Bio

Clinical Focus


  • Gynecology
  • Recurrent Pregnancy Loss and Miscarriage
  • Reprod. Endocrinology and Infertility
  • Fertility (Reproductive Medicine)

Academic Appointments


Administrative Appointments


  • Director, Recurrent Pregnancy Loss Program, Reproductive Endocrinology & Infertilty Division, Stanford University (2007 - Present)
  • Associate Director of the REI fellowship, Stanford University (2004 - Present)

Honors & Awards


  • CREOG - Faculty Teaching Award, Stanford University Medical Center, Department of Obstetrics and Gynecology (2006)

Professional Education


  • Fellowship:Stanford University School of Medicine (2003) CA
  • Board Certification: Reprod. Endocrinology and Infertility, American Board of Obstetrics and Gynecology (2006)
  • Medical Education:Univ of California San Francisco (1996) CA
  • Residency:Baylor College of Medicine (2000) TX
  • Board Certification: Obstetrics and Gynecology, American Board of Obstetrics and Gynecology (2005)
  • Internship:Baylor College of Medicine (1997) TX
  • Board Certified, American Board of OB/GYN, Reproductive Endocrinology and Infertility (2006)
  • Board Certified, American Board of OB/GYN, Obstetrics and Gynecology (2005)
  • MD, UC-San Francisco, Medicine (1996)
  • BS, M.I.T., Biology (1992)

Research & Scholarship

Current Research and Scholarly Interests


Pregnancies after infertility: prospectively collecting serum and consent for outcomes research in all women with history of infertility or recurrent miscarriage. Planned projects include evaluation of testosterone levels in relationship to fertility treatments, prospective study on pregnancy outcomes of women with PCOS compared to other women undergoing fertility treatments, miscarriage rates with different diagnoses and treatments.

Karyotypes of miscarriages: collecting karyotype information, ultrasound findings and clinical characteristics on patients miscarrying undergoing D&Cs. Over 350 karyotypes already entered. Objective: to evaluate subsequent pregnancy outcomes and utility of workup for recurrent pregnancy loss in setting of normal and abnormal karyotypes.

Unexplained recurrent pregnancy loss and immune changes. Objective: analyzing peripheral blood and RNA by micro array analysis in women with and without unexplained recurrent pregnancy loss during the luteal phase of the menstrual and early pregnancy.

Clinical Trials


  • Efficacy Study of Preconception Treatment of an Asymptomatic Bacterial Infection in an Infertility Population Recruiting

    Bacterial vaginosis (BV) is a common vaginal infection characterized by a pathologic shift in the normal vaginal flora. BV has been associated with a number of poor reproductive outcomes, including infertility, preterm labor and premature rupture of membranes. If BV does disrupt normal embryologic development, then the treatment of BV prior to conception may improve implantation rates and other pregnancy outcomes in the infertile population. This is a prospective, randomized, double-blind, placebo-controlled trial in which infertile women undergoing intrauterine insemination or embryo transfer are screened for BV prior to treatment. Those patients who screen positive for BV will then be randomized into the treatment arm(metronidazole 500mg by mouth twice daily for 7 days) or the control arm (placebo by mouth twice daily for 7 days). The primary outcome, positive pregnancy test rate (i.e. biochemical pregnancy rate), will then be assessed. Secondary outcomes, such as clinical pregnancy rate, miscarriage rate, and live birth rate will also be examined.

    View full details

  • Day of Embryo Transfer for Patients Undergoing In Vitro Fertilization Not Recruiting

    We are examining whether pregnancy rates differ based on day of embryo transfer in patients who replace all available embryos after an IVF cycle. Patients must be undergoing IVF treatment at Stanford University and patients will not receive compensation for their participation (no medical costs covered or patient payment for participation).

    Stanford is currently not accepting patients for this trial. For more information, please contact Lora Shahine, (650) 498 - 7911.

    View full details

Teaching

2013-14 Courses


Publications

Journal Articles


  • Embryo selection with preimplantation chromosomal screening in patients with recurrent pregnancy loss. Seminars in reproductive medicine Shahine, L. K., Lathi, R. B. 2014; 32 (2): 93-99

    Abstract

    Recurrent pregnancy loss (RPL) is a multifactorial disorder which is often challenging for both patients and providers. Guidelines for the evaluation and treatment of patients with RPL include screening for uterine abnormalities, parental chromosomes, and antiphospholipid antibodies, but approximately half of RPL patients remain unexplained. The current recommendation for patients with unexplained RPL is expectant management which offers most patients a 60 to 80% success rate over time. Genetic imbalances in the embryo, including inherited unbalanced translocations and de novo aneuploidy, are frequent causes of miscarriage. Preimplantation genetic screening (PGS) has been proposed as an effective method for selecting viable embryos for transfer that may result lower risk of miscarriage for patients with unexplained RPL and carriers of balanced translocations. The current evidence examining the use of in vitro fertilization with PGS in patients with RPL reveals variable results, due to differences in technologies used and variable patient populations. Newer approaches, which include blastocyst biopsy and the ability to screen for all 24 chromosomes, show the most promise in reducing miscarriage rates. Studies that identify which patients are most likely to benefit from PGS and include live birth rates per initiated cycles are needed before universally recommending this treatment to couples with RPL.

    View details for DOI 10.1055/s-0033-1363550

    View details for PubMedID 24515903

  • Frequency of the Male Infertility Evaluation: Data from the National Survey of Family Growth JOURNAL OF UROLOGY Eisenberg, M. L., Lathi, R. B., Baker, V. L., Westphal, L. M., Milki, A. A., Nangia, A. K. 2013; 189 (3): 1030-1034

    Abstract

    An estimated 7 million American couples per year seek infertility care in the United States. A male factor contributes to 50% of cases but it is unclear what proportion of infertile couples undergoes male evaluation.We analyzed data from cycles 5 to 7 of the National Survey of Family Growth performed by the Centers for Disease Control to determine the frequency of a male infertility evaluation, and associated reproductive and demographic factors.A total of 25,846 women and 11,067 men were surveyed. Male evaluation was not completed in 18% of couples when the male partner was asked vs 27% when female partners were asked. This corresponds to approximately 370,000 to 860,000 men in the population who were not evaluated at the time of infertility evaluation. Longer infertility duration and white race were associated with increased odds of male infertility evaluation. The male and female samples showed no change in the receipt of male examination with time.Many men from infertile couples do not undergo male evaluation in the United States. Given the potential implications to reproductive goals and male health, further examination of this pattern is warranted.

    View details for DOI 10.1016/j.juro.2012.08.239

    View details for Web of Science ID 000315109600076

    View details for PubMedID 23009868

  • Outcomes of trophectoderm biopsy on cryopreserved blastocysts: a case series REPRODUCTIVE BIOMEDICINE ONLINE Lathi, R. B., Massie, J. A., Gilani, M., Milki, A. A., Westphal, L. M., Baker, V. L., Behr, B. 2012; 25 (5): 504-507

    Abstract

    Preimplantation genetic diagnosis (PGD) is an increasingly common adjunct to IVF. The information gained from PGD may be used to reduce the incidence of chromosomally abnormal pregnancies and augment the current selection process of embryos. As such, patients may choose to utilize PGD in either fresh or cryopreserved IVF cycles. It is a common practice to cryopreserve excess embryos at the blastocyst stage. In these cases, trophectoderm biopsy is the only technique available for PGD. This articles reports this study centre's experience with trophectoderm biopsies of cryopreserved blastocysts in 12 patients who underwent 13 cycles of PGD. The implantation rate per embryo transferred was 46% and the ongoing pregnancy rate per embryo transfer was 63%. The results from this case series demonstrate that trophectoderm biopsy on cryopreserved blastocysts to perform PGD is logistically feasible. In addition, the rate of implantation and ongoing pregnancy were maintained within a reasonable range to justify the procedure. Preimplantation genetic diagnosis (PGD) is an increasingly common adjunct to IVF and is used to evaluate the genetic makeup of the embryo prior to transfer of the embryo into the uterus. The information gained from PGD may be used to identify single-gene disorders that result in genetic disease, reduce the incidence of chromosomally abnormal pregnancies and/or augment the selection process of embryos to be transferred. In order to perform PGD, a biopsy of the embryo is the performed and cells are removed for testing. PGD may be performed in either fresh or frozen (cryopreserved) IVF cycles. Patients who have cryopreserved embryos remaining in storage from a previous fresh cycle may wish to have these embryos tested with PGD. Many embryos are frozen on day 5 of development, referred to as the blastocyst stage. At this stage of development, embryo biopsy is performed via a technique known as 'trophectoderm biopsy', in which 1-3 of the cells destined to become the placenta are removed from the embryo for chromosomal testing. We report our experience with trophectoderm biopsy of frozen blastocysts in 12 patients who underwent 13 cycles of PGD. The implantation rate per embryo transferred was 46% and the ongoing pregnancy rate per embryo transfer was 63%. The results from this case series demonstrate that trophectoderm biopsy on cryopreserved blastocysts to perform PGD is logistically feasible. In addition, the rate of implantation and ongoing pregnancy were maintained within a reasonable range to justify the procedure.

