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Article ; Online: Ovulation induction with letrozole and dexamethasone in infertile patients with letrozole-resistant polycystic ovary syndrome.

Neblett, Michael F / Baumgarten, Sarah C / Babayev, Samir N / Shenoy, Chandra C

Journal of assisted reproduction and genetics

2023 Volume 40, Issue 6, Page(s) 1461–1466

Abstract: Purpose: To assess efficacy of adjuvant dexamethasone during letrozole cycles for ovulation induction (OI) in women with letrozole-resistant polycystic ovary syndrome (PCOS).: Methods: We retrospectively evaluated 42 cycles of OI from 28 infertile ... ...

Abstract	Purpose: To assess efficacy of adjuvant dexamethasone during letrozole cycles for ovulation induction (OI) in women with letrozole-resistant polycystic ovary syndrome (PCOS). Methods: We retrospectively evaluated 42 cycles of OI from 28 infertile women with letrozole-resistant PCOS between September 2019 and November 2022. Letrozole was initiated on cycle day 3 for 5 days and increased via a stair-step approach to 7.5 mg as indicated. Patients were deemed letrozole-resistant if no dominant follicle was identified on transvaginal ultrasound following this dose. Resistant patients then received 5 additional days of letrozole 7.5 mg with low-dose dexamethasone 0.5 mg for 7 days and had a repeat ultrasound. The primary outcome was ovulation rate determined by the presence of a dominant follicle on ultrasound. Secondary outcomes included endometrial thickness, number of measurable follicles, and pregnancy outcomes among responders. Results: Twenty-two of 28 (79%) letrozole-resistant PCOS patients had evidence of ovulation after the addition of dexamethasone in 35 out of 42 (83%) cycles. Clinical pregnancy occurred in 20% of ovulatory cycles with a cumulative rate of 32%. All clinical pregnancies resulted in a live birth. Patients who responded to adjuvant dexamethasone were more likely to have a shorter duration of infertility; however, there were no differences in other demographics, serum androgens including DHEA-S, or pretreatment glycemic status. Conclusion: Adding dexamethasone to letrozole increased ovulation rates in letrozole-resistant PCOS patients undergoing OI with similar pregnancy outcomes to prior studies. The addition of dexamethasone is an effective, inexpensive, and safe option for PCOS patients otherwise at risk for cycle cancelation.
MeSH term(s)	Pregnancy ; Humans ; Female ; Letrozole/therapeutic use ; Infertility, Female/drug therapy ; Infertility, Female/complications ; Polycystic Ovary Syndrome/complications ; Polycystic Ovary Syndrome/drug therapy ; Clomiphene/therapeutic use ; Retrospective Studies ; Nitriles/therapeutic use ; Triazoles/therapeutic use ; Fertility Agents, Female/therapeutic use ; Ovulation Induction/methods ; Dexamethasone/therapeutic use ; Pregnancy Rate
Chemical Substances	Letrozole (7LKK855W8I) ; Clomiphene (1HRS458QU2) ; Nitriles ; Triazoles ; Fertility Agents, Female ; Dexamethasone (7S5I7G3JQL)
Language	English
Publishing date	2023-05-02
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1112577-9
ISSN	1573-7330 ; 1058-0468
ISSN (online)	1573-7330
ISSN	1058-0468
DOI	10.1007/s10815-023-02817-9
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Zs.A 1985: Show issues

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Article ; Online: Abnormal rate of human chorionic gonadotropin rise: a case series of patients with viable intrauterine pregnancies after embryo transfer.

Rauchfuss, Lauren Kendall / Ainsworth, Alessandra J / Shenoy, Chandra C

F&S reports

2021 Volume 2, Issue 1, Page(s) 129–132

Abstract: Objective: To report three cases of viable intrauterine pregnancies after embryo transfer with lower quantitative human chorionic gonadotropin (hCG) rates of rise than that expected in 99% of normal intrauterine pregnancies, based on current guidelines.! ...

