Biomedical subjects

J K Choe

Publications and source records attributed to J K Choe.

At least 19 recordsLinked to original sources

PubMed2006

A reassessment of comparative pregnancy and implantation rates following embryo transfer in recipients vs their infertile donors also trying to conceive in the background of performing salpingectomy for hydrosalpinx.

PURPOSE: To compare pregnancy and implantation rates in egg donors trying to conceive vs their recipients in the background of salpingectomy for hydrosalpinx prior to IVF-ET. METHODS: A retrospective six-year review of all donor egg cycles where the eggs are supplied by an infertile donor trying to conceive herself was carried out. Salpingectomy for hydrosalpinx was performed prior to IVF-ET. RESULTS: Clinical and delivered pregnancy rates (PRs) following fresh ET were not significantly different in donors vs recipients (60.0%, 45.8% vs 56.8%, 50.8%). Implantation rates were 27.3% vs 32.6%. The respective implantation rates following frozen ET were 13.8% and 14.4%. CONCLUSIONS: In the background of salpingectomy for hydrosalpinges the much higher PRs in recipients vs donors is no longer seen. The trend for higher implantation rates in recipients (about 20%) following fresh but not frozen transfer could still reflect some adverse effect of the controlled ovarian hyperstimulation regimen in a minority of women.

Adult↗

PubMed2005

Non-homogeneous hyperechogenic echo pattern three days after frozen embryo transfer is associated with lower pregnancy rates.

OBJECTIVE: To evaluate the association of mid-luteal phase echo patterns and pregnancy rates (PRs) following frozen embryo transfer (ET). METHODS: Sonographic evaluation of endometrial echo patterns was performed three days after ET in the first frozen ET cycle of women < 40 years of age who used their own oocytes as well as all donor oocyte recipients. RESULTS: The distribution of echo patterns and clinical PRs were similar in women using their own eggs and women who used donor oocytes; therefore all data was combined. The clinical PR was 49.5% with a hyperechogenic echo pattern vs 38.8% with a non-hyperechogenic pattern, p = .007. CONCLUSION: A larger study of frozen ET and mid-luteal echo pattern now demonstrates conclusions similar to the data from fresh ET in hyperstimulated in vitro fertilization (IVF)-ET cycles in that failure to attain a hyperechogenic echo pattern three days after ET is associated with lower pregnancy rates.

Adult↗

PubMed2005

Frozen embryo transfer outcome according to reason for freezing the embryos.

PURPOSE: To determine if cryopreservation influences pregnancy outcome following transfer. METHODS: Retrospective cohort analyses of frozen embryo transfer (ET) cycles divided into five different categories according to reason for freezing. RESULTS: Frozen embryos remaining as a result of failing to conceive with the previous fresh transfer or those remaining because of cancellation of fresh ET related to inadequate endometrial thickness, result in lower pregnancy rates (PRs). CONCLUSIONS: The fact that embryos never deselected in a group whose fresh ET was canceled because of risk of ovarian hyperstimulation did not have the best results suggests that these oocytes may not be of equal quality to those attained with a more modest response.

Abortion, Spontaneous↗

PubMed2005

Leukocyte immunotherapy improves live delivery rates following embryo transfer in women with at least two previous failures: a retrospective review.

PURPOSE: To determine whether leukocyte immunotherapy (LIT) could improve live delivery rate following embryo transfer (ET) in women who were not successful in prior attempts. METHODS: Paternal leukocytes were intradermally injected in some women who had failed to have a successful pregnancy following at least two prior ETs approximately two weeks prior to fresh or frozen ET and repeated at the time of the 3rd rising serum beta human chorionic gonadotropin level and at eight weeks if a pregnancy occurred. Clinical pregnancy and live pregnancy rates (PRs) were compared to those women having ETs during the same time period not receiving LIT. RESULTS: Thirty-six of 94 (38.3%) patients receiving LIT (group 1) conceived following fresh or frozen ET vs 98 of 341 (28.7%) for women not receiving LIT (group 2) (p = NS). The live delivery rate per ET cycle was 30.8% (39/94) vs 19.7% for group 2 (p = .02). For the subset of women failing despite five previous ETs 17 of 37 (45.9%) group 1 women had a clinical pregnancy vs 18 of 64 (28.1%) group 2 women (p = .07%) and live delivery rates were 35.1% (13/37) vs 15.6% (10/64) (p = .024). CONCLUSIONS: These retrospective data encourage a prospective study of LIT combined with progesterone vs controls receiving progesterone only for recalcitrant patients having ETs.

Adult↗

PubMed2005

A comparison of luteal phase support in graduated estradiol/progesterone replacement cycles using intramuscular progesterone alone versus combination with vaginal suppositories on outcome following frozen embryo transfer.