    View details for DOI 10.1016/j.rbmo.2012.06.021

    View details for Web of Science ID 000310639600010

    View details for PubMedID 22985500

  • Oocyte retrieval following continued stimulation five days beyond ovulation yields live birth after frozen embryo transfer JOURNAL OF ASSISTED REPRODUCTION AND GENETICS Friedman, B. E., Pao, S., Westphal, L. M., Lathi, R. B. 2012; 29 (5): 433-435

    View details for DOI 10.1007/s10815-012-9721-2

    View details for Web of Science ID 000303881200011

    View details for PubMedID 22327896

  • Informatics Enhanced SNP Microarray Analysis of 30 Miscarriage Samples Compared to Routine Cytogenetics PLOS ONE Lathi, R. B., Loring, M., Massie, J. A., Demko, Z. P., Johnson, D., Sigurjonsson, S., Gemelos, G., Rabinowitz, M. 2012; 7 (3)

    Abstract

    The metaphase karyotype is often used as a diagnostic tool in the setting of early miscarriage; however this technique has several limitations. We evaluate a new technique for karyotyping that uses single nucleotide polymorphism microarrays (SNP). This technique was compared in a blinded, prospective fashion, to the traditional metaphase karyotype.Patients undergoing dilation and curettage for first trimester miscarriage between February and August 2010 were enrolled. Samples of chorionic villi were equally divided and sent for microarray testing in parallel with routine cytogenetic testing.Thirty samples were analyzed, with only four discordant results. Discordant results occurred when the entire genome was duplicated or when a balanced rearrangement was present. Cytogenetic karyotyping took an average of 29 days while microarray-based karytoyping took an average of 12 days.Molecular karyotyping of POC after missed abortion using SNP microarray analysis allows for the ability to detect maternal cell contamination and provides rapid results with good concordance to standard cytogenetic analysis.

    View details for DOI 10.1371/journal.pone.0031282

    View details for Web of Science ID 000303017700008

    View details for PubMedID 22403611

  • Testosterone concentrations in early pregnancy: relation to method of conception in an infertile population REPRODUCTIVE BIOMEDICINE ONLINE Lathi, R. B., Moayeri, S. E., Reddy, C. D., Gebhardt, J., Behr, B., Westphal, L. M. 2012; 24 (3): 360-363

    Abstract

    This prospective cohort study of infertility patients compared testosterone concentrations in early pregnancy in infertility patients who conceived naturally or after treatment. Although all groups demonstrated some increase in pregnancy testosterone from baseline concentrations, subjects who conceived following ovulation induction showed a significantly increased rise in testosterone as compared with controls (P<0.01).

    View details for DOI 10.1016/j.rbmo.2011.11.018

    View details for Web of Science ID 000303046700015

    View details for PubMedID 22285241

  • Successful frozen blastocyst transfers after failed fresh transfers in assisted reproductive technologies patients with hydrosalpinx AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY Sueldo, C. M., Milki, A. A., Lathi, R. B. 2012; 206 (3): E4-E6

    Abstract

    Untreated hydrosalpinx is known to decrease in vitro fertilization success. We report on 4 patients with hydrosalpinx for whom fresh transfers of 11 good quality embryos did not produce a pregnancy; however, frozen blastocyst transfers in natural cycles resulted in several successful pregnancies, with an implantation rate of 60% (9/15 blastocysts implanted).

    View details for DOI 10.1016/j.ajog.2011.12.020

    View details for Web of Science ID 000300878600002

    View details for PubMedID 22285169

  • Comparison of morbidity associated with laparoscopic myomectomy and hysterectomy for the treatment of uterine leiomyomas. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC Lemyre, M., Bujold, E., Lathi, R., Bhagan, L., Huang, J. Q., Nezhat, C. 2012; 34 (1): 57-62

    Abstract

    To compare short-term morbidity and quality of life after laparoscopic hysterectomy (LH) and laparoscopic myomectomy (LM) for the treatment of symptomatic uterine leiomyomas.We performed a prospective, observational study of women who were eligible for both surgical procedures. After informed consent was obtained, each participant was asked to complete the SF-12v2 Health Survey before surgery and to repeat it seven days and 28 days after surgery. Data on short-term morbidities, such as operative time, blood loss, length of hospital stay, and surgical complications, were collected by an obstetrician-gynaecologist. Women who underwent LH were compared by non-parametric statistical analyses with those who underwent LM.Sixty-one women were recruited between January 1 and December 31, 2008, including 40 who underwent LM and 21 LH. Women who underwent LH were older, had higher parity, and were less likely to have infertility than those who chose LM. Median LH operative time of 223 minutes (IQR 214 to 241) was slightly longer than for LM (188 minutes, IQR 154 to 239; P = 0.02). However, we found no difference between the two groups in terms of SF-12v2 fluctuation, blood loss, hospital stay, and short-term complications.Laparoscopic myomectomy is a viable alternative to laparoscopic hysterectomy for women with symptomatic leiomyomas who want conservative surgery. The procedures have similar morbidity and impact on quality of life.

    View details for PubMedID 22260764

  • Early pregnancy testosterone after ovarian stimulation and pregnancy outcome FERTILITY AND STERILITY Gustin, S. L., Mukherjee, G., Baker, V. L., Westphal, L. M., Milki, A. A., Lathi, R. B. 2012; 97 (1): 23-U48

    Abstract

    To examine early pregnancy (EP) testosterone (T) after ovarian stimulation and its effect on singleton pregnancy outcomes.Prospective cohort study.University-based tertiary care center.Subfertile women who conceived with or without fertility treatment.Ovarian stimulation for assisted reproduction, collection of serum total T levels in early pregnancy, and pregnancy follow-up.Rate of preterm delivery, low birth weight (LBW) (<2,500 g), and hypertensive disorders of pregnancy.EP serum samples were measured from 266 singleton pregnancies. The mean T level among spontaneous conceptions was 74.90 ng/dL (SD 48.35 ng/dL); 103 ng/mL was the 90th percentile. Mean EP T was increased among patients who underwent ovarian stimulation compared with nonstimulated control subjects. In patients undergoing IVF, T levels in EP were linearly correlated with the number of oocytes retrieved. When pregnancy outcomes in women with normal T were compared with women with elevated T (>90th percentile), we did not see an increased risk for preterm delivery, hypertensive disorders of pregnancy, LBW infants, or cesarean delivery (odds ratio ratios 1.43, 0.38, 1.39, and 0.85, respectively).Elevations in EP T are associated with ovarian stimulation but do not appear to be associated with adverse pregnancy outcome. Further investigation to determine the etiology of increased maternal and neonatal morbidity among subfertile women is warranted.

    View details for DOI 10.1016/j.fertnstert.2011.10.020

    View details for Web of Science ID 000298367600009

    View details for PubMedID 22112646

  • First Trimester Miscarriage Evaluation SEMINARS IN REPRODUCTIVE MEDICINE Lathi, R. B., Hazard, F. K., Heerema-McKenney, A., Taylor, J., Chueh, J. T. 2011; 29 (6): 463-469

    Abstract

    Miscarriage is a relatively common occurrence for otherwise healthy women. Despite its frequency, evaluation for cause is rare. The most common cause of miscarriage is sporadic chromosome errors. Chromosomal analysis of the miscarriage offers an explanation in at least 50% of cases. Conventional cytogenetic evaluation can only be done on fresh tissue, so it is critical that the treating physician consider genetic testing at the time of the miscarriage. Ultrasound can estimate the gestational age at the time of miscarriage and identify major abnormalities in some embryos. A careful pathological examination can add to the evaluation by ruling out rare disorders with the highest recurrence risk. A multidisciplinary approach to miscarriage evaluation is essential to understanding the cause and risk of recurrence. A thorough evaluation of a miscarriage, in combination with emotional support, can often provide the necessary reassurance and confidence as the patient prepares for her next pregnancy.

    View details for DOI 10.1055/s-0031-1293200

    View details for Web of Science ID 000298281100003

    View details for PubMedID 22161459

  • Sextuplet heterotopic pregnancy presenting as ovarian hyperstimulation syndrome and hemoperitoneum FERTILITY AND STERILITY Fisher, S. L., Massie, J. A., Blumenfeld, Y. J., Lathi, R. B. 2011; 95 (7)

    Abstract

    To describe a case of bilateral ruptured heterotopic pregnancies presenting as persistent ovarian hyperstimulation syndrome in a quadruplet pregnancy.Case report.University hospital and clinic.An infertile patient who conceived using gonadotropin therapy.Culdocentesis with resultant aspiration of sanguinous fluid prompted laparoscopic exploration and bilateral salpingectomies.Not applicable.Gross hemoperitoneum and ruptured bilateral heterotopic sextuplet pregnancy.Patients who conceive after gonadotropin therapy should be closely monitored during treatment and in early pregnancy to recognize and minimize morbidity and complications. After superovulation, the presence of an intrauterine pregnancy, either single or multiple, does not rule out the possibility of ectopic pregnancy, and this should always be considered as a possibility in the setting of acute anemia.

