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Biomedical subjects

Mark D Hornstein

Publications and source records attributed to Mark D Hornstein.

At least 19 recordsLinked to original sources
PubMed2006

Assessment of United States fertility clinic websites according to the American Society for Reproductive Medicine (ASRM)/Society for Assisted Reproductive Technology (SART) guidelines.

OBJECTIVE: To evaluate SART-member fertility clinic websites for their compliance with the 2004 ASRM/SART guidelines for advertising (which is deemed mandatory for clinic membership), to survey the general characteristics of the websites, and to assess differences between academic and private clinic websites. DESIGN: Cross-sectional evaluation. SETTING: The Internet. PATIENTS: None. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Eleven objective criteria based on 2004 ASRM/SART guidelines for advertising and eight objective criteria for general characteristics of fertility clinic websites. RESULTS: All 384 SART-registered clinics were evaluated; 289 (75.3%) had functional websites (211 private, 78 academic). Success rates were published on 51% of websites (117 private, 31 academic), the majority of which were private clinics (p=.025). The percentage of fertility clinic websites adhering to ASRM/SART guidelines was low in all categories (ranging from 2.8%-54.5% in private centers and 1.3%-37.2% in academic centers). No statistically significant difference was found in the services offered at private versus academic clinics. CONCLUSION: A significant proportion of SART-member fertility clinics, both private and academic, that have websites are not following the ASRM/SART guidelines for advertising. Increased dissemination and awareness of the guidelines is warranted.

Academic Medical Centers↗
PubMed2006

Effects of culture medium on HCG concentrations and their value in predicting successful IVF outcome.

The hypothesis was tested that the medium used to culture embryos affects the concentration of human chorionic gonadotrophin (HCG) early in pregnancy. The value of these concentrations in predicting successful outcome was also assessed for each medium studied. Patients undergoing IVF between January 1998 and December 2004 and having a day 3 embryo transfer were stratified into one of four groups according to the medium in which their embryos were cultured (P1, IVF500, G1.2, and G1.3). Using receiver operating characteristic (ROC) curve analysis, cut-off values for serum HCG concentrations on day 15 after embryo transfer were calculated for optimal discrimination between cycles resulting in implantation failure and success for each medium. Cut-off points were chosen to maximize sensitivity and specificity. For viable singleton pregnancies, mean HCG concentrations were greater for G1.3 and lower for IVF500 compared with the other media. Discriminatory HCG cut-off concentrations for predicting implantation success were lowest for IVF500, intermediate for P1 and G1.2 and highest for G1.3. The data support the hypothesis that the medium used to culture embryos significantly affects the concentrations of HCG early in pregnancy. Furthermore, when using HCG cut-off concentrations to assess pregnancy outcome, medium type should be taken into consideration.

Adult↗
PubMed2006

Effects of lifetime exercise on the outcome of in vitro fertilization.

OBJECTIVE: To estimate whether exercise before the first cycle of in vitro fertilization (IVF) affects cycle outcomes. METHODS: A total of 2,232 patients were prospectively enrolled before undergoing their first cycle of IVF for the treatment of infertility from 1994-2003 at three IVF clinics in the greater Boston area. The primary IVF outcomes of interest included successful live birth and four points of cycle failure: cycle cancellation, failed fertilization, implantation failure, and pregnancy loss. Unconditional logistic regression adjusting for observed confounders was used to quantify the relation between self-reported exercise and cycle outcome. RESULTS: In general, women who reported regular exercise were no more likely to have a live birth compared with those women who did not report exercise (odds ratio [OR] 0.8, 95% confidence interval [CI] 0.7-1.0; P = .07). Women who reported exercising 4 hours or more per week for 1-9 years were 40% less likely to have a live birth (OR 0.6, CI 0.4-0.8) and were almost three times more likely to experience cycle cancellation (OR 2.8, CI 1.5-5.3) and twice as likely to have an implantation failure (OR 2.0, CI 1.4-3.1) or pregnancy loss (OR 2.0, CI 1.2-3.4) than women who did not report exercise. In general, women who participated in cardiovascular exercise had a 30% lower chance of successful live birth (OR 0.7, CI 0.6-0.9) than women who reported no exercise. CONCLUSION: Regular exercise before in vitro fertilization may negatively affect outcomes, especially in women who exercised 4 or more hours per week for 1-9 years and those who participated in cardiovascular exercise. LEVEL OF EVIDENCE: II-2.