Abstract	Objective: To report three cases of viable intrauterine pregnancies after embryo transfer with lower quantitative human chorionic gonadotropin (hCG) rates of rise than that expected in 99% of normal intrauterine pregnancies, based on current guidelines. Design: Case series. Setting: Tertiary care center. Patients: Three patients underwent in vitro fertilization for ovulatory dysfunction or male factor infertility and had successful live births after an unusually low rate of hCG rise following embryo transfer. Interventions: In vitro fertilization was utilized for all three patients. Main outcome measures: Serial hCG levels. Results: Three cases of abnormally rising hCG levels were described. All cases presented achieved pregnancy through assisted reproductive technologies. The lowest documented rate of rise for each case, over 48 hours, was 22.1%, 23.3%, and 26.9%. All three cases resulted in live births. Literature on this topic was reviewed. Conclusions: Based on the cases presented, we recommend conservative management for patients found to have abnormally low rise hCG levels after embryo transfer; a high clinical suspicion for ectopic pregnancy should be maintained.
Language	English
Publishing date	2021-02-11
Publishing country	United States
Document type	Journal Article
ISSN	2666-3341
ISSN (online)	2666-3341
DOI	10.1016/j.xfre.2020.11.006
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Article ; Online: Three degrees of separation: complete uterine and cervical septa.

Miller, Colleen M / Shenoy, Chandra C / Khan, Zaraq

Fertility and sterility

2021 Volume 116, Issue 3, Page(s) 915–916

Abstract: Objective: To review the diagnosis and management of 3 variations of incomplete müllerian duct fusion and reabsorption.: Design: Narrated video delineating the surgical management of 3 müllerian anomalies; this video was deemed exempt from review by ... ...

Abstract	Objective: To review the diagnosis and management of 3 variations of incomplete müllerian duct fusion and reabsorption. Design: Narrated video delineating the surgical management of 3 müllerian anomalies; this video was deemed exempt from review by the institutional review board of the Mayo Clinic. Setting: Tertiary care academic medical center. Patient(s): This video focuses on 3 müllerian anomalies: complete septate uterus with a single septate cervix (septate uterus unicollis); complete septate uterus with duplicated cervix (septate uterus bicollis); and complete duplication of the uterus and cervix (uterine didelphys). Intervention(s): Magnetic resonance imaging (MRI), cervical septoplasty, operative hysteroscopy, and uterine septoplasty. Main outcome measure(s): Several variations of uterine malformations exist. In our practice, we differentiate complete septate uteri as either unicollis or bicollis via MRI and vaginal examination. The bicollis presentation can be identified on MRI by the "lambda sign," which is seen as the 2 cervices that diverge as they enter the vagina. This is in comparison with the unicollis presentation when the single septate cervix can be traced with parallel lines as it enters the vagina. The circle method is described in this video to help distinguish between a single and duplicated cervix on examination. Result(s): The cervical and uterine septa were resected completely in the patient with a complete septate uterus unicollis. In contrast, the uterine septum was resected completely and the 2 cervical canals were not incised in the case of the complete septate uterus bicollis. Although uterine and cervical septa resection is controversial, our practice is to avoid the incision of the 2 cervical canals in cases that are more clearly consistent with a bicollis classification. Conclusion(s): Müllerian anomalies represent a continuum of disorders caused by different degrees of disruption in embryogenesis. MRI with vaginal gel and vaginal examination are tools to help classify the anomaly and guide surgical management.
MeSH term(s)	Cervix Uteri/abnormalities ; Cervix Uteri/diagnostic imaging ; Cervix Uteri/surgery ; Female ; Humans ; Magnetic Resonance Imaging ; Mullerian Ducts/abnormalities ; Mullerian Ducts/diagnostic imaging ; Mullerian Ducts/surgery ; Urogenital Abnormalities/diagnostic imaging ; Urogenital Abnormalities/surgery ; Uterus/abnormalities ; Uterus/diagnostic imaging ; Uterus/surgery
Language	English
Publishing date	2021-05-18
Publishing country	United States
Document type	Case Reports ; Video-Audio Media
ZDB-ID	80133-1
ISSN	1556-5653 ; 0015-0282
ISSN (online)	1556-5653
ISSN	0015-0282
DOI	10.1016/j.fertnstert.2021.04.027
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Article ; Online: Normal and Abnormal Appearances of the Ovaries during Assisted Reproduction: Multimodality Imaging Review.

