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Single Euploid Embryo Transfer Outcomes after Uterine Septum Resection

Study Objective: To study pregnancy outcomes after single euploid embryo transfer (SEET) in patients who underwent prior uterine septum resection to those with uteri of normal contour, without M€ullerian anomalies or uterine abnormalities including polyps or fibroids, and without a history of prior uterine surgeries.

Design: Retrospective cohort study.

Setting: Single academic affiliated center.

Patients: 60 cycles of patients with prior hysteroscopic uterine septum resection who underwent an autologous SEET
between 2012 and 2020 were used as the investigational cohort. A 3:1 ratio propensity score matched control cohort of 180 single euploid embryo transfer cycles from patients without a history of uterine septa were used as the control group.

Interventions: No interventions administered.

Measurements and Main Results: Pregnancy, clinical pregnancy loss, ongoing clinical pregnancy, and live birth rates in patients with a history of uterine septum resection compared with matched patients without M€ullerian anomalies or uterine surgeries.
Patients with a prior uterine septum had significantly lower rates of chemical pregnancy (58.33% vs 77.2%, p = .004), implantation (41.67% vs 65.6%, p = .001), and live birth (33.33% vs 57.8%, p = .001) per transfer. No statistical difference in clinical pregnancy loss rates was found when comparing septum patients with controls (8.33% vs 7.8%, p = .89).

Conclusion: Patients with a history of hysteroscopic resection who undergo in vitro fertilization are more susceptible to suboptimal clinical outcomes compared with patients with normal uteri. Early pregnancy loss rates in patients with a uterine septum are higher than in those without; however, after resection, the rates are comparable. Patients born with septate uteri require assessment of surgical intervention prior to SEET, and to optimize their reproductive outcomes. Journal of Minimally Invasive Gynecology (2024) 00, 1−6. © 2024 AAGL. All rights reserved.

Correlation of self‑reported racial background to euploidy status and live birth rates in assisted reproductive technology cycles

Purpose To determine whether the embryonic euploidy rate and live birth outcomes following single, euploid embryo
transfer (SEET) difer among women of self-reported racial and ethnic backgrounds.

Methods This retrospective cohort study included all infertile patients of diferent self-reported racial backgrounds who underwent In vitro fertilization (IVF) with preimplantation genetic testing for aneuploidy (PGT-A) and an autologous single euploid embryo transfer (SEET) from December 2015 to December 2019 at a single private and academic assisted reproduction technology center. Primary outcome measures included ploidy rates among diferent racial groups. Secondary outcomes included clinical pregnancy, clinical pregnancy loss, and live birth rates.

Results Five thousand fve hundred sixty-two patients who underwent an IVF cycle with ICSI-PGT-A were included. A
total of 24,491 blastocysts were analyzed. White participants had on average more euploid embryos and higher euploidy
rates when compared to their counterparts (p≤0.0001). However, after controlling for confounding factors, there was no
association between race and the odds of having a higher euploidy rate (aOR 1.31; 95% CI 0.63–2.17, p=0.42). A total of
4949 patients underwent SEET. Pregnancy outcomes did not difer among patients of varying self-reported races.

Conclusions Euploidy rates and pregnancy outcomes were comparable among patients of diferent racial backgrounds who underwent a SEET.

Walking the tightrope: Fertility preservation among hereditary breast and ovarian Cancer syndrome Previvors

Introduction: Fertility-related concerns cause significant anxiety among patients with Hereditary Breast and Ovarian Cancer Syndrome (HBOC). The Society of Gynecologic Oncology and the American Society for Reproductive Medicine recommend patients diagnosed with HBOC receive early referral to a reproductive endocrinologist. However, evidence about fertility trends in this patient population are limited and guidelines are scarce. The aim of this study is to compare fertility preservation among patients with HBOC to control patients undergoing fertility treatment without a diagnosis of infertility.

Methods: This retrospective study included patients who presented to a single academic institution for fertility preservation in the setting of diagnosis of HBOC. In this study, HBOC patients are referred to as those who had tested positive for pathogenic mutations in BRCA1, BRCA2 or were at high-risk for HBOC based on a strong family history (defined as >3 family members diagnosed with HBOC) without a genetic mutation. HBOC patients were matched in a 1:1 fashion to a control group undergoing fertility preservation without a diagnosis of infertility or HBOC. All analysis was done using SPSS version 9.4 (SAS Institute, Cary, NC).

Results: Between August 1st, 2016 and August 1st, 2022, 81 patients presented to the study center for consultation in the setting of HBOC. Of those who presented, 48 (59.2%) ultimately underwent oocyte cryopreservation and 33 (40.7%) underwent embryo cryopreservation. Patients who underwent oocyte cryopreservation due to BRCA1 status were more likely to present for fertility consultation at a younger age compared to control patients (32.6 vs. 34.7 years, p = 0.03) and were more likely to undergo oocyte cryopreservation at a younger age (32.1 vs. 34.6 years, p = 0.007). There was no difference in age at initial consultation or age at procedure for patients with BRCA2 or patients with a strong family history compared to control patients (p > 0.05). There was no difference in the mean age of patients with HBOC at presentation for consultation for embryo cryopreservation or the mean age the patient with HBOC underwent embryo cryopreservation compared to control patients (p > 0.05). Patients with BRCA1 or BRCA2 did not have expedited time from consultation to first cycle start (p > 0.05). After adjusting for factors including anti-Müllerian hormone (AMH) level and age, patients considered in the HBOC group due to family history had less time between consultation and oocyte cryopreservation cycle compared to control patients. (179 vs. 317 days, p = 0.045). There was no difference in time from consultation to starting cycle for embryo cryopreservation for patients with HBOC compared to controls (p > 0.05).

Conclusion: Patients with HBOC did not undergo expedited fertility treatment compared to control patients undergoing oocyte and embryo cryopreservation for non-infertility reasons. Patients diagnosed with BRCA1 had more oocytes retrieved compared to the control population which is possibly due to earlier age of presentation in the setting of recommended age of risk reducing surgery being age 35–40. When age matched, cycle outcomes did not differ between HBOC and control patients. Given the known cancer prevention benefit and recommendations for risk-reducing surgery, future studies should focus on guidelines for fertility preservation for patients with HBOC.

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