Body Mass Index↗
PubMed2006

Is there a role for preparatory cycle in ovum donation recipients?

PURPOSE OF REVIEW: In ovum donation cycles, the role of preparatory cycles to ensure proper endometrial development in the recipient remains controversial. As evidenced in the literature, endometrial receptivity is critical in conception. Therefore, endometrial preparation with exogenous hormones in addition to synchronization of the recipient and donor are essential in achieving a successful outcome. RECENT FINDINGS: There are very limited data specifically examining the benefit of recipients undergoing preparatory cycles prior to their actual egg donation cycle. One study concluded that trial hormone replacement treatment cycles with endometrial biopsies may be useful in older reproductive-age women but not in younger women. Another study showed no difference in pregnancy rates between those who did and did not undergo preparatory cycles. SUMMARY: Since one of the integral elements of preparatory cycles is determining endometrial dating, with relatively conflicting data, these mock cycles may not be as beneficial as expected. Therefore, for those who routinely use preparatory cycles, the potential risks, benefits, and costs of these cycles, increased hormonal exposure, the relatively invasive nature of the procedure, and time prior to performing them must be considered.

Endometrium↗
PubMed2005

Preimplantation sex selection demand and preferences in an infertility population.

OBJECTIVE: To determine the demand and preferences of infertility patients for sex selection and the method and sex they would choose, and to investigate the relationship between these choices and their demographic and socioeconomic characteristics. DESIGN: Cross-sectional survey. SETTING: University hospital-based fertility center. PATIENT(S): One thousand five hundred consecutive women who presented for infertility care. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Self-report questionnaire assessing the demand and preferences for sex selection. RESULT(S): Of respondents, 40.8% wanted to select the sex of their next child for no added cost. Of these patients, 45.9% had no living children and 48.4% had children all of one sex. After adjustment for observed predictors of gender preference, we found a significant preference for a female child among women who were older, not religious, willing to pay for sex selection, had more living children, had only sons, or had a diagnosis of male infertility. Nulliparous women did not significantly prefer one sex over the other. Among parous women, those with only daughters significantly desired to select a male child, whereas those with sons significantly desired to select a female child. In terms of the method of sex selection, 55.0%, 41.0%, and 4.0% of the patients would use sperm separation, preimplantation genetic diagnosis, or neither method, respectively. CONCLUSION(S): There is significant demand among infertility patients for preimplantation sex selection, with a significant portion of this demand coming from patients who do not have any children or have children all of one sex.

Adult↗
PubMed2005

Disparities in access to infertility services in a state with mandated insurance coverage.

The objective of our study was to examine the demographic and socioeconomic characteristics of patients accessing infertility services in a state (Massachusetts) with mandated and comprehensive insurance coverage for such services. Even in a state with such insurance coverage, disparities in access to infertility services exist, with the majority of individuals accessing those services being Caucasian, highly educated, and wealthy.

Chi-Square Distribution↗
PubMed2004

Trends in embryo-transfer practice and in outcomes of the use of assisted reproductive technology in the United States.

BACKGROUND: During the past decade in the United States, increasing attention has been paid to lowering the incidence of multiple gestations resulting from the use of assisted reproductive technology. To determine whether such efforts have been successful, we assessed national trends in embryo-transfer practice patterns and in outcomes after the use of assisted reproductive technology. METHODS: We analyzed data on outcomes of assisted reproductive technology procedures as reported to the Centers for Disease Control and Prevention from 1995 to 2001 by fertility clinics in the United States. We also analyzed data from the National Center for Health Statistics on the rates of twin births and triplet or higher-order multiple births. RESULTS: From 1995 to 2001 in the United States, the number of infertility clinics, the number of fresh-embryo cycles initiated, and the number of fresh-embryo transfers increased steadily. The average number of embryos transferred per cycle began decreasing in 1997, with the steepest decline (an 11.1 percent decrease) between 1998 and 1999. In contrast, the number of pregnancies and live births per cycle during the period from 1995 to 2001 steadily increased. Even though the percentage of pregnancies with twins did not change significantly between 1997 and 2001, the percentage of pregnancies with three or more fetuses significantly decreased every year, with the steepest decline (a 20.8 percent decrease) between 1998 and 1999, after the publication in 1998 of the American Society for Reproductive Medicine guidelines for embryo transfer. CONCLUSIONS: Since 1997 in the United States, there have been consistent decreases in both the number of embryos transferred per cycle and the percentage of pregnancies with three or more fetuses, as well as a consistent increase in the percentage of live births per cycle.