Smith, Katherine A / Parvinian, Ahmad / Ainsworth, Alessandra J / Shenoy, Chandra C / Packard, Ann T

Radiographics : a review publication of the Radiological Society of North America, Inc

2023 Volume 43, Issue 11, Page(s) e230089

Abstract: Infertility is a common diagnosis that prompts many couples and individuals to seek assisted reproductive technology (ART) for assistance with conception. These technologies have become increasingly used in the United States in the past several decades, ... ...

Abstract	Infertility is a common diagnosis that prompts many couples and individuals to seek assisted reproductive technology (ART) for assistance with conception. These technologies have become increasingly used in the United States in the past several decades, with 326 468 ART cycles performed in 2020, resulting in 75 023 live births. This ubiquity of ART also increases the likelihood that radiologists will encounter both normal and abnormal imaging findings associated with these treatments. Thus, radiologists of all subspecialties should be familiar with the multimodality appearance of the ovaries and pelvis in patients undergoing ART treatments. Furthermore, it is imperative that radiologists understand the appearance expected during different stages of the ART process. During stimulated ovulatory cycles, it is normal and expected for the ovaries to appear enlarged and to contain numerous cystic follicles, often with a small to moderate volume of pelvic free fluid. After oocyte retrieval, hemorrhagic ovarian follicles and a small to moderate volume of blood products in the cul-de-sac can be expected to be seen. Multiple nonemergency and emergency complications are related to ART, many of which can be seen at imaging. The most encountered emergency complications of ART include ovarian hyperstimulation syndrome, ectopic pregnancy, heterotopic pregnancy, multiple gestations, ovarian torsion, and procedural complications related to oocyte retrieval. These complications have important clinical implications, thus necessitating accurate and timely detection by the radiologist and the clinical team.
MeSH term(s)	Female ; Humans ; Pregnancy ; Multimodal Imaging ; Ovarian Hyperstimulation Syndrome/diagnosis ; Ovarian Hyperstimulation Syndrome/etiology ; Pregnancy, Ectopic ; Pregnancy, Multiple ; Reproductive Techniques, Assisted/adverse effects
Language	English
Publishing date	2023-07-14
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	603172-9
ISSN	1527-1323 ; 0271-5333
ISSN (online)	1527-1323
ISSN	0271-5333
DOI	10.1148/rg.230089
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Zs.A 1751: Show issues

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Article ; Online: Hidden spaces: treatment of an occult uterovaginal septum.

Occhino, John A / Shenoy, Chandra C / Khan, Zaraq

Fertility and sterility

2020 Volume 114, Issue 6, Page(s) 1350–1351

Abstract: Objective: To describe the unique presentation and surgical management of a complete uterovaginal septum.: Design: Video case report.: Setting: Tertiary care academic medical center.: Patient(s): A 25-year-old woman, gravida 2, para 0-0-2-0, ... ...

Abstract	Objective: To describe the unique presentation and surgical management of a complete uterovaginal septum. Design: Video case report. Setting: Tertiary care academic medical center. Patient(s): A 25-year-old woman, gravida 2, para 0-0-2-0, referred for evaluation after imaging and clinical examination revealed conflicting information. She was initially seen by her local provider for menorrhagia. Locally an ultrasound revealed a septate uterus, and examination under anesthesia with hysteroscopy noted a single vagina and cervix with a unicornuate uterus. Due to incongruous findings, she was referred for evaluation. Intervention(s): Magnetic resonance imaging (MRI), examination under anesthesia, vaginal surgery, and operative hysteroscopy. Main outcomes and measure(s): The MRI identified a complete uterovaginal septum with a single septate cervix. Vaginal gel was used to define vaginal anatomy, and the gel was noted to fill the right hemivagina with none noted on the left. Examination under anesthesia revealed an imperforate hymen with a small opening on the left as the cause for confusion in the clinical presentation. A hymenectomy was performed followed by guided surgical management of a complete uterovaginal septum, unicollis. Result(s): The patient was discharged home the same day of surgery. Conclusion(s): Presentation of müllerian anomalies are often complex, and anatomic variations in commonly described anomalies make misdiagnoses common. Advanced imaging with use of MRI with vaginal gel or three-dimensional ultrasonography and detailed examination are often helpful. Differentiating between unicollis and bicollis presentations in complete uterovaginal septum cases is an important distinction during surgical management.
MeSH term(s)	Adult ; Congenital Abnormalities ; Female ; Humans ; Hymen/abnormalities ; Hysteroscopy ; Magnetic Resonance Imaging ; Treatment Outcome ; Ultrasonography ; Uterus/abnormalities ; Uterus/diagnostic imaging ; Uterus/surgery ; Vagina/abnormalities ; Vagina/diagnostic imaging ; Vagina/surgery
Language	English
Publishing date	2020-09-06
Publishing country	United States
Document type	Case Reports ; Video-Audio Media
ZDB-ID	80133-1
ISSN	1556-5653 ; 0015-0282
ISSN (online)	1556-5653
ISSN	0015-0282
DOI	10.1016/j.fertnstert.2020.08.020
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Zs.A 73: Show issues

