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Objective To evaluate the economical benefit of preimplantation genetic testing of aneuploidies (PGT-A) when applied in an extended culture and stringent elective single ET framework. Design Theoretical cost-effectiveness study. Setting Not applicable. Patients/Animal(s) None. Intervention(s) Comparison of the cost-effectiveness between two IVF treatment strategies: serial transfer of all available blastocysts without genetic testing (first fresh transfer and subsequent frozen-thawed transfer); and systematic use of genetic testing (trophectoderm biopsy, freeze-all, and frozen-thawed transfers of euploid blastocysts). The costs considered for this analysis are based on regional public health system provider. Main Outcome Measure(s) Costs per live birth. Result(s) Cost-effectiveness profile of PGT-A improves with female age and number of available blastocysts. Sensitivity analyses varying the costs of ET, the costs of genetic analyses, the magnitude of the detrimental impact of PGT-A on live birth rate, and the crude live birth rates change to some extent the thresholds for effectiveness but generally confirm the notion that PGT-A can be economically advantageous in some specific subgroups. Conclusion(s) PGT-A can be cost-effective in specific clinical settings and population groups. Economic considerations deserve attention in the debate regarding the clinical utility of PGT-A.

Objective To study the relative role of female age and ovarian reserve, measured through serum antimullerian hormone (AMH) in determining the rate and number of euploid blastocysts in in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles. Design Retrospective analysis of cycles performed in 2014–2015. Setting Tertiary referral IVF center. Patient(s) A total of 578 infertile couples undergoing IVF/ICSI and preimplantation genetic screening (PGS) analysis. Interventions(s) All embryos were cultured and biopsied at the blastocyst stage. The method involved whole-genome amplification followed by array comparative genome hybridization. Serum AMH was measured by means of the modified Beckman Coulter AMH Gen II assay. Main Outcome Measures The rate and number of euploid blastocysts and their correlation with ovarian reserve and response to stimulation. Result(s) The mean (±SD) age of patients was 37.6 ± 4.1 years, and the mean number of blastocysts per patient was 3.1 ± 2. The total number of blastocysts available to the analysis was 1,814, and 36% of them were euploid after PGS. Age and serum AMH were significantly and independently related to the rate of euploid blastocysts available for patients. As an effect of the cohort size, the number of mature oocytes positively affected the total number of euploid blastocysts per patient. Conclusion(s) A strong positive age-independent relationship between AMH level and the rate of euploid blastocysts was found. This confirms that the measurement of ovarian reserve by means of AMH has high relevance when counseling infertile patients.

The objectives of this study were to identify whether there is a decline in Müllerian inhibiting substance (MIS) in the female rat during chronological aging, and to define the physiological basis of aging-related changes in MIS. The results demonstrate that there is an exponential decline in both serum and ovarian levels of MIS with increasing female age, and that the histologic origin for the reduction in serum levels of MIS is a decline in the number of small ovarian follicles expressing MIS.

Objectives To examine seminal parameters predictive for success in a cycle of GIFT and to construct an algorithm using pertinent seminal data as well as easily obtained historical data to predict pregnancy and viable pregnancy rates. Design A retrospective study of 544cycles in 376 couples. Setting A private IVF-ET and GIFT center. Patients Couples in a GIFT program with a mean of 53.6months of infertility who had failed to conceive with other therapies. Interventions Gamete intrafallopian transfer. Main Outcome Measures Pregnancy as a function of laboratory historical data with emphasis on seminal parameters. Results Motility was the only seminal parameter that was predictive. Success was correlated with the number of oocytes returned and inversely related to female age. An algorithm to predict pregnancy in a GIFT cycle as well as viable pregnancy was constructed. Conclusions Motility is the only seminal parameter predictive for success in a GIFT cycle. An easily programmable algorithm can be constructed to help patient and physician decide on the appropriateness of GIFT for each couple.

Objective To assess the results obtained in our clinic with intracytoplasmic sperm injection (ICSI) in severe male factor infertility and failed fertilization and to determine if the age of the female has any impact on those results. Design Retrospective study. Setting Private high-complexity Human Reproduction Center. Patients One hundred five couples with a total of 114 procedures. Eighty-six were classified as severe male factor and 19 were classified as previous failed fertilization. Interventions Treatment was performed by ICSI. Main Outcome Measure Normal fertilization, cleavage, and implantation, total, term, and ongoing pregnancy rates in the total population and in different age brackets. Results Excellent fertilization, cleavage, and implantation rates were obtained with this procedure (78%, 85%, and 13.5%, respectively). The total pregnancy rates were 43% and 46% per cycle and per transfer and 31.5% and 33.6% in terms of term and ongoing pregnancy rates. A significant reduction in implantation and total, and term and ongoing pregnancy rates was seen after the age of 35 years. Conclusions The results obtained with ICSI are quite satisfactory with proper equipment and careful training. The age of the female is an important parameter in determining prognosis and treatment outcome.

We evaluated the in vitro fertilization (IVF) outcome in 54 cycles using cryopreserved/thawed semen from fertile donors. Controls were other IVF patients matched by time frame, female age, stimulation protocol, number of pre-embryos transferred, and absence of a male factor using freshly ejaculated normal semen samples. In the study group and controls, respectively, post-thaw swim-up motility was 83.1% and 89.5%; fertilization rate of preovulatory oocytes (91.8%, 95.7%) and ongoing pregnancy rate (PR) per transfer (21.1%, 25.0%) were similar. The excellent fertilization rate with frozen/thawed semen was achieved through high-concentration insemination (0.5 x 10(6) motile sperm/mL). With use of frozen/thawed samples from infertile men (normal and subfertile samples), PR was similar but fertilization rate was lower. Cryopreserved semen is a valuable option for infertile couples in IVF therapy.

The purpose of this study was to determine whether routine examination of the male partner is of value in assessing couples complaining of involuntary infertility. The relationship between male age, a previous paternity, male physical characteristics, and fertility outcome was examined. Life table analysis was performed after accounting for known female factors. Five hundred forty-four couples were recruited to the study. All conceptions were independent of treatment to either partner in which the female partner was found to be "normal" on investigation. Although male age and several physical characteristics were related to fertility outcome when all couples were examined, this was, by virtue of these variables, being related to female age and the length of involuntary infertility before investigation. When only those couples were examined in which the female partner was normal on investigation (n = 250), past paternity (x1(2) = 4.21, P = 0.040, RR = 1.81) was the only variable that retained a significant relationship to fertility outcome. It was concluded that routine examination of the male partner is of no prognostic value for couples complaining of involuntary infertility.