrey Wang, Gary Nakhuda, Mark V. Sauer and Melvin Thornton II.
Human chorionic gonadotropin (hCG) is used to promote final oocyte (egg cell) maturation for IVF. For ease of administration and improved patient tolerance, use of subcutaneous (SC) Ovidrel instead of intramuscular (IM) u-hCG has been used in women undergoing egg retrieval for oocyte donation. However, a decrease in serum hCG levels, a measure of patient compliance with the drug therapy, was noted after Ovidrel self-administration. The researchers conducted a retrospective cohort study to determine if the lower hCG levels associated with Ovidrel were associated with any measurable detrimental effects on the oocytes or resulting embryos. They found that Ovidrel injection resulted in significantly lower serum hCG levels compared to u-hCG and these levels did not correlate with BMI. And, despite lower serum hCG levels, all clinical outcome parameters were statistically identical. Thus, SC Ovidrel can be reliably used for oocyte donation.
- Good News for Female Cancer Patients Seeking to Save Their Eggs. "Favorable Clinical Outcomes Attained in Young Cancer Patients Undergoing Oncofertility Treatments" by Drs. Bo Yu, Nataki C. Douglas, Janet Choi and Mark V. Sauer.
Cancer is commonly diagnosed in women of reproductive age who may desire to freeze (cryopreserve) their eggs or embryos prior to undergoing chemotherapy, radiation or extirpative surgery. The researchers compared the clinical outcomes of cancer patients undergoing egg retrieval with age-matched controls, in order to ascertain if their underlying illness affected their reproductive performance. They found that cancer patients experienced a reasonable response to ovulation induction and as a result, had similar mature oocytes harvested as age-matched controls. The fertilization rate was comparable to controls and all patients successfully achieved embryos or oocytes for cryopreservation despite their illness and the requisite expedited approach to care. Therefore, female patients with cancer should be encouraged to have MIS (Müllerian Inhibiting Substance) assessment, and when their reproductive profile is favorable, be considered for embryo or oocyte cryopreservation in order to maximize opportunity for future fertility before undergoing gonadotoxic treatments.
- Pregnancy Possible in Breast Cancer Patients After Chemotherapy. "Dissociation of Müllerian Inhibiting Substance (MIS) and Estradiol (E2) Levels After Chemotherapy in Young Women With Breast Cancer" by Drs. Bo Yu, Dawn L. Hershman, Michel J. Ferin, Nataki Douglas, Gary S. Nakhuda and Rogerio A. Lobo.
The goal of the study was to evaluate the effect of chemotherapy on ovarian function in young women with breast cancer, assessing a marker of ovarian reserve, MIS, as well as E2, Follicle Stimulating Hormone (FSH) and menstrual status. Chemotherapy decreases ovarian reserve rapidly and dramatically as reflected by levels of MIS. After chemotherapy, although E2 levels recover quickly, with 58 percent of women regaining menstrual function by 52 weeks, all MIS levels remain below the normal range of age-matched fertile women. In spite of the concern of reduced fertility six months after chemotherapy, reflected by very low MIS levels, researchers have documented that pregnancy can occur.
NewYork-Presbyterian Hospital — based in New York City — is the nation's largest not-for-profit, non-sectarian hospital, with 2,242 beds. It provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine at five major centers: NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian Hospital/Columbia University Medical Center, Morgan Stanley Children's Hospital of NewYork-Presbyterian, NewYork-Presbyterian Hospital/Allen Pavilion and NewYork-Presbyterian Hospital/Westchester Division. One of the largest and most comprehensive health care institutions in the world, the Hospital is committed to excellence in patient care, research, education and community service. It ranks sixth in U.S.News & World Report's guide to "America's Best Hospitals," ranks first on New York magazine's "Best Hospitals" survey, has the greatest number of physicians listed in New York magazine's "Best Doctors" issue, and is included among Solucient's top 15 major teaching hospitals. The Hospital is ranked with among the lowest mortality rates for heart attack and heart failure in the country, according to a 2007 U.S. Department of Health and Human Services (HHS) report card. The Hospital has academic affiliations with two of the nation's leading medical colleges: Weill Cornell Medical College and Columbia University College of Physicians and Surgeons.
Columbia University Medical Center
Columbia University Medical Center provides international leadership in basic, pre-clinical and clinical research, in medical and health sciences education, and in patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians & Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Established in 1767, Columbia's College of Physicians & Surgeons was the first institution in the country to grant the M.D. degree and is among the most selective medical schools in the country. Columbia University Medical Center is home to the largest medical research enterprise in New York City and state and one of the largest in the United States. For more information, please visit www.cumc.columbia.edu.