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Article ; Online: Embryo Blastomere Exclusion Identified in a Time-Lapse Culture System Is Associated with Embryo Ploidy.

Shenoy, Chandra C / Bader, Alexandra / Walker, David L / Fredrickson, Jolene R / Weaver, Amy L / Zhao, Yulian

Reproductive sciences (Thousand Oaks, Calif.)

2022 Volume 30, Issue 6, Page(s) 1911–1916

Abstract: This study examined blastomere exclusion which is seen during embryo development and could represent imperfect cell division or a mechanism of aneuploidy correction. This was a retrospective cohort study which included embryos cultured in a time-lapse ... ...

Abstract	This study examined blastomere exclusion which is seen during embryo development and could represent imperfect cell division or a mechanism of aneuploidy correction. This was a retrospective cohort study which included embryos cultured in a time-lapse incubator undergoing preimplantation genetic testing for aneuploidy (PGT-A) with trophectoderm biopsy. Embryos were evaluated for blastomere exclusion early in development, late in development, both, or neither. Blastomere exclusion was compared to embryo ploidy. Embryos with no blastomere exclusion had an aneuploidy rate of 52.9%, while embryos displaying blastomere exclusion at any stage had an aneuploidy rate of 68.5% (p < .001). Early blastomere exclusion was not significantly associated with an increased aneuploidy risk (59.2% vs. 52.9% in no blastomere exclusions; p = 0.22). However, embryos with late blastomere exclusion were significantly more likely to be aneuploid, compared to embryos with no blastomere exclusions (77.5% vs. 52.9%; p < 0.001) as were embryos with both early + late blastomere exclusions (71.2% vs. 52.9%; p < 0.001). Upon restricting the analysis to aneuploid embryos, the presence of any blastomere exclusion was not significantly associated with complex aneuploidy, defined as 2 more affected chromosomes (43.9% vs. 38.7%; p = 0.28). However, the proportion with adverse embryo genetics significantly increased with the timing of blastomere exclusion (38.7%, 37%, 45.5%, and 50% for none, early, late, and early + late; p = 0.043). Late blastomere exclusion or a combination of both early + late blastomere exclusion was associated with an increased risk of aneuploid embryo genetics. Embryo selection using time-lapse culture systems should incorporate these findings when untested embryos are transferred.
MeSH term(s)	Pregnancy ; Female ; Humans ; Retrospective Studies ; Blastocyst/pathology ; Time-Lapse Imaging ; Preimplantation Diagnosis ; Fertilization in Vitro ; Ploidies ; Aneuploidy
Language	English
Publishing date	2022-12-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	2276411-2
ISSN	1933-7205 ; 1933-7191
ISSN (online)	1933-7205
ISSN	1933-7191
DOI	10.1007/s43032-022-01141-4
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Zs.A 4113: Show issues

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Article: Optimal Embryo Selection: The Irreplaceable Role of the Embryologist in an Age of Advancing Technology.

