June 2016

All the papers from the June 2016 issue of Fertility and Sterility.

Clinical hormonal ovarian and genetic aspects of 46 XX patients with congenital adrenal hyperplasia due to CYP17A1 defects

P450c17 deficiency due to inactivating CYP17A1 mutation in 46,XX patients is associated with primary or secondary amenorrhea, absent/sparse pubic hair, hypertension, and high prevalence of ovarian macrocysts with a risk of torsion. In patients with hypergonadotropic hypogonadism, high basal progesterone level is a hallmark for this diagnosis.

A new more detailed stratification of low responders to ovarian stimulation: from a poor ovarian response to a low prognosis concept

The management of patients with impaired or poor ovarian response (POR) remains a controversial and complex clinical issue. A systematic review of 47 randomized controlled trials revealed 41 different definitions of POR (1). Notably, the number of oocytes retrieved was adopted as a criterion of POR in 40% of the trials, although the threshold number differed considerably among studies (1). To standardize the definition of POR, Ferraretti et al. (2) proposed new criteria, known as the “Bologna criteria,” based on three conditions: 1) advanced maternal age (≥40 years) or any other POR risk factor; 2) a previous incident of POR; and 3) a low ovarian reserve test in terms of antimüllerian hormone (AMH) and antral follicle count (AFC).

Social and ethical implications of fertility preservation

We now have the ability to store sperm, oocytes, embryos, and testicular and ovarian tissue in the frozen state for future use with varying degrees of success. Although sperm cryopreservation has been available for well over 60 years, other technologies have only recently been developed and are still being refined. These technological advances have raised multiple questions and issues as to when and how such technologies should be used. The initial intent was to utilize these tissues for individuals who had somehow lost their ability to reproduce.

Proposal for a national registry to monitor women with Turner syndrome seeking assisted reproductive technology

Many women with Turner syndrome (TS) are eager to become pregnant. A small number (5%–10%) will have a spontaneous pregnancy, an outcome thought to be more likely in women with mosaicism (1). The increased availability of oocyte donation (OD) through assisted reproductive technology (ART) has enabled an unknown number of women with TS to achieve a pregnancy. A gathering body of evidence, however, suggests that pregnancy is high risk, secondary to potential aortic dissection and rupture and a significant risk of developing hypertensive disorders of pregnancy.

Surrogacy: Yes or no?

Why is surrogacy so highly debated as a pertinent solution for women with infertility caused by uterine factors? Surrogacy implies that a woman becomes pregnant and gives birth to a child with the intention of giving away this child to another person or couple who intends to raise the child.

Every last baby out of every last egg: the appropriate goal for fertility treatment in women older than 40 years

Another patient in her 40s came to see me for a second opinion last week. Her story is quite typical, and it is easy to summarize in general terms. The patient is aged 42 years and has undergone three IVF cycles without success. More accurately, she has undergone three IVF retrievals but did not have an ET. This is because she was told that all of her embryos were found to be chromosomally abnormal. She was further advised that she seems to only be producing abnormal embryos and that she should now pursue oocyte donation.

Imaging in reproduction

Advanced imaging technologies have an indispensable role in our ability to noninvasively evaluate and treat couples with reproductive difficulties. Understanding the range of possibilities enables an individually tailored approach.