    View details for DOI 10.1016/j.fertnstert.2011.01.172

    View details for Web of Science ID 000290791000088

    View details for PubMedID 21406303

  • The effect of air bubble position after blastocyst transfer on pregnancy rates in IVF cycles FERTILITY AND STERILITY Friedman, B. E., Lathi, R. B., Henne, M. B., Fisher, S. L., Milki, A. A. 2011; 95 (3): 944-947

    Abstract

    To investigate the relationship between air bubble position after blastocyst transfer (BT) and pregnancy rates (PRs).Retrospective cohort study.University-based infertility center.Three hundred fifteen consecutive nondonor BTs by a single provider.Catheters were loaded with 25 ?L of culture media, 20 ?L of air, 25 ?L of media containing the blastocysts, 20 ?L of air, and a small amount of additional media. The distance from the air bubble to the fundus, as seen on abdominal ultrasound examination, was measured at the time of transfer. Air bubble location was categorized as <10 mm, 10-20 mm, and >20 mm from the fundus.Clinical pregnancy rate.After controlling for age, parity, FSH and frozen transfers, and accounting for repeated cycles per patient, the PRs for both the >20-mm (38.3%) and the 10-20-mm (42.0%) from the fundus group were significantly reduced compared with the group in which the bubble was <10 mm from the fundus (62.5%).This study is the first to suggest that BT closer to the fundus is associated with higher PR. Although no ectopic pregnancies occurred in the <10-mm group, this outcome should be monitored closely in larger studies.

    View details for DOI 10.1016/j.fertnstert.2010.07.1063

    View details for Web of Science ID 000287480300019

    View details for PubMedID 20810105

  • Age-Related Success with Elective Single versus Double Blastocyst Transfer. ISRN obstetrics and gynecology Friedman, B. E., Davis, L. B., Lathi, R. B., Westphal, L. M., Baker, V. L., Milki, A. A. 2011; 2011: 656204-?

    Abstract

    Background. Although the optimal outcome of assisted reproductive technology (ART) is a healthy singleton pregnancy, the rate of twin gestation from ART in women over the age of 35 is persistently high. Methods/Findings. We compared clinical pregnancy rates (PRs), ongoing pregnancy/live birth rates, and multiple gestation rates (MGRs) in 108 women who chose elective single blastocyst transfer (eSBT) to 415 women who chose elective double blastocyst transfer (eDBT) at a hospital-based IVF center. There was no significant difference in PR between eSBT and eDBT (57.4% versus 50.2%, P = 0.47) nor between eSBT and eDBT within each age group: <35, 35-37, 38-40, and >40. The risk of multiple gestations, however, was greatly increased between eSBT and eDBT (1.6 versus 32.4%, P < 0.00005), and this difference did not vary across age groups. Conclusion(s). Women undergoing eDBT are at uniformly high risk of multiple gestation regardless of age. eSBT appears to significantly lower the risk of multiple gestation without compromising PR.

    View details for DOI 10.5402/2011/656204

    View details for PubMedID 22191047

  • Day 2 versus day 3 embryo transfer in poor responders: a prospective randomized trial FERTILITY AND STERILITY Shahine, L. K., Milki, A. A., Westphal, L. M., Baker, V. L., Behr, B., Lathi, R. B. 2011; 95 (1): 330-332

    Abstract

    Day 2 embryo transfer has been suggested as a method to improve pregnancy rates in poor responders compared with day 3 transfer. Our prospective randomized controlled trial does not show a difference in outcomes based on day of embryo transfer.

    View details for DOI 10.1016/j.fertnstert.2010.06.093

    View details for Web of Science ID 000285411600086

    View details for PubMedID 20813357

  • Is infertility a risk factor for female sexual dysfunction? A case-control study FERTILITY AND STERILITY Millheiser, L. S., Helmer, A. E., Quintero, R. B., Westphal, L. M., Milki, A. A., Lathi, R. B. 2010; 94 (6): 2022-2025

    Abstract

    To determine the impact of infertility on female sexual function.A case-control study.Academic infertility and gynecology practices.One hundred nineteen women with infertility and 99 healthy female controls without infertility between the ages of 18 and 45 years were included in this study.Anonymous survey and Female Sexual Function Index.Female Sexual Function Index scores, frequency of sexual intercourse and masturbation, and sex-life satisfaction.Twenty-five percent of our control group had Female Sexual Function Index scores that put them at risk for sexual dysfunction (<26.55), whereas 40% of our patients with infertility met this criterion. Compared with the control group, the patients with infertility had significantly lower scores in the desire and arousal domains and lower frequency of intercourse and masturbation. The patients with infertility retrospectively reported a sex-life satisfaction score that was similar to that of the controls before their diagnosis, whereas their current sex-life satisfaction scores were significantly lower than those of the controls.Women with a diagnosis of infertility were found to be at higher risk for sexual dysfunction on the basis of their Female Sexual Function Index scores compared with women without infertility. The interaction of sexual function and infertility is complex and deserves further study.

    View details for DOI 10.1016/j.fertnstert.2010.01.037

    View details for Web of Science ID 000283441400016

    View details for PubMedID 20206929

  • Etiology of recurrent pregnancy loss in women over the age of 35 years FERTILITY AND STERILITY Marquard, K., Westphal, L. M., Milki, A. A., Lathi, R. B. 2010; 94 (4): 1473-1477

    Abstract

    To determine the rate of embryonic chromosomal abnormalities, thrombophilias, and uterine anomalies in women over the age of 35 years with recurrent pregnancy loss (RPL).Retrospective cohort study.Academic reproductive endocrinology and infertility clinic.Women>or=35 years old with >or=3 first trimester miscarriages.None.Age, number of prior losses, cytogenetic testing of the products of conception (POC), uterine cavity evaluation, parental karyotype, TSH, and antiphospholipd antibody (APA) and thrombophilia testing. Aneuploidy in the POC in women with RPL was compared with sporadic miscarriages (or=35 years.Among 43 RPL patients, there were 50 miscarriages in which cytogenetic analysis was performed. In the RPL group, the incidence of chromosomal abnormalities in the POC was 78% (39 out of 50) compared with a 70% incidence (98 out of 140) in the sporadic losses. Thrombophilia results in the RPL patients were normal in 38 patients, four patients had APA syndrome, and one had protein C deficiency. Forty out of 43 had normal uterine cavities. Both TSH and parental karyotypes were normal in all of the patients tested. When the evaluation of RPL included karyotype of the POC, only 18% remained without explanation. However, without fetal cytogenetics, 80% of miscarriages would have been unexplained.In older patients with RPL, fetal chromosomal abnormalities are responsible for the majority of miscarriages. Other causes were present in only 20% of cases.

    View details for DOI 10.1016/j.fertnstert.2009.06.041

    View details for Web of Science ID 000281674600051

    View details for PubMedID 19643401

  • Deep phenotyping to predict live birth outcomes in in vitro fertilization PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA Banerjee, P., Choi, B., Shahine, L. K., Jun, S. H., O'leary, K., Lathi, R. B., Westphal, L. M., Wong, W. H., Yao, M. W. 2010; 107 (31): 13570-13575

    Abstract

    Nearly 75% of in vitro fertilization (IVF) treatments do not result in live births and patients are largely guided by a generalized age-based prognostic stratification. We sought to provide personalized and validated prognosis by using available clinical and embryo data from prior, failed treatments to predict live birth probabilities in the subsequent treatment. We generated a boosted tree model, IVFBT, by training it with IVF outcomes data from 1,676 first cycles (C1s) from 2003-2006, followed by external validation with 634 cycles from 2007-2008, respectively. We tested whether this model could predict the probability of having a live birth in the subsequent treatment (C2). By using nondeterministic methods to identify prognostic factors and their relative nonredundant contribution, we generated a prediction model, IVF(BT), that was superior to the age-based control by providing over 1,000-fold improvement to fit new data (p<0.05), and increased discrimination by receiver-operative characteristic analysis (area-under-the-curve, 0.80 vs. 0.68 for C1, 0.68 vs. 0.58 for C2). IVFBT provided predictions that were more accurate for approximately 83% of C1 and approximately 60% of C2 cycles that were out of the range predicted by age. Over half of those patients were reclassified to have higher live birth probabilities. We showed that data from a prior cycle could be used effectively to provide personalized and validated live birth probabilities in a subsequent cycle. Our approach may be replicated and further validated in other IVF clinics.