Rauchfuss, Lauren Kendall / Zhao, Yulian / Walker, David / Galantis, Terri / Fredrickson, Jolene / Barud, Kathrynne / Shenoy, Chandra

Journal of human reproductive sciences

2023 Volume 16, Issue 3, Page(s) 227–232

Abstract: Background: Time-lapse incubators allow for ongoing evaluation of embryos without culture condition disruption. The use of time-lapse incubation has been shown to improve outcomes either by improving overall conditions or providing additional ... ...

Abstract	Background: Time-lapse incubators allow for ongoing evaluation of embryos without culture condition disruption. The use of time-lapse incubation has been shown to improve outcomes either by improving overall conditions or providing additional information to aid in embryo selection for transfer. Time-lapse incubators can also utilise morphokinetic models to rank embryos based on morphokinetic parameters. We sought to compare a morphokinetic model for embryo comparison to traditional morphologic evaluation. Aims: The aim of the study is to compare a morphokinetic model for embryo comparison to traditional morphologic evaluation. Settings and design: This is a retrospective cohort design. Materials and methods: Embryos cultured in a time-lapse culture system that had traditional morphologic evaluation, morphokinetic modelling and known live birth outcomes were included in this study. Embryos with unknown competence were excluded, including when two embryos were transferred with a single live birth resulted. Statistical analysis used: Receiver operating characteristic (ROC) curves were determined for both the morphologic analysis and the morphokinetic model on culture day 3 and day 5. Using the ROC-determined cutoff that optimised both sensitivity and specificity, a binary outcome for each test was analysed using agreement statistics to determine if one method of embryo evaluation was superior to the other. Results: Morphological and morphokinetic grading were both predictive of embryo competence on days 3 and 5. However, on day 3, morphologic grading was superior to morphokinetic grading with area under the curve (AUC) of 0.66 ( Conclusion: Traditional morphology was noted to be a better diagnostic tool (higher AUC) on culture day 3 while a morphokinetic model was superior on day 5.
Language	English
Publishing date	2023-09-29
Publishing country	India
Document type	Journal Article
ZDB-ID	2418984-4
ISSN	1998-4766 ; 0974-1208
ISSN (online)	1998-4766
ISSN	0974-1208
DOI	10.4103/jhrs.jhrs_98_23
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Article ; Online: Patient perceptions of body mass index restrictions limiting fertility care for women with high body mass index.

Riggan, Kirsten A / Rousseau, Abigail C / DSouza, Karen N / Woodward, Kristen T / Lue, Jaida / Phelan, Sean M / Allyse, Megan A / Shenoy, Chandra C

Reproductive biomedicine online

2023 Volume 47, Issue 2, Page(s) 103210

Abstract: Research question: What is the patient experience of women with high body mass index (BMI) with BMI restrictions that limit fertility care?: Design: Qualitative study using in-depth, semi-structured interview methodology. Interview transcripts were ... ...

Abstract	Research question: What is the patient experience of women with high body mass index (BMI) with BMI restrictions that limit fertility care? Design: Qualitative study using in-depth, semi-structured interview methodology. Interview transcripts were analysed for iterative themes in accordance with principles of grounded theory. Results: Forty women with a BMI of 35 kg/m Conclusions: Participant experiences highlight a need for enhanced strategies for communicating BMI restrictions and weight loss recommendations in ways that are perceived to be supportive of patients' fertility goals without further contributing to weight bias and stigma experienced in medical settings. Opportunities for training to mitigate experiences of weight stigma may be beneficial for clinical and non-clinical staff. Evaluation of BMI policies should be undertaken within the context of clinic policies that permit or prohibit fertility care for other high-risk groups.
MeSH term(s)	Pregnancy ; Humans ; Female ; Body Mass Index ; Obesity/therapy ; Fertility ; Fertility Preservation ; Weight Loss
Language	English
Publishing date	2023-04-09
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2113823-0
ISSN	1472-6491 ; 1472-6483
ISSN (online)	1472-6491
ISSN	1472-6483
DOI	10.1016/j.rbmo.2023.04.001
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Zs.A 5792: Show issues

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Article ; Online: Underutilization of pretreatment fertility preservation counseling in reproductive-age women with gastrointestinal cancer.