PURPOSE: To compare pregnancy outcome following frozen embryo transfer according to type of progesterone (P) support given in the luteal phase. METHODS: Retrospective cohort analysis of frozen embryo transfer (ET) cycles in which ovulation was suppressed by graduated estradiol in the follicular phase. Two P regimens in the luteal phase were compared: P vaginal suppositories and intramuscular P vs intramuscular alone. RESULTS: The clinical and viable pregnancy rates were significantly higher for the women receiving only intramuscular P (57.6% and 43.7%) vs those receiving combined therapy (45.9% and 35.6%, respectively). The implantation rates were not significantly different (22.6% vs 19.5%). CONCLUSION: The increased pregnancy rates with intramuscular P may have been related to a higher number of embryos transferred (3.69 vs 3.26). Nevertheless, intramuscular P alone is at least as effective, if not more effective, than combined therapy for frozen embryo transfers.

Adult↗

PubMed2005

Ectopic pregnancy is not more likely following fresh vs frozen embryo transfer.

PURPOSE: To determine if the risk of ectopic pregnancy is greater following frozen vs fresh embryo transfer (ET). METHODS: Retrospective review of pregnancy outcome from January 1, 1997 to November 30, 2003. Cryopreservation was used as a simple freezing method and one-step removal of cryoprotectant. The cycles consisted mostly of graduated estradiol and progesterone supplementation. RESULTS: The ectopic pregnancy rate in 1,445 clinical pregnancies from fresh ET was 2.6% vs 2.0% of 975 clinical pregnancies resulting from frozen ET. CONCLUSION: In contrast to the conclusions of two previous studies, the present study evaluating twice as many clinical pregnancies than the two aforementioned studies combined failed to show any greater risk of ectopic pregnancy when transfers were performed on day 3.

Adult↗

PubMed2005

A novel method to evaluate pregnancy rates following in vitro fertilization to enable a better understanding of the true efficacy of the procedure.

PURPOSE: To propose a new method of evaluating in vitro fertilization (IVF)-embryo transfer (ET) outcome so that statistics are not biased against IVF centers that have strong cryopreservation programs. METHODS: A retrospective review was made of all patients undergoing IVF-ET in a four and a half year time period having at least two embryos transferred. There were no other exclusions. All types of problems and controlled ovarian hyperstimulation protocols were used. Data were analyzed according to four age groups: < or =35, 36-39, 40-42, > or =43. Pregnancy rates were calculated according to a given oocyte harvest where a pregnancy was counted if the woman conceived on the fresh transfer or any succeeding frozen ET from embryos obtained from oocytes retrieved on that harvest. Also pregnancy rates per transfer and retrieval were evaluated. RESULTS: For women < or =35 to age 39 the new category of clinical pregnancy rate per oocyte harvest was significantly higher than the pregnancy rate per transfer. The pregnancy rate per transfer was significantly higher than the pregnancy rate per retrieval in women up to age 42. CONCLUSIONS: We propose that calculating pregnancy rate per harvest is the best method to evaluate the true efficacy of IVF-ET especially from programs with a strong emphasis on cryopreservation.

Adult↗

PubMed2004

Neither sildenafil nor vaginal estradiol improves endometrial thickness in women with thin endometria after taking oral estradiol in graduating dosages.

PURPOSE: To determine if sildenafil improves endometrial thickness better than vaginal estradiol (E2) in women with a history of thin endometria. METHODS: Women failing to attain an 8 mm endometrial thickness on either the oocyte retrieval cycle or their first frozen embryo transfer (ET) despite an oral graduated E2 regimen were treated again with graduated oral E2 and were also randomly assigned to vaginal sildenafil or vaginal E2 therapy. Endometrial thickness was compared between the groups. RESULTS: Neither vaginal E2 nor sildenafil significantly improved endometrial thickness or blood flow in the subsequent frozen ET-cycle. CONCLUSIONS: These data fail to corroborate previous claims that 25 mg sildenafil four times daily intravaginally can improve endometrial thickness.

Administration, Intravaginal↗

PubMed2004

Outcome of in vitro fertilization-embryo transfer according to age in poor responders with elevated baseline serum follicle stimulation hormone using minimal or no gonadotropin stimulation.

PURPOSE: To determine whether decreased ovarian reserve or advancing age are more associated with decreased oocyte quality. METHODS: Women with baseline serum follicle stimulating hormone (FSH) > 12 mIU/ml who demonstrated previous poor response to controlled ovarian hyperstimulation (COH) had oocyte retrieval without gonadotropin stimulation in natural cycles or with minimal stimulation (maximum 75 IU gonadotropins) without agonists or antagonists were evaluated following in vitro fertilization-embryo transfer. RESULTS: The ongoing/delivered pregnancy rates were 27.3%, 30.8%, 21.7%, and 0.0%, respectively, with a mean of 1.06 embryos per transfer. The implantation rates were 33.3%, 28.6%, 14.7%, and 6.0%. Approximately half of the retrievals resulted in failed fertilization. CONCLUSION: Using these minimal or no drug COH regimens in a difficult group of women, age was found to be a more adverse infertility factor than elevated serum FSH.