    View details for DOI 10.1073/pnas.1002296107

    View details for Web of Science ID 000280605900006

    View details for PubMedID 20643955

  • Coexistence of endometriosis in women with symptomatic leiomyomas FERTILITY AND STERILITY Huang, J. Q., Lathi, R. B., Lemyre, M., Rodriguez, H. E., Nezhat, C. H., Nezhat, C. 2010; 94 (2): 720-723

    Abstract

    To investigate the coexistence of endometriosis in women presenting with symptomatic leiomyomas.Retrospective study.Tertiary university medical center.We reviewed the medical records of 131 patients who underwent laparoscopic myomectomy or hysterectomy. All patients were consented for possible concomitant diagnosis and treatment of endometriosis.All patients underwent laparoscopic myomectomy or hysterectomy.The main outcome measure of the study was the presence or absence of endometriosis.Of the 131 patients, 113 were diagnosed with endometriosis and fibroids, while 18 were diagnosed with fibroids alone. Patients with fibroids were on average 4.0 years older than those with endometriosis and fibroids (41 vs. 45). Patients with both diagnoses were also more likely to present with pelvic pain and nulliparity than those with fibroids alone.An overwhelming majority of patients with symptomatic fibroids were also diagnosed with endometriosis. Overlooking the concomitant diagnosis of endometriosis in these women may lead to suboptimal treatment of the patients. Further studies are needed to evaluate the impact of surgical treatments on symptom resolution.

    View details for DOI 10.1016/j.fertnstert.2009.03.052

    View details for Web of Science ID 000279758800047

    View details for PubMedID 19393995

  • Karyotype of miscarriages in relation to maternal weight HUMAN REPRODUCTION Landres, I. V., Milki, A. A., Lathi, R. B. 2010; 25 (5): 1123-1126

    Abstract

    Obesity has been identified as a risk factor for spontaneous miscarriage although the mechanism is unclear. The purpose of this study is to better understand the effect of obesity on early pregnancy success by examining the cytogenetic results of miscarriages in women with normal and elevated body mass index (BMI).We conducted a retrospective case-control study in an academic infertility practice. Medical records of women ages <40 years with first trimester missed abortion (n = 204), who underwent dilatation and curettage between 1999 and 2008, were reviewed for demographics, BMI, diagnosis of polycystic ovary syndrome (PCOS) and karyotype analysis. chi(2) and Student's t-test analysis were used for statistical analysis, with P < 0.05 considered significant.A total of 204 miscarriages were included, from women with a mean age of 34.5 years. The overall rate of aneuploidy was 59%. Women with BMI > or = 25 kg/m(2) had a significant increase in euploid miscarriages compared with women with lower BMI (P = 0.04), despite a similar mean age (34.4 years for both).We found a significant increase in normal embryonic karyotypes in the miscarriages of overweight and obese women (BMI > or = 25). These results suggest that the excess risk of miscarriages in the overweight and obese population is independent of embryonic aneuploidy. Further studies are needed to assess the impact of lifestyle modification, insulin resistance and PCOS on pregnancy outcomes in the overweight and obese population.

    View details for DOI 10.1093/humrep/deq025

    View details for Web of Science ID 000276732800006

    View details for PubMedID 20190263

  • Asian Ethnicity and Poor Outcomes After In Vitro Fertilization Blastocyst Transfer OBSTETRICS AND GYNECOLOGY Langen, E. S., Shahine, L. K., Lamb, J. D., Lathi, R. B., Milki, A. A., Fujimoto, V. Y., Westphal, L. M. 2010; 115 (3): 591-596

    Abstract

    To estimate the effect of ethnicity on in vitro fertilization (IVF) outcomes after blastocyst transfer.We conducted a review of fresh blastocyst transfer IVF cycles from January 1, 2005, to December 31, 2006. Data collection included demographic information, infertility history, treatment protocol details, and treatment outcomes. Statistics were performed using the Student t test and chi2 test. To establish the independent contribution of Asian ethnicity, a multivariable logistic regression analysis was performed.We reviewed 180 blastocyst transfer cycles among white (62%) and Asian (38%) women. The groups were similar in most baseline characteristics. Asian women, however, had a lower body mass index (22.6 compared with 24.2, P=.02), were more likely to be nulligravid (53% compared with 35%, P=.03), and were more likely to have had at least one prior IVF cycle (37% compared with 20%, P=.02) The groups were similar in treatment characteristics, number of oocytes retrieved, fertilization rate, and number of blastocysts transferred. However, Asian women had a thicker endometrial lining (10.9 compared with 10.2, P=.02). Despite these similarities, Asian women had a lower implantation rate (28% compared with 45%, P=.01), clinical pregnancy rate (43% compared with 59%, P=.03), and live birthrate (31% compared with 48%, P=.02). In multivariable analysis, the decreased live birthrate among Asian women persisted (adjusted odds ratio 0.48, 95% confidence interval 0.24-0.96, P=.04).When compared with white women, Asian women have lower clinical pregnancy and live birthrates after blastocyst transfer.

    View details for DOI 10.1097/AOG.0b013e3181cf45c1

    View details for Web of Science ID 000275132300016

    View details for PubMedID 20177291

  • Poor Prognosis with In Vitro Fertilization in Indian Women Compared to Caucasian Women Despite Similar Embryo Quality PLOS ONE Shahine, L. K., Lamb, J. D., Lathi, R. B., Milki, A. A., Langen, E., Westphal, L. M. 2009; 4 (10)

    Abstract

    Disease prevalence and response to medical therapy may differ among patients of diverse ethnicities. Poor outcomes with in vitro fertilization (IVF) treatment have been previously shown in Indian women compared to Caucasian women, and some evidence suggests that poor embryo quality may be a cause for the discrepancy. In our center, only patients with the highest quality cleavage stage embryos are considered eligible for extending embryo culture to the blastocyst stage. We compared live birth rates (LBR) between Indian and Caucasian women after blastocyst transfer to investigate whether differences in IVF outcomes between these ethnicities would persist in patients who transferred similar quality embryos.In this retrospective cohort analysis, we compared IVF outcome between 145 Caucasians and 80 Indians who had a blastocyst transfer between January 1, 2005 and June 31, 2007 in our university center. Indians were younger than Caucasians by 2.7 years (34.03 vs. 36.71, P = 0.03), were more likely to have an agonist down regulation protocol (68% vs. 43%, P<0.01), and were more likely to have polycystic ovarian syndrome (PCOS), although not significant, (24% vs. 14%, P = 0.06). Sixty eight percent of Indian patients had the highest quality embryos (4AB blastocyst or better) transferred compared to 71% of the Caucasians (P = 0.2). LBR was significantly lower in the Indians compared to the Caucasians (24% vs. 41%, P<0.01) with an odds ratio of 0.63, (95%CI 0.46-0.86). Controlling for age, stimulation protocol and PCOS showed persistently lower LBR with an adjusted odds ratio of 0.56, (95%CI 0.40-0.79) in the multivariate analysis.Despite younger age and similar embryo quality, Indians had a significantly lower LBR than Caucasians. In this preliminary study, poor prognosis after IVF for Indian ethnicity persisted despite limiting analysis to patients with high quality embryos transferred. Further investigation into explanations for ethnic differences in reproduction is needed.

    View details for DOI 10.1371/journal.pone.0007599

    View details for Web of Science ID 000271147200015

    View details for PubMedID 19855835

  • Effect of selective serotonin reuptake inhibitors on in vitro fertilization outcome FERTILITY AND STERILITY Friedman, B. E., Rogers, J. L., Shahine, L. K., Westphal, L. M., Lathi, R. B. 2009; 92 (4): 1312-1314

    Abstract

    A review of 950 patients was performed to investigate the impact of selective serotonin reuptake inhibitors (SSRIs) on in vitro fertilization outcome. The 41 patients (4.3%) taking an SSRI had a higher cycle cancellation rate but no statistically significant difference in pregnancy rate and live birth rate per cycle started.

    View details for DOI 10.1016/j.fertnstert.2009.03.060

    View details for Web of Science ID 000270616100027

    View details for PubMedID 19423105

  • Oocyte retrieval versus conversion to intrauterine insemination in patients with poor response to gonadotropin therapy FERTILITY AND STERILITY Shahine, L. K., Lathi, R. B., Baker, V. L. 2009; 92 (4): 1315-1317

    Abstract

    We compared cycle characteristics and outcomes for planned in vitro fertilization cycles with five or fewer developing follicles that proceeded to retrieval (n = 170) with those that converted to intrauterine insemination (IUI) (n = 50). The risk of no embryo transfer was 24% in cycles that proceeded to retrieval. Live birth rate per cycle started was similar for IUI (6%) compared with retrieval (7%).

    View details for DOI 10.1016/j.fertnstert.2009.03.059

    View details for Web of Science ID 000270616100028

    View details for PubMedID 19393998

  • Normal pregnancy after tetraploid karyotype on trophectoderm biopsy FERTILITY AND STERILITY Krieg, S. A., Lathi, R. B., Behr, B., Westphal, L. M. 2009; 92 (3)

    Abstract

    To report a case of successful pregnancy after trophectoderm biopsy and fluorescence in situ hybridization (FISH) revealed a tetraploid karyotype.Case report.A university medical center.An infertility patient desiring trophectoderm biopsy on frozen blastocysts to facilitate preimplantation genetic screening.Frozen blastocysts were thawed on the evening before transfer. Trophectoderm biopsy was performed the following morning. FISH results were available the same day, and two embryos with tetraploid results were transferred.Chorionic villus sample (CVS) and newborn exam.Normal diploid CVS result and a healthy male infant.Although multiple cells can be analyzed using trophectoderm biopsy, abnormalities in the trophectoderm may not be present in the inner cell mass.