Gudmundsdottir, Hallbera / Glasgow, Amy E / Bews, Katherine A / Ruddy, Kathryn J / Thiels, Cornelius A / Shenoy, Chandra C

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

2023 Volume 49, Issue 3, Page(s) 667–672

Abstract: Introduction: Young patients with cancer face unique challenges, including disruption of family planning and fertility. Young adults represent an increasing proportion of gastrointestinal cancer patients, and the prevalence of pretreatment fertility ... ...

Abstract	Introduction: Young patients with cancer face unique challenges, including disruption of family planning and fertility. Young adults represent an increasing proportion of gastrointestinal cancer patients, and the prevalence of pretreatment fertility preservation counseling in this population is unknown. Methods: Women 18-40 years who underwent surgery for gastric, colorectal, hepatobiliary, or pancreatic cancer from 2004 to 2019 were identified through the Mayo Clinic Cancer Registry. Natural language processing was used to search electronic medical records and identify documentation of pretreatment fertility counseling. Results: In total, 216 reproductive-age women who underwent resection of gastrointestinal cancers were identified. Pretreatment fertility preservation counseling by any provider was documented in 29 (13%) of the entire cohort. This increased to 26 (23%) in women who also received systemic therapy. This rate did not change over time (p > 0.05). Women who had pretreatment fertility preservation counseling were younger, had higher stage disease, and were more likely to undergo chemotherapy (all p < 0.05). Of the 29 women who had a documented pretreatment discussion, 22 (76%) met with a fertility specialist and 14 (48%) eventually underwent a fertility preservation procedure. Conclusion: A small subset of reproductive-age women who underwent surgery for gastrointestinal cancer had documented pretreatment fertility preservation counseling and only one in ten women met with a fertility specialist. The high rate of proceeding to fertility preservation treatment further supports the importance of this discussion in all patients and represents an opportunity for improvement.
MeSH term(s)	Young Adult ; Humans ; Female ; Fertility Preservation/methods ; Fertility Preservation/psychology ; Counseling/methods ; Gastrointestinal Neoplasms ; Neoplasms ; Fertility
Language	English
Publishing date	2023-02-02
Publishing country	England
Document type	Journal Article
ZDB-ID	632519-1
ISSN	1532-2157 ; 0748-7983
ISSN (online)	1532-2157
ISSN	0748-7983
DOI	10.1016/j.ejso.2023.01.029
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Zs.A 1149: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Seizure control in women with epilepsy undergoing assisted reproductive technology.

Abdulrazaq, Aisha A / Ainsworth, Alessandra J / Britton, Jeffrey W / Shenoy, Chandra C / Babayev, Samir N / Cascino, Gregory D / Smith, Kelsey M

Epilepsia

2023 Volume 64, Issue 10, Page(s) e207–e213

Abstract: The objective of this study was to determine seizure control in women with epilepsy (WWE) undergoing assisted reproductive technology (ART). Through retrospective chart review, WWE undergoing ART were identified. Demographics and details regarding ... ...

Abstract	The objective of this study was to determine seizure control in women with epilepsy (WWE) undergoing assisted reproductive technology (ART). Through retrospective chart review, WWE undergoing ART were identified. Demographics and details regarding epilepsy type, seizure control, and ART procedures were extracted. Seizure frequency prior to and during ART were compared. We identified 12 WWE, who underwent 29 embryo transfers, resulting in 16 pregnancies and 10 live births. Nine women were seizure-free at least 2 years before fertility treatment, including three with resolved epilepsy. Seven were on antiseizure medications throughout fertility treatment and pregnancy, with only one on polytherapy. Eleven (all with controlled epilepsy or epilepsy in remission) remained seizure-free throughout fertility treatment. One woman with drug-resistant epilepsy continued to have seizures throughout fertility treatment and pregnancy without an exacerbation of seizure frequency. There was no increased seizure frequency associated with fertility treatment and subsequent pregnancy in this small series of WWE. Although this study was statistically underpowered, our results provide some preliminary evidence that ART might not pose a threat to seizure control, but larger, confirmatory studies are necessary.
Language	English
Publishing date	2023-08-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	216382-2
ISSN	1528-1167 ; 0013-9580
ISSN (online)	1528-1167
ISSN	0013-9580
DOI	10.1111/epi.17748
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