Adult↗
PubMed2004

The role of preparatory cycles in ovum donation recipients: a retrospective study.

PURPOSE: To determine whether preparatory cycles affect in vitro fertilization (IVF) outcome in ovum donation. METHODS: Medical records of 98 ovum donation recipients undergoing their first egg donation cycle were analyzed retrospectively. Preparatory cycles were performed in 50 patients with leuprolide acetate, estrogen, and progesterone. An endometrial biopsy was performed on day 10-12 of progesterone supplementation, to determine adequacy of the preparatory cycle. RESULTS: Pregnancy rates in women with and without preparatory cycles were 42.0% and 43.8%, respectively. Among ovum donation recipients who underwent preparatory cycles, the percentages of adequate endometrial biopsies in pregnant versus nonpregnant groups were 76.2% and 84.3%, respectively. No results showed statistical significance. CONCLUSIONS: Preparatory cycles do not increase pregnancy rates in ovum donation recipients. In addition, no correlation was noted between adequate endometrial biopsies and higher pregnancy rates.

Adult↗
PubMed2003

Factors associated with disposition of cryopreserved reproductive tissue.

OBJECTIVE: To study patient characteristics associated with the preferences for the disposition of cryopreserved semen and embryos in the event of death or divorce. DESIGN: Retrospective exploratory study. SETTING: Tertiary care academic medical center. PATIENT(S): One hundred twelve men banking sperm, 54 female patients (partners of men banking sperm) undergoing in vitro fertilization (IVF), and 112 women undergoing IVF who were not partners of men banking sperm. INTERVENTION(S): Male patients banking sperm and couples undergoing IVF completed a standard consent form detailing their desired dispositions (disposal or release to a surviving party) of cryopreserved sperm and embryos in the event of death or divorce. MAIN OUTCOME MEASURE(S): Effect of marital status, age, reason for sperm banking, infertility diagnosis, partner status (single or significant-other partner) on sperm, and embryo disposition choice. RESULT(S): In the event of death, married men were 5.5 times more likely to release banked sperm to a surviving party than were single men. The estimated odds of giving sperm to a survivor were 1.07 times greater with every 1-year increase in age. The choice of sperm disposal was significantly related to the banking reason for the case of banking prior to chemotherapy and/or radiation for malignancy. In the case of male death, the decisions of couples undergoing IVF for embryo disposition agreed with choices of male patients for sperm disposition approximately 33% of the time more often than by chance alone. CONCLUSION(S): Decisions surrounding disposition of cryopreserved sperm are significantly associated with marital status, age, and reason for banking sperm. Respective choices of sperm and embryo disposition in couples undergoing IVF were similar in the situation of male death.

Adolescent↗
PubMed2003

Is intracytoplasmic sperm injection safe?

OBJECTIVE: To review the pregnancy and birth outcomes of patients undergoing intracytoplasmic sperm injection (ICSI). DESIGN: Selective review of the literature. SETTING: Couples undergoing either conventional IVF or ICSI and their resulting offspring. PATIENT(S): None. MAIN OUTCOME MEASURE(S): None. INTERVENTION(S): None. RESULTS: These observational studies are unfortunately inherently biased. Regardless, the information and experiences from these large centers cannot be ignored. These experiences reveal that birth weight may be decreased by an amount that is generally not clinically relevant. Chromosomal and genetic abnormalities are increased probably only as a direct corollary to the underlying parental risk. Congenital malformations reveal no clustering of any single specific abnormality. Developmental assessment is available for up to 2 years, and no major delays have been identified in either motor or mental function. CONCLUSION(S): Intracytoplasmic sperm injection appears to be a safe alternative for couples who otherwise would be unable to achieve pregnancy. The inherent risks associated with these genetically "at risk" couples mandate thorough evaluation and counseling before undertaking ICSI.

Child, Preschool↗
PubMed2003

Human progesterone receptor polymorphisms and implantation failure during in vitro fertilization.