    View details for DOI 10.1016/j.fertnstert.2009.06.007

    View details for Web of Science ID 000283282700007

    View details for PubMedID 19608167

  • Effect of methotrexate exposure on subsequent fertility in women undergoing controlled ovarian stimulation FERTILITY AND STERILITY McLaren, J. F., Burney, R. O., Milki, A. A., Westphal, L. M., Dahan, M. H., Lathi, R. B. 2009; 92 (2): 515-519

    Abstract

    To evaluate the pregnancy rate, ovarian responsiveness, and endometrial thickness in infertility patients with a history of methotrexate exposure who subsequently underwent controlled ovarian stimulation.Retrospective cohort study.University reproductive endocrinology and infertility program.Forty-eight women with infertility undergoing ovarian stimulation after receiving methotrexate treatment for ectopic gestation.Methotrexate administration and controlled ovarian stimulation.Pregnancy rate, cycle day 3 FSH levels, number of oocytes retrieved, and endometrial thickness.The cumulative intrauterine pregnancy rate achieved with controlled ovarian stimulation at 2 years after methotrexate exposure was 43%, with a mean time to conceive of 181 days. Thirty-five patients with similar fertility treatments pre- and post-methotrexate were identified. Within this group, when an IVF cycle occurred within 180 days of methotrexate exposure, a significant decline in oocytes retrieved was observed. Cycles performed later than 180 days after methotrexate exposure did not exhibit a decrease in oocyte production. Endometrial development was similar at all time points examined.These findings suggest a time-limited and reversible impact of methotrexate on oocyte yield. If confirmed by larger clinical series and/or animal data, these results may impact the management of ectopic gestation in the patient with a history of infertility or the timing of subsequent treatments.

    View details for DOI 10.1016/j.fertnstert.2008.07.009

    View details for Web of Science ID 000268915200017

    View details for PubMedID 18829004

  • Laparoscopy in women with unexplained infertility: a cost-effectiveness analysis FERTILITY AND STERILITY Moayeri, S. E., Lee, H. C., Lathi, R. B., Westphal, L. M., Milki, A. A., Garber, A. M. 2009; 92 (2): 471-480

    Abstract

    To evaluate the cost effectiveness of laparoscopy for unexplained infertility.We performed a cost-effectiveness analysis using a computer-generated decision analysis tree. Data used to construct the mathematical model were extracted from the literature or obtained from our practice. We compared outcomes following four treatment strategies: [1] no treatment, [2] standard infertility treatment algorithm (SITA), [3] laparoscopy with expectant management (LSC/EM), and [4] laparoscopy with infertility therapy (LSC/IT). The incremental cost-effectiveness ratio (ICER) was calculated, and one-way sensitivity analyses assessed the impact of varying base-case estimates.Academic in vitro fertilization practice.Computer-simulated patients assigned to one of four treatments.Fertility treatment or laparoscopy.Incremental cost-effectiveness ratios.Using base-case assumptions, LSC/EM was preferred (ICER =$128,400 per live-birth in U.S. dollars). Changing the following did not alter results: rates and costs of multiple gestations, penalty for high-order multiples, infertility treatment costs, and endometriosis prevalence. Outcomes were most affected by patient dropout from infertility treatments-SITA was preferred when dropout was less than 9% per cycle. Less important factors included surgical costs, acceptability of twins, and the effects of untreated endometriosis on fecundity.Laparoscopy is cost effective in the initial management of young women with infertility, particularly when infertility treatment dropout rates exceed 9% per cycle.

    View details for DOI 10.1016/j.fertnstert.2008.05.074

    View details for Web of Science ID 000268915200011

    View details for PubMedID 18722609

  • Pregnancy after trophectoderm biopsy of frozen-thawed blastocyst FERTILITY AND STERILITY Lathi, R. B., Behr, B. 2009; 91 (5): 1938-1940

    Abstract

    To report a case of a successful pregnancy after trophectoderm biopsy and three-probe fluorescent in situ hybridization of a frozen blastocyst.Techniques and instrumentation.A University Medical Center.Infertility patient desiring trophectoderm biopsy on frozen blastocyst for preimplantation testing, from an IVF cycle at a referring IVF program.Frozen blastocysts were thawed the evening before the planned transfer. Trophectoderm biopsy was performed in the morning. The fluorescent in situ hybridization results were obtained the same day; embryo transfer was performed under ultrasound guidance.Serum betahCG and transvaginal ultrasound.Positive betahCG and ongoing pregnancy.Trophectoderm biopsy can be used as a means for testing frozen blastocysts in patients with excess embryos cryopreserved on day 5 or 6 from previously preformed IVF cycles.

    View details for DOI 10.1016/j.fertnstert.2008.02.132

    View details for Web of Science ID 000265969200055

    View details for PubMedID 18371958

  • Menstrual bleeding from an endometriotic lesion FERTILITY AND STERILITY Burney, R. O., Lathi, R. B. 2009; 91 (5): 1926-1927

    Abstract

    We present a case in which endometriotic lesions were observed to be focally hemorrhagic at laparoscopy performed during menstruation. Red vesicular lesions likely represent early disease with intact capacity for hormonally induced menstrual bleeding.

    View details for DOI 10.1016/j.fertnstert.2008.08.125

    View details for Web of Science ID 000265969200052

    View details for PubMedID 18930191

  • Embryo quality before and after surgical treatment of endometriosis in infertile patients JOURNAL OF ASSISTED REPRODUCTION AND GENETICS Shahine, L. K., Burney, R. O., Behr, B., Milki, A. A., Westphal, L. M., Lathi, R. B. 2009; 26 (2-3): 69-73

    Abstract

    To investigate the hypothesis that surgical treatment of endometriosis in infertile patients may improve pregnancy rates by improving embryo quality.We conducted a retrospective evaluation of 30 infertile patients treated with in vitro fertilization (IVF) before and after surgery for endometriosis. Patients served as their own controls and only cycles with similar stimulation protocols were compared.Using standard visual evaluation, embryo quality on day 3 was similar before and after surgical treatment of endometriosis. Fifty seven percent of patients had stage I-II endometriosis and 43% had stage III-IV disease. No patients had a live birth after the first IVF cycle and 43% of patients had a live birth with the IVF cycle after surgery.Surgical treatment of endometriosis does not alter embryo quality in patients with infertility treated with IVF.

    View details for DOI 10.1007/s10815-008-9287-1

    View details for Web of Science ID 000264178200001

    View details for PubMedID 19214735

  • Basal follicle-stimulating hormone as a predictor of fetal aneuploidy FERTILITY AND STERILITY Massie, J. A., Burney, R. O., Milki, A. A., Westphal, L. M., Lathi, R. B. 2008; 90 (6): 2351-2355

    Abstract

    To determine whether an elevated basal FSH concentration is an independent predictor of fetal aneuploidy, as measured in spontaneous abortions (SAB).Retrospective study.Academic reproductive endocrinology and infertility center.All women with karyotypes of chorionic villi isolated from first trimester spontaneous miscarriages at the time of dilation and curettage from 1999 to 2006. The highest basal serum FSH level in the year preceding dilation and curettage was recorded.Monitoring of early pregnancy.Fetal karyotype.A total of 177 spontaneous miscarriages with karyotypes (70 euploid and 107 aneuploid) were identified, of which 53% were conceived by IVF. The aneuploid cohort consisted of trisomic (87%), teraploid (9.3%), and monosomic (3.7%) gestations. Using logistic regression analysis, basal FSH was not found to be independently predictive of an aneuploid gestation in our data set.Our data do not support the hypothesis that an elevated basal FSH concentration is associated with an increase in fetal aneuploidy. Our findings suggest that the association between diminished ovarian reserve and SAB may result from nonkaryotypic factors.

    View details for DOI 10.1016/j.fertnstert.2007.10.041

    View details for Web of Science ID 000261566800047

    View details for PubMedID 18178189

  • Transvaginal ligation of the cervical branches of the uterine artery and injection of vasopressin initial in a cervical pregnancy as an step to controlling hemorrhage - A case report JOURNAL OF REPRODUCTIVE MEDICINE Davis, L. B., Lathi, R. B., Milki, A. A., Dahan, M. H. 2008; 53 (5): 365-368

    Abstract

    Hemorrhage from a cervical pregnancy is a time-sensitive matter. Effective temporization measures for the initial management of this hemorrhage have not previously been reported in the literature.A 43-year-old woman, gravida 0, underwent in vitro fertilization and embryo transfer. She subsequently presented to the office with sudden onset of vaginal hemorrhage due to a cervical pregnancy. Cervical artery sutures were placed, and a cervical vasoconstricting agent was injected, at which point the patient's bleeding stopped. She then underwent successful treatment with dilation and curettage.Conservative measures to manage hemorrhage due to cervical pregnancy can be initiated, with possible rapid establishment of hemostasis until definitive treatment can be achieved.

    View details for Web of Science ID 000256157600012

    View details for PubMedID 18567285

  • Aneuploidy in the miscarriages of infertile women and the potential benefit of preimplanation genetic diagnosis FERTILITY AND STERILITY Lathi, R. B., Westphal, L. M., Milki, A. A. 2008; 89 (2): 353-357

    Abstract

    To evaluate the frequency of specific aneuploidies in miscarriages in an infertility practice and calculate the potential sensitivities of the different aneuploidy screening options for preimplantation genetic diagnosis (PGD) in this setting.Retrospective analysis.Academic reproductive endocrinology and infertility practice.Women with miscarriages that had karyotype analysis on products of conception.None.Karyotype of spontaneous abortions compared with commercially available PGD options.Of the 273 karyotypes analyzed, 177 (64.8%) were abnormal. The average age of the patients was 37 +/- 4.5 years. Using a limited five-probe panel, 54 of the 177 (31%) abnormal karyotypes would have been detected. In contrast, an extended PGD panel (using 9, 10, or 12 chromosome probes) would have detected 127, 131, and 140 of 177 abnormalities, 72%, 74%, and 79% respectively. The difference between the limited (5-probe) and extended (9-, 10-, and 12-probe) panels was statistically significant. There was not a statistically significant difference among the extended panels.Most of the abnormalities seen in miscarriages are detectable by PGD with extended panels. A significantly higher percentage of these abnormalities could be detected by screening for 9, 10, or 12 chromosomes compared with only 5.

    View details for DOI 10.1016/j.fertnstert.2007.02.040

    View details for Web of Science ID 000253246100011

    View details for PubMedID 17509575

  • Elective single blastocyst transfer in women older than 35 FERTILITY AND STERILITY Davis, L. B., Lathi, R. B., Westphal, L. M., Milki, A. A. 2008; 89 (1): 230-231

    Abstract

    A retrospective review of all patients older than 35 who underwent elective single blastocyst transfer was performed. Twenty-three of the 45 patients (51.1%) have an ongoing pregnancy or liveborn delivery, with a mean age of 37.3 years, demonstrating a clear role for elective single transfer in this relatively older IVF population.

    View details for DOI 10.1016/j.fertnstert.2007.02.047

    View details for Web of Science ID 000252498700033

    View details for PubMedID 17509586

  • Cytogenetic testing of anembryonic pregnancies compared to embryonic missed abortions JOURNAL OF ASSISTED REPRODUCTION AND GENETICS Lathi, R. B., Mark, S. D., Westphal, L. M., Milki, A. A. 2007; 24 (11): 521-524

    Abstract

    The objective of this study is to determine the rate of abnormalities detected by cytogenetic testing of first trimester miscarriages, in patients with and without an embryonic pole seen on ultrasound.A retrospective study of 272 D&Cs for missed abortions in an academic infertility practice from 1999 to 2006. Karyotype results were compared with transvaginal ultrasound findings. Chi-squared analysis was used with a P < 0.05 for significance.There was a high rate of abnormal karyotypes in all miscarriages (65%). Rates of abnormal karyotypes were 58% and 68% in cases with anembryonic gestations and those with a fetal pole seen, respectively (P > 0.05).The high rate of abnormalities detected in both groups suggests that useful results can be obtained from chromosomal testing of the POC regardless of ultrasound findings. Further studies on the prognostic value and cost effectiveness of chromosomal testing are needed.

    View details for DOI 10.1007/s10815-007-9166-1

    View details for Web of Science ID 000251425800004

    View details for PubMedID 17899357

  • Preoperative vaginal preparation with baby shampoo compared with povidone-iodine before gynecologic procedures JOURNAL OF MINIMALLY INVASIVE GYNECOLOGY Lewis, L. A., Lathi, R. B., Crochet, P., Nezhat, C. 2007; 14 (6): 736-739

    Abstract

    The objective of this study was to compare the postoperative infection rates between patients receiving either povidone-iodine (PI) or baby shampoo vaginal preparations before gynecologic surgery.Cohort study (Canadian Task Force classification II-2).University referral center for gynecologic endoscopy.All patients underwent minimally invasive gynecologic surgery including hysteroscopy or laparoscopy.The agents used for vaginal preparation were either baby shampoo in a 1:1 dilution with sterile normal saline solution or PI 7.5% scrub solution.Charts were reviewed for evidence of infection within 30 days of surgery (symptoms of urinary tract infection, abdominal or vaginal wound infections, temperature > 100.4 degrees F, and fungal or bacterial vaginitis). A total of 249 cases were collected; 96 subjects underwent surgery before the change to baby shampoo and 153 subjects after. Both groups were well matched for the types of surgery performed, age, risk factors for postoperative infections, and the postoperative diagnosis. The infection rates were 14/96 (14.6%) with PI preparation versus 18/153 (11.8%) with baby shampoo (p = .52).Baby shampoo should be studied as an alternative to PI because it is a nonirritating, inexpensive mild detergent. This preliminary study suggests that baby shampoo is as effective as PI in preventing postoperative infection.

    View details for DOI 10.1016/j.jmig.2007.05.010

    View details for Web of Science ID 000250986900013

    View details for PubMedID 17980335

  • Pelvic pain after gonadotropin administration as a potential sign of endometriosis FERTILITY AND STERILITY Jun, S. H., Lathi, R. B. 2007; 88 (4): 986-987

    Abstract

    We describe five patients who developed significant pelvic pain, requiring narcotics, during a controlled ovarian hyperstimulation cycle and who were surgically diagnosed with significant endometriosis. Severe pain, especially if it requires narcotics, is unusual for patients undergoing controlled ovarian hyperstimulation and may be an indicator of endometriosis.

    View details for DOI 10.1016/j.fertnstert.2006.12.054

    View details for Web of Science ID 000250192800034

    View details for PubMedID 17428478

  • A comparison of letrozole to gonadotropins for ovulation induction, in subjects who failed to conceive with clomiphene citrate FERTILITY AND STERILITY Quintero, R. B., Urban, R., Lathi, R. B., Westphal, L. M., Dahan, M. H. 2007; 88 (4): 879-885

    Abstract

    To compare pregnancy rates (PR) for letrozole and gonadotropins in individuals who failed to conceive with clomiphene citrate (CC).Retrospective cohort study.University reproductive center.Individuals treated with letrozole or gonadotropins who failed to conceive with CC.Controlled ovarian hyperstimulation (COH), transvaginal ultrasound, ovulation induction, IUI.Pregnancy rates per cycle.Among patients who failed to conceive with at least three cycles of CC, gonadotropins had a higher PR per cycle than letrozole. Among individuals who failed to conceive with less than three cycles of CC and whose medications were changed because of thin uterine lining or intolerable side effects, average PR per cycle for letrozole and gonadotropin treatments were equivalent. All patients conceived within three stimulation cycles with either gonadotropins or letrozole.In patients who failed to conceive with CC, gonadotropins have higher PR for ovulation induction than letrozole. However, PR were high enough with letrozole to justify its use in this population of patients. Letrozole and gonadotropins should not be used for more than three cycles without a conception.

    View details for DOI 10.1016/j.fertnstert.2006.11.166

    View details for Web of Science ID 000250192800017

    View details for PubMedID 17920403

  • The effect of infertility medication on thyroid function in hypothyroid women who conceive THYROID Davis, L. B., Lathi, R. B., Dahan, M. H. 2007; 17 (8): 773-777

    Abstract

    To determine whether infertility medications alter thyroid status in patients with treated hypothyroidism, and whether resulting pregnancies require additional thyroid supplementation compared with those conceived spontaneously.Prospective observational study of 18 infertility patients with treated hypothyroidism who conceived between July 2005 and July 2006 with or without infertility medications. Thyroid studies were performed prior to conception, at the time of pregnancy diagnosis, and approximately 6 weeks after an increase in thyroid replacement dose.Orally medicated conceptions were similar to spontaneous conceptions on all thyroid related variables, and therefore the two groups were combined for analysis. Although there was a nonsignificant difference in thyrotropin (TSH) levels postconception (3.8 mIU/L vs. 2.2 mIU/L, p = 0.30), there was no difference in TSH levels after increase in thyroid replacement dose (1.7 mIU/L vs. 1.1 mIU/L, p = 0.30) between patients who conceived after gonadotropin stimulation compared with those who conceived spontaneously or with oral medications. The mean percent dose increases for the nongonadotropin and gonadotropin pregnancy groups were 30.6% and 32.4%, respectively.Hypothyroid patients who conceive after gonadotropin stimulation or with oral medications for ovulation induction do not need additional thyroid supplementation compared with those who conceive spontaneously.

    View details for DOI 10.1089/thy.2007.0065

    View details for Web of Science ID 000249145300011

    View details for PubMedID 17725435

  • Rupture of ectopic pregnancy with minimally detectable beta-human chorionic gonadotropin levels: A report of 2 cases JOURNAL OF REPRODUCTIVE MEDICINE Fu, J., Henne, M. B., Blumstein, S., Lathi, R. B. 2007; 52 (6): 541-542

    Abstract

    Several studies have demonstrated that 25-77% of ectopic pregnancies spontaneously resolve with expectant management. However, expectant management is controversial and should be considered only for patients with small, unruptured gestational sacs, low beta-human chorionic gonadotropin (beta-hCG) levels and absence of symptoms. There is no consensus on how long to follow such patients.Two patients with beta-hCG levels < 10 mIU/mL presented with ruptured ectopic pregnancy and hemoperitoneum.While expectant management of a suspected ectopic pregnancy may allow spontaneous resolution of such an ectopic pregnancy, rupture may occur at any time and even with extremely low beta-hCG levels. Patients need to be counseled about the risks of rupture and symptoms, immediate action should be taken if symptoms develop, and serum beta-hCG levels should be followed to zero.

    View details for Web of Science ID 000247354600017

    View details for PubMedID 17694977

  • Metformin and fetal malformations FERTILITY AND STERILITY Shahine, L., Lathi, R. B., Dahan, M. H. 2007; 87 (5): 1240-1240
  • Risk of monozygotic twinning with blastocyst transfer decreases over time: an 8-year experience FERTILITY AND STERILITY Moayeri, S. E., Behr, B., Lathi, R. B., Westphal, L. M., Milki, A. A. 2007; 87 (5): 1028-1032

    Abstract

    The purpose of our study is to compare the occurrence of monozygotic twinning (MZT) from blastocyst transfer (BT) in our program between an earlier and more recent time period.Retrospective.Academic IVF practice.All pregnancies conceived between March 2002 and December 2005 (N = 932) in our program were compared to pregnancies conceived before March 2002 (N = 554), which were the subject of a previous study.None.The incidence of MZT with day 3 embryo transfer and BT were compared between the study and control groups.During the study period, the rate of MZT was not significantly different for BT at 2.3% (9/385) compared to day 3 embryo transfer at 1.8% (10/547). This rate of 2.3% for BT was significantly lower than the rate of 5.6% (11/197) reported at our institution for BT before March 2002.Our study suggests that the risk of MZT with BT is significantly lower in the more recent time period and is in the range of what is seen with cleavage stage transfer. It is likely that improvements in culture systems as experience is gained with BT played a role.

    View details for DOI 10.1016/j.fertnstert.2006.09.013

    View details for Web of Science ID 000246583600006

    View details for PubMedID 17343858

  • Serum total testosterone levels in a patient with late onset 21-hydroxylase deficiency and a twin gestation FERTILITY AND STERILITY Mains, L. M., Lathi, R. B., Burney, R. O., Dahan, M. H. 2007; 87 (5)

    Abstract

    To present serum androgen levels during pregnancy in a twin gestation complicated by maternal late onset 21-hydroxylase deficiency.Case report.University teaching hospital reproductive endocrinology and infertility practice.A 27-year-old with nonclassic 21-hydroxylase deficiency and infertility, twin female fetuses, and elevated androgens.Steroid replacement.Serum T and 17-hydroxyprogesterone (17-OHP) levels.Elevated androgen levels persisted throughout pregnancy in spite of aggressive steroid replacement. However, twin girls were born without any evidence of virilization.The changes associated with a twin gestation may result in excessive stimulation of androgens in mothers with nonclassic 21-hydroxylase deficiency. However, the increased placental aromatase provides protection.

    View details for DOI 10.1016/j.fertnstert.2006.07.1545

    View details for Web of Science ID 000207688100002

    View details for PubMedID 17418835

  • Effect of reduced oxygen concentrations on the outcome of in vitro fertilization FERTILITY AND STERILITY Kea, B., Gebhardt, J., Watt, J., Westphal, L. M., Lathi, R. B., Milki, A. A., Behr, B. 2007; 87 (1): 213-216

    Abstract

    We compared the effects of two standard oxygen concentrations, physiological (5% O(2), 5% CO(2), and 90% N(2)) and atmospheric (5% CO(2) with the balance as air), on fertilization, embryo development, and pregnancy rate in 106 patients undergoing IVF, excluding donor oocyte cycles and preimplantation genetic diagnosis cycles. The differences in oxygen concentration did not significantly affect fertilization rate, blastocyst formation, or pregnancy rate, but there was a significant difference in mean embryo score between physiological and atmospheric groups on day 3.

    View details for DOI 10.1016/j.fertnstert.2006.05.066

    View details for Web of Science ID 000243436600035

    View details for PubMedID 17081523

  • Night sweats and elevated follicle-stimulating hormone levels while taking selective serotonin reuptake inhibitors OBSTETRICS AND GYNECOLOGY Shahine, L. K., Lathi, R. B. 2006; 108 (3): 741-742

    Abstract

    Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to women with depression and anxiety disorders. Although night sweats are a reported adverse effect, some women have relief of vasomotor symptoms during perimenopausal period while taking them. The relationships between SSRIs, thermoregulation, gonadotropins, and estrogen and their connection to fertility remain unclear.A reproductive-aged woman, seeking treatment for infertility, experienced night sweats and elevated follicle-stimulating hormone levels while taking SSRIs for treatment of depression.Many women of reproductive age are taking SSRIs, but the affect of SSRIs on normal reproductive function is unknown and further research in this area is needed.

    View details for Web of Science ID 000247038500016

    View details for PubMedID 17018486

  • Congenital interruption of the ampullary portion of the fallopian tube FERTILITY AND STERILITY Dahan, M. H., Burney, R., Lathi, R. 2006; 85 (6): 1820-1821

    Abstract

    We present a rare case of a congenital isolated missing segment of the fallopian tube, including hysterosalpingographic and laparoscopic images. We conclude that when this occurs without concomitant müllerian anomalies, the mechanism of development would not be expected to be associated with an increase in renal abnormalities.

    View details for DOI 10.1016/j.fertnstert.2006.01.012

    View details for Web of Science ID 000238427700031

    View details for PubMedID 16678820

  • Predictive value of magnetic resonance imaging in differentiating between leiomyoma and adenomyosis. JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons Moghadam, R., Lathi, R. B., Shahmohamady, B., Saberi, N. S., Nezhat, C. H., Nezhat, F., Nezhat, C. 2006; 10 (2): 216-219

    Abstract

    We evaluated the role of MRI as a preoperative diagnostic tool for leiomyoma and adenomyosis.This is a retrospective chart review at a university-based hospital. The study included 1517 women who underwent hysterectomy or myomectomy over a 5-year period, and 153 women with a preoperative pelvic MRI were included. Comparisons were made between the results of the MRI and postoperative pathology reports.The MRI and pathology report were the same for 136 of 144 women with leiomyoma and 12 of 31 women with adenomyosis. The MRI had 94% sensitivity and 33% specificity for leiomyoma and 38% sensitivity and 91% specificity for adenomyosis. Positive and negative predictive values of MRI for leiomyoma were 95% and 27% with 90% accuracy. Positive and negative predictive values of MRI for adenomyosis were 52% and 85%, respectively, with 80% accuracy.MRI has a high sensitivity and a low specificity for diagnosing leiomyoma and a high specificity and a low sensitivity for diagnosing adenomyosis. Due to the high cost and technical variations, we suggest using MRI only as an adjunctive diagnostic tool when ultrasound is not conclusive and differentiation between the 2 pathologies ultimately affects patient management.

    View details for PubMedID 16882423

  • Role of laparoscopic treatment of endometriosis in patients with failed in vitro fertilization cycles FERTILITY AND STERILITY Littman, E., Giudice, L., Lathi, R., Berker, B., Milki, A., Nezhat, C. 2005; 84 (6): 1574-1578

    Abstract

    To report our experience in patients with previous IVF failures who conceived after laparoscopic treatment of endometriosis.Retrospective case series.Tertiary center IVF and endoscopy programs.Infertility patients with history of prior IVF failures.Laparoscopic evaluation and treatment of endometriosis by the same surgeon.Occurrence of conception after laparoscopic treatment of endometriosis.Of 29 patients with prior IVF failures, 22 conceived after laparoscopic treatment of endometriosis, including 15 non-IVF pregnancies and 7 IVF pregnancies.In the absence of tubal occlusion or severe male factor infertility, laparoscopy may still be considered for the treatment of endometriosis even after multiple IVF failures.

    View details for DOI 10.1016/j.fertnstert.2005.02.059

    View details for Web of Science ID 000234184200002

    View details for PubMedID 16359945

  • The dilemma of endometriosis: is consensus possible with an enigma? FERTILITY AND STERILITY Nezhat, C., Littman, E. D., Lathi, R. B., Berker, B., Westphal, L. M., Giudice, L. C., Milki, A. A. 2005; 84 (6): 1587-1588

    Abstract

    Many will agree that the use of laparoscopy to diagnose and potientially treat endometriosis in patients who suffer from infertility has been superseded by IVF and sometimes oocyte donation, especially in older patients. The findings of our study add another dimension to management of endometriosis in the setting of infertility and emphasize the importance of keeping laparoscopy in the infertility management equation.

    View details for DOI 10.1016/j.fertnstert.2005.06.033

    View details for Web of Science ID 000234184200007

    View details for PubMedID 16359950

  • Dose-dependent insulin regulation of insulin-like growth factor binding protein-1 in human endometrial stromal cells is mediated by distinct signaling pathways JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM Lathi, R. B., Hess, A. P., Tulac, S., Nayak, N. R., Conti, M., Giudice, L. C. 2005; 90 (3): 1599-1606

    Abstract

    IGF binding protein-1 (IGFBP-1) is a major product of decidualized human endometrial stromal cells and decidua, and as a modulator of IGF action and/or by independent mechanisms, it regulates cell growth and differentiation and embryonic implantation in these tissues. IGFBP-1 secretion is primarily stimulated by progesterone and cAMP and is inhibited by insulin and IGFs. The signaling pathways mediating the latter are not well defined, and the current study was conducted to determine which pathways mediate the effects of insulin on IGFBP-1 mRNA and protein expression by human endometrial stromal cells decidualized in vitro by progesterone. Cells were cultured and treated with different combinations of insulin; wortmannin, an inhibitor of the phosphatidylinositide-3-kinase (PI3-kinase) pathway; and PD98059, an inhibitor of the MAPK pathway. IGFBP-1 mRNA was determined by real-time PCR, and protein secretion in the conditioned medium was measured by ELISA. Activation of the PI3-kinase and the MAPK pathways was assessed by the detection of phosphorylated AKT and ERK in Western blots, respectively. Insulin inhibited IGFBP-1 mRNA and protein secretion in a dose-dependent fashion, with an ED(50) for the latter 0.127 ng/ml (21.6 pm). Inhibitor studies revealed that at low doses, insulin acts through the PI3-kinase pathway, whereas at higher levels it also activates the MAPK pathway in the inhibition of IGFBP-1. The data demonstrate that human endometrium is a target for insulin action in the regulation of IGFBP-1. At physiological levels insulin likely plays a homeostatic role for energy metabolism in the endometrium, and in hyperinsulinemic states, insulin action on the endometrium may activate cellular mitosis via the MAPK pathway and perhaps predispose this tissue to hyperplasia and/or cancer.

    View details for DOI 10.1210/jc.2004-1676

    View details for Web of Science ID 000227523600050

    View details for PubMedID 15613433

  • Rate of aneuploidy in miscarriages following in vitro fertilization and intracytoplasmic sperm injection FERTILITY AND STERILITY Lathi, R. B., Milki, A. A. 2004; 81 (5): 1270-1272

    Abstract

    To evaluate the incidence of aneuploidy in miscarriages after IVF and intracytoplasmic sperm injection (ICSI) procedures.Retrospective study.University IVF program.All IVF patients with missed abortions undergoing uterine curettage.Cytogenetic analysis of products of conception (POC).Incidence of aneuploidy in POC.Thirty-two of 59 specimens (54%) reviewed were abnormal. The patients with ICSI were more likely to have aneuploidy identified in their POC than conventional IVF, 76% vs. 41%. The average ages in these groups were similar: 37.1 vs. 37.8 years. There was a trend toward decreased aneuploidy with day 5 compared to day 3 embryo transfers; 38% vs. 63%.We found a significantly higher aneuploidy rate in the abortuses of patients who conceived with ICSI. It is possible that this increased incidence is due to abnormalities in the sperm of patients with ICSI, but could also be partially related to the technique itself.

    View details for DOI 10.1016/j.fertnstert.2003.09.065

    View details for Web of Science ID 000221439400016

    View details for PubMedID 15136088

  • Interferon-related and other immune genes are downregulated in peripheral blood leukocytes in the luteal phase of the menstrual cycle JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM Dosiou, C., Lathi, R. B., Tulac, S., Huang, S. T., Giudice, L. C. 2004; 89 (5): 2501-2504

    Abstract

    Interaction between the endocrine and the immune systems has been suggested by observations of sexual dimorphism of the immune response, differential susceptibility to autoimmunity between the sexes, changes in autoimmune disease activity during the menstrual cycle and in pregnancy and in vitro studies of hormonal influence on cytokine production.We hypothesized that if there is hormonal regulation of the immune response, this would be manifest in peripheral blood leukocytes (PBLs) at different phases of the menstrual cycle. In this study, we describe gene profiling of PBLs from the follicular and luteal phases of the menstrual cycle. We observe important differences in immune gene expression, with significant down-regulation of the Th1 immune response in the luteal phase. A significant number of interferon (IFN)-related genes are amongst the downregulated genes. These results support significant hormonal regulation of the immune system and may have therapeutic implications in diseases of autoimmunity in women.

    View details for DOI 10.1210/jc.2003-031647

    View details for Web of Science ID 000221220100076

    View details for PubMedID 15126584

  • Tissue sampling technique affects accuracy of karyotype from missed abortions JOURNAL OF ASSISTED REPRODUCTION AND GENETICS Lathi, R. B., Milki, A. A. 2002; 19 (11): 536-538

    Abstract

    To determine if careful specimen selection and washing of tissue from first trimester missed abortion products of conception specimens increases the sensitivity of routine cytogenetics in detecting aneuploidy.Retrospective review of cytogenetics results from tissue from dilation and curettage for missed abortion in a university fertility practice between 1998 and 2001. A technique of careful selection and washing of the specimen was implemented in July 1999. Results from before (n = 15) and after (n = 41) this change were compared. Cytogenetics reports from other physicians using the same laboratory were used for comparison (n = 59).The percentage of 46XX results was significantly decreased in the test group when compared to historical and community controls: 29% vs. 73% and 56% respectively. The percentage of aneuploid results was significantly higher in the test group at 61% vs. 7% and 36% in the historical and community controls respectively.Thorough separation and cleaning of villi prior to sending missed abortion specimens significantly increases sensitivity of conventional cytogenetics for detecting aneuploidy by decreasing maternal contamination.

    View details for Web of Science ID 000178996100006

    View details for PubMedID 12484496

  • Recombinant gonadotropins. Current women's health reports Lathi, R. B., Milki, A. A. 2001; 1 (2): 157-163

    Abstract

    Recombinant DNA technology makes it possible to produce large amounts of human gene products for pharmacologic applications, supplanting the need for human tissues. The genes for the alpha and beta subunits of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and human chorionic gonadotropin (hCG) have been characterized and cloned. Recombinant FSH (rFSH) has been shown to be safe and effective in the treatment of fertility disorders. In comparison with the urinary gonadotropin products, human menopausal gonadotropins (HMG), and urinary follitropins (uFSH), rFSH is more potent and better tolerated by patients. Recombinant HCG appears to be as efficacious as urinary HCG with the benefit of improved local tolerance. Recombinant LH (rLH) is likely to be recommended as a supplement to rFSH for ovulation induction in hypogonadotropic women. It may also benefit in vitro fertilization patients undergoing controlled ovarian hyperstimulation with rFSH combined with pituitary suppression, with a gonadotropin-releasing hormone agonist or antagonist.

    View details for PubMedID 12112963

Conference Proceedings


  • Ovarian stimulation and the risk of aneuploid conceptions Massie, J. A., Shahine, L. K., Milki, A. A., Westphal, L. M., Lathi, R. B. ELSEVIER SCIENCE INC. 2011: 970-972

    Abstract

    To examine the rate of aneuploidy in missed abortions in patients who conceived after FSH ovarian stimulation compared with women who conceived in a natural cycle.Retrospective cohort.Academic reproductive endocrinology and infertility center.Women with karyotyping of products of conception (POC) from a missed abortion from January 1999 through August 2007. The rate of aneuploidy was compared between patients with a history of infertility who conceived naturally and patients with a history of infertility who conceived with FSH treatment.Ovarian stimulation with FSH, intrauterine insemination, and in vitro fertilization; genetic testing of POC after dilation and curettage.Embryonic karyotype.A total of 229 pregnancies met inclusion criteria, and of these, 64% had an abnormal karyotype. The rate of aneuploidy was 63% in the study group and 70% in the control group. This difference was not statistically significant.The incidence of embryonic aneuploidy was not higher in pregnancies conceived with FSH stimulation compared with spontaneous conceptions in infertility patients. This suggests that exogenous FSH exposure does not increase the risk of aneuploidy.

    View details for DOI 10.1016/j.fertnstert.2010.07.1088

    View details for Web of Science ID 000287480300024

    View details for PubMedID 20828683

  • CHARACTERIZATION OF A RECURRENT PREGNANCY LOSS GENE EXPRESSION SIGNATURE IN PERIPHERAL BLOOD LEUKOCYTES (PBL). Maas, K. H., Krieg, S., Dosiou, C., Nayak, N., Linda, G. C., Lathi, R. B. ELSEVIER SCIENCE INC. 2010: S47-S47
  • The effect of selective serotonin reuptake inhibitors on in vitro fertilization outcome Friedman, B. E., Rogers, J. L., Shahine, L. K., Westphal, L. M., Lathi, R. B. ELSEVIER SCIENCE INC. 2008: S12-S12
  • Optimal ovarian stimulation protocol for IVF-ET treatment in the patient with endometriosis. Burney, R. O., Henne, M., