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Biomedical subjects

James P Toner

Publications and source records attributed to James P Toner.

5 recordsLinked to original sources
PubMed2004

Modest follicle-stimulating hormone elevations in younger women: warn but don't disqualify.

Markers of quantitative defects in egg production (low ovarian reserve) have often been used to exclude patients from treatment, even when egg quality is apt to be satisfactory. Women younger than 38 years of age with modest FSH elevations (10-15 or even 20 IU/L) have acceptable pregnancy rates despite their limited production of eggs ("quality matters more than quantity") and so should be given the opportunity to try IVF.

Adult↗
PubMed2004

Follicle-stimulating hormone and estradiol levels independently predict the success of assisted reproductive technology treatment.

OBJECTIVE: To evaluate the relationship between early follicular phase levels of FSH and E(2) and outcomes of therapy with assisted reproductive technologies (ART). DESIGN: Retrospective cohort study. SETTING: ART centers in the United States. PATIENT(S): Women receiving 19,682 ART procedures performed in 135 clinics. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Rates of clinical pregnancy, live birth delivery, and high ovarian response (>/=10 oocytes retrieved after stimulation). RESULT(S): The ratio of each FSH or E(2) value to the respective upper limit of normal value for the clinic was computed. Within each age group, rates of pregnancy, live birth, and high ovarian response decreased linearly as FSH levels increased. For example, among women 35 years of age and younger, pregnancy rates (PR) ranged from 41.1% (FSH ratio 0-0.5) to 18.5% (FSH ratio >2.0). The three outcomes exhibited a similar downward trend as E(2) ratios increased. When both hormone ratios were elevated, outcomes were least favorable. These relationships remained statistically significant after we adjusted for diagnosis, number of embryos transferred, previous births, previous ART therapy, and use of GIFT, zygote intrafallopian transfer (ZIFT), intracytoplasmic sperm injection (ICSI), or assisted hatching. CONCLUSION(S): The FSH and E(2) ratios predict ART success independent of age and other clinical prognostic factors.

Adult↗
PubMed2002

Clinical outcomes among recipients of donated eggs: an analysis of the U.S. national experience, 1996-1998.

OBJECTIVE: To evaluate the role of recipient age on the outcome of donor egg cycles. DESIGN: Retrospective cohort study of aggregated national cycles of donor egg therapy that are collected by Society for Assisted Reproductive Technology and the Centers for Disease Control and Prevention. SETTING: Assisted reproductive technology centers in the United States that report their results to the Centers for Disease Control and Prevention by way of the Society for Assisted Reproductive Technology. PATIENT(S): Recipients of embryos (17,339 cycles) derived from donated eggs between 1996 and 1998. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Rates of implantation, clinical intrauterine pregnancy, pregnancy loss, and delivery based on the age of the recipient. RESULT(S): Success of donor egg therapy was remarkably constant among recipients aged 25 years through those in their late forties. At higher ages, declining rates of implantation, clinical pregnancy, and delivery were seen, along with small increases of pregnancy loss. During the course of the 3 years studied, fewer embryos were transferred and higher rates of implantation were observed. CONCLUSION(S): The success of donor egg therapy is unaffected by recipient age up to the later 40s, after which they begin to decline. Although recipient age per se is likely to be the major cause of this effect, other factors may contribute to this observation.

Abortion, Spontaneous↗
PubMed2002

Progress we can be proud of: U.S. trends in assisted reproduction over the first 20 years.

OBJECTIVE: Documentation of the significant progress of assisted reproductive technology (ART) therapy in the United States. DESIGN: Tabulation of data from the annual published reports of ART activity in the United States for the years 1985 through 1999. SETTING: ART centers in the United States that report their results to the Centers for Disease Control and Prevention (CDC) via the Society for Assisted Reproductive Technology (SART). PATIENT(S): The annual reports included 647,208 cycles of treatment. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The number of clinics and cycles, and the rates of pregnancy, delivery, miscarriage, and multiple pregnancy were examined. Practice trends were also examined. RESULT(S): The number of clinics and cycles has grown steadily. The 155,661 clinical pregnancies led to 128,608 births and 177,745 babies born. The advent of intracytoplasmic sperm injection (ICSI) and the fall of GIFT and zygote intrafallopian transfer (ZIFT) are noted. Pregnancy rates have risen steadily in all therapies, and the number of deliveries of triplets or more has declined dramatically in the most recent reporting years. CONCLUSION(S): Over the years, ART therapies have steadily become more effective, with notable reductions in multiple pregnancies, the ability to avoid laparoscopy (for egg retrieval and in some cases tubal transfers), and effective therapy for serious sperm, egg, and uterine problems, none of which was true in the early years. This has occurred owing to the dedication and ingenuity of practitioners, and, notably, without federal regulation of clinical practice.

Female↗