OBJECTIVE: Polymorphic variants of the human progesterone receptor gene have been described, but their potential influence on in vitro fertilization outcome have not been studied. STUDY DESIGN: DNA was available from 317 women (cases) who had >or=2 embryo transfers without a clinical pregnancy and from 288 women (control subjects) who became pregnant after 1 in vitro fertilization attempt. With protocols that were specific for H770H (C/T genotype) and +331G/A polymorphism, amplification of polymorphism fragments, digestion with restriction enzymes, and gel visualization were performed. RESULTS: Allele frequencies for the 2 variants were 15.5% for H770H T and 4.1% for +331A in cases and 17.9% and 3.6% in control subjects, respectively. Both polymorphisms were rare among non-white subjects. Possession of a H770H T allele was associated with a decreased risk for implantation failure, which was nonsignificant overall but significant in women aged <35 years (adjusted relative risk, 0.52 [95% CI, 0.28, 0.97]). Possession of a +331A allele was associated with an increased risk of implantation failure, which was nonsignificant overall but significant in women who weighed <135 pounds (adjusted relative risk, 3.85 [95% CI, 1.20, 12.30]). The +331G/A polymorphism tended to increase the risk for implantation failure in women with an H770H C/C genotype, but not in women with a C/T or TT genotype (P=.09). Among white women who were H770H C/C, there was a significant trend (P=.03) in the proportion of +331G/A carriers as the number of implantation failures increased, from 8.6% of women with 0 failed attempts to 40% among women with >or=5 failed attempts. CONCLUSION: Although human progesterone receptor polymorphisms do not clearly affect the risk for implantation failure in most women who undergo in vitro fertilization, the likelihood that a woman carries the +331G/A human progesterone receptor polymorphism increases with the number of failed attempts at implantation.

Adult↗
PubMed2003

Hertig and beyond: a systematic and practical approach to the endometrial biopsy.

Evaluation of the endometrial biopsy is a challenge to practicing pathologists, largely due to the wide range of morphologic patterns resulting from both normal and abnormal cyclic changes, exogenous hormones, infections, and intrauterine tumors. Successfully addressing these challenges requires that the practitioner (i) understand the clinical questions being asked, (ii) have a realistic expectation for answering these questions, and (iii) have a systematic approach to resolving these questions in the context of these expectations. The approach outlined begins with the subdividing of women with endometrial alterations into three general categories: (i) women in their fourth decade undergoing evaluation for infertility, (ii) women in their fifth decade who experience abnormal uterine bleeding, and (iii) women in their sixth decade and beyond who experience postmenopausal bleeding. The clinical expectations for each group are unique, as are the morphologic patterns most commonly encountered. Algorithms for the laboratory management of cyclic changes, dysfunctional bleeding, and mixed-pattern endometria are provided, as are pitfalls in interpretation and exclusion of neoplasia.

Adult↗
PubMed2002

Insurance coverage and outcomes of in vitro fertilization.

BACKGROUND: Although most insurance companies in the United States do not cover in vitro fertilization, a few states mandate such coverage. METHODS: We used 1998 data reported to the Centers for Disease Control and Prevention by 360 fertility clinics in the United States and 2000 U.S. Census data to determine utilization and outcomes of in vitro fertilization services according to the status of insurance coverage. RESULTS: Of the states in which in vitro fertilization services were available, 3 states (31 clinics) required complete insurance coverage, 5 states (27 clinics) required partial coverage, and 37 states plus Puerto Rico and the District of Columbia (302 clinics) required no coverage. Clinics in states that required complete coverage performed more in vitro fertilization cycles than clinics in states that required partial or no coverage (3.35 vs. 1.46 and 1.21 transfers per 1000 women of reproductive age, respectively; P<0.001) and more transfers of frozen embryos (0.43 vs. 0.30 and 0.20 per 1000 women of reproductive age, respectively; P<0.001). The percentage of cycles that resulted in live births was higher in states that did not require any coverage than in states that required partial or complete coverage (25.7 percent vs. 22.2 percent and 22.7 percent, respectively; P<0.001), but the percentage of pregnancies with three or more fetuses was also higher (11.2 percent vs. 8.9 percent and 9.7 percent, respectively; P=0.007). The number of fresh embryos transferred per cycle was lower in states that required complete coverage than in states that required partial or no coverage (P=0.001 and P<0.001, respectively). CONCLUSIONS: State-mandated insurance coverage for in vitro fertilization services is associated with increased utilization of these services but with decreases in the number of embryos transferred per cycle, the percentage of cycles resulting in pregnancy, and the percentage of pregnancies with three or more fetuses.

Ambulatory Care Facilities↗
PubMed2002

Characteristics of patients with endometriosis in the United States and the United Kingdom.

OBJECTIVE: To investigate differences in characteristics of patients with endometriosis in the United States and the United Kingdom. DESIGN: Patient questionnaire. SETTING: Two university-based endometriosis referral centers. PATIENT(S): Women with surgically diagnosed endometriosis. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Patient demographics, menstrual and obstetric history, contraceptive use, medical history, risk factors, family history, endometriosis diagnosis, and current pain status and treatment. RESULT(S): Most demographic characteristics were similar between groups. However, patients in the United States were diagnosed at a younger age than were patients in the United Kingdom (25.6 +/- 6.7 years vs. 28.0 +/- 7.1 years) and more commonly presented with an ovarian mass. More U.K. women used oral contraceptives before diagnosis and were younger at first use. U.K. patients underwent fewer additional surgeries than U.S. patients but reported that surgery alone provided the best relief of symptoms, whereas most U.S. patients reported that surgical and medical therapy together provided the best relief of symptoms. CONCLUSION(S): The many similarities in demographics and symptoms among women with endometriosis in the U.S. and the U.K. support the universality of the disease process. Despite a variety of treatments, most patients from both groups still experienced pain from their endometriosis at the time of the survey.

Adult↗
PubMed2002

Prolonged GnRH agonist and add-back therapy for symptomatic endometriosis: long-term follow-up.

OBJECTIVE: To assess post-treatment effects in endometriosis patients of a 12-month course of GnRH agonist alone or with one of three "add-back" regimens. METHODS: This is a post-treatment follow-up analysis of a randomized, double-masked, placebo-controlled 52-week trial. All patients had received monthly leuprolide acetate and were randomized to one of four groups: A-daily placebo; B-daily norethindrone acetate 5 mg; C-daily norethindrone acetate 5 mg and conjugated equine estrogens 0.625 mg; and D-daily norethindrone acetate 5 mg and conjugated equine estrogens 1.25 mg. Of 201 patients enrolled in the initial trial, 123 completed at least 280 days of therapy and entered the follow-up period. Physical findings and symptoms were quantified, and lumbar spine bone mineral density was determined at intervals for up to 12 and 24 months post-therapy. RESULTS: Symptom and pelvic examination scores remained significantly below baseline for at least 8 months after completion of therapy for all four groups (P <.05). Findings were not affected by endometriosis scores noted on screening laparoscopy. Mean bone mineral density values remained at or above baseline in all add-back groups. The significant mean loss in bone density in group A during therapy reversed slowly and had not returned to baseline at the final follow-up visit (P <.001). CONCLUSION: GnRH agonist and norethindrone acetate alone or combined with low-dose conjugated equine estrogens administered to symptomatic endometriosis patients for 12 months provides extended pain relief and bone mineral density preservation after completion of therapy.

Adult↗
PubMed2002

Fertility options for HIV patients.

PURPOSE OF REVIEW: This paper reviews the latest reproductive options for HIV infected couples. In light of the new treatment options and improved prognosis for HIV patients, policymakers have issued recent statements to guide physicians in the care of HIV patients desiring fertility. We will review the advances in reproductive technologies and ethical considerations that have led to these most recent statements. RECENT FINDINGS: Millions of young adults of reproductive age are afflicted with the HIV virus. With the improvement in treatment options for HIV patients and the increase in their life expectancy it is not surprising that many HIV patients desire children. Assisted reproductive technologies can assist serodiscordant couples in achieving pregnancy while at the same time minimizing risk of HIV transmission to the uninfected partner. Several European fertility clinics have a great deal of experience in providing both intrauterine inseminations and in-vitro fertilization to serodiscordant couples without seroconversion of the uninfected female partners. This is both a medical and an ethical issue. Guidelines from policymakers regarding this issue have changed over the years as a result of both changes in disease prognosis and the reproductive technologies. SUMMARY: Reproductive technologies provide a logical way to minimize HIV transmission for HIV couples desiring pregnancy. Although the most recent research is compelling, much more needs to be performed in order to establish the safety of these techniques. Protocols need to be put in place in order to assist physicians in better serving these patients. In addition, many ethical and legal issues need to be addressed before these treatments can become standard of care in the United States.

Ethics, Medical↗