Adult↗

PubMed2004

Shared donor oocyte system to determine if top embryos can be derived from oocyte factors or more likely from an oocyte/sperm interaction.

PURPOSE: To determine if top embryos require an unusual, and possibly fortuitous, combination of excellent oocyte quality and sperm, or whether some oocyte property alone leads to the formation of superior quality embryos on day 3. METHODS: The embryo quality of donor oocyte recipient cycles was evaluated to find a woman who made 100% top embryos. After finding such an individual, the quality of the recipient's embryos was also evaluated. The shared donor oocyte recipient cycles were also evaluated for pregnancy outcome. RESULTS: All 15 embryos were graded top. The six embryos transferred to the donor and recipient resulted in two sets of triplets. One of the fetuses of the recipient aborted related to trisomy 21. CONCLUSION: The data indicates that the formation of an extremely high percentage (100%) of top embryos can be related to an oocyte factor. It is extremely unlikely to find two male partners who produce sperm with a unique property that makes superior morphologic embryos implant.

Adult↗

PubMed2003

Effect of transferring frozen-thawed embryos resulting from fertilization of immature oocytes matured one day in culture prior to intracytoplasmic sperm injection (ICSI) on implantation rates.

PURPOSE: To evaluate whether it is efficacious to allow immature (metaphase I or germinal vesicle stage) oocytes to incubate one more day and then perform ICSI. METHOD: A retrospective study of frozen embryo transfers (ET) of deselected frozen embryos was performed to see if inclusion of a higher percentage of embryos derived from in vitro maturation of oocytes resulted in lower implantation rates. RESULTS: The implantation rate following transfer of frozen-thawed embryos, where embryos derived from immature oocytes constituted < or = 40% of the embryos (group 1) was similar to group 2 with > 40% (11.3% vs 9.8%). However, group 1 had a 10.2% implantation rate for viable (past first trimester) sacs vs only 4.3% for group 2. CONCLUSIONS: Pregnancies from transfer of frozen-thawed embryos derived from in vitro cultured immature oocytes are as likely to implant as the other deselected frozen-thawed embryos.

Cryopreservation↗

PubMed2002

The effect on IVF outcome of small intramural fibroids not compressing the uterine cavity as determined by a prospective matched control study.

BACKGROUND: Several studies have reported that the presence of intramural fibroids affects conception following IVF. We attempted to corroborate or refute the conclusions relating to IVF and leiomyomas of the aforementioned studies. METHODS: Women with small intramural leiomyomata (< or = 5 cm) discovered on initial pelvic sonographic studies performed in preparation for IVF were prospectively matched by age, with the next patient of the same age undergoing IVF who did not demonstrate fibroids (controls). RESULTS: Though no significant differences were found in outcome when comparing these two groups, there was a distinct trend for lower live delivery rates and higher miscarriage rates. CONCLUSIONS: These data support the conclusions of the only other prospective matched control study evaluating similar factors, i.e. that small intramural fibroids can negatively affect IVF outcome. Nevertheless, we think that a multicentre study should be conducted first before evaluating whether myomectomy improves outcome or not.

Abortion, Spontaneous↗

PubMed2002

Successful pregnancy in a 42-year-old woman with imminent ovarian failure following ovulation induction with ethinyl estradiol without gonadotropins and in vitro fertilization.

PURPOSE: To describe the methodology used to induce ovulation in a 41-year-old woman with imminent ovarian failure and tubal factor so that in vitro fertilization-embryo transfer (IVF-ET) could be performed. METHODS: Ethinyl estradiol was used to suppress elevated serum follicle stimulating hormone (FSH) levels, thus theoretically allowing restoration of down-regulated FSH receptors and response to endogenous gonadotropins. RESULTS: One oocyte was retrieved and fertilized and one embryo was transferred. The patient conceived and is presently in her last trimester. CONCLUSION: Successful pregnancy following IVF-ET is possible in women with imminent ovarian failure - even in women older than age 40.

Adult↗

PubMed2002

Prognosis following in vitro fertilization-embryo transfer (IVF-ET) in patients with elevated day 2 or 3 serum follicle stimulating hormone (FSH) is better in younger vs older patients.

PURPOSE: To determine if younger women with increased day 2 or 3 serum follicle stimulating hormone (FSH) levels have a better prognosis than older women with similar FSH elevations. METHODS: Retrospective comparison of in vitro fertilization (IVF) outcome from cycles from 1/1/97 to 9/30/99 according to serum FSH < or = 12 vs > 12 and age < or = 38 or > 38. Only cycles where follicular phase leuprolide acetate was used were included. RESULTS: Age group < or = 38 - clinical pregnancy rate (PR)/transfer was 32% with lower FSH vs 28.6% with higher FSH. The respective PRs for the older group were 30.3% and 5.5%. CONCLUSIONS: Oocyte quality as evidenced by PRs following IVF-ET seems to be better in younger vs older patients despite increased basal serum FSH levels.

Adult↗

PubMed2002

A study to determine if embryo cryopreservation influences the potential of rapidly growing embryos to successfully implant in uterine environments not influenced by controlled ovarian hyperstimulation.

PURPOSE: To determine if transferring at least one embryo with eight blastomeres at 72 hours improves prognosis of donor oocyte recipients. The study aim was to verify if cryopreservation increases or decreases the advantage of rapidly growing embryos. The study could exclude the influence of controlled ovarian hyperstimulation (COH) on the uterine environment. METHODS: All transfers, fresh or frozen, using exclusively embryos that resulted from fertilization of donor oocytes over a three-year period were evaluated. RESULTS: Significantly higher pregnancy rates (PRs) and delivery rates were found in donor oocyte recipients receiving at least one eight-cell embryo compared to transfers without any eight-cell embryos. These differences were not found when comparing frozen embryo transfers (ETs). The data could not be explained by confounding variables. CONCLUSIONS: The inclusion of at least one 8-cell embryo on day 3 fresh ET resulted in higher PRs even without the influence of COH. However, higher blastomere number did not influence frozen ET outcome.

Blastomeres↗

PubMed2002

Live birth after posthumous testicular sperm aspiration and intracytoplasmic sperm injection with cryopreserved sperm: case report.

PURPOSE: To determine if a viable pregnancy is possible after aspiration of sperm from the testes of a man several hours after his death. METHOD: Following cryopreservation of the aspirated sperm, in vitro fertilization (IVF)-embryo transfer (ET) with intracytoplasmic sperm injection (ICSI) was used. The sperm selected were either those with motility or plumper non-motile sperm. RESULTS: Fertilization of oocytes and ET occurred following all five IVF-ET cycles. A clinical pregnancy was achieved in cycle 1 with non-motile sperm and a viable pregnancy resulted from cycle 5 with ICSI performed with viable sperm. CONCLUSION: Viable pregnancies following IVF-ET and ICSI are possible even when using testicular sperm obtained posthumously.

Adult↗

PubMed2002

Evidence that exclusive use of Follistim may produce better pregnancy results than the use of Gonal-F following in vitro fertilization (IVF) - embryo transfer (ET).

PURPOSE: To evaluate whether the equal mixture of human menopausal gonadotropin (hMG) to recombinant (r) follicle stimulating hormone (FSH) for controlled ovarian hyperstimulation (COH) adversely affects outcome following in vitro fertilization (IVF). Furthermore, to determine if the specific rFSH preparation used has any differing effects on outcome. METHODS: Retrospective study of women using the luteal phase leuprolide acetate-gonadotropin COH regimen. Outcome measures included clinical and viable pregnancy rates (PRs) and implantation rates. RESULTS: The clinical and viable PRs and implantation rates were significantly lower in the group receiving exclusively Gonal-F. Addition of hMG to the treatment protocol not only did not lower the PRs further, but in fact seemed to obviate the adverse effect of Gonal-F. CONCLUSION: Since exclusive use of Gonal-F did not adversely affect fertilization rates or quality of embryos we suspect its exclusive use in some way makes the uterine environment less receptive.

Adult↗

PubMed2001

Fresh embryo transfer is more effective than frozen for donor oocyte recipients but not for donors.

BACKGROUND: Recipients of donor oocytes need to be synchronized to the donor's cycle if fresh embryos are to be transferred on the cycle of oocyte retrieval. It would be much easier to merely retrieve the oocytes from the donor, fertilize the oocytes with the recipient's male partner's spermatozoa, cryopreserve the embryos, then transfer on an oestrogen/progesterone treatment programme. METHODS: The IVF outcomes of all patients enrolled in a shared oocyte programme from January 1997 to June 1999 were reviewed. Pregnancy and implantation rates were computed and statistically analysed. RESULTS: There was a significantly higher clinical pregnancy rate for recipients who had a fresh embryo transfer compared with recipients whose first embryo transfer consisted of frozen/thawed embryos (63.4 versus 43.6%). CONCLUSIONS: Conception is more likely after fresh than frozen embryo transfer with recipients but is similar to donor conception rates. If a uterine defect, per se, even without the use of the controlled ovarian stimulation regimen, could explain the difference between fresh pregnancy and implantation rates in donors versus recipients, then these same differences would have been seen when comparing frozen transfers, but they were, in fact, similar.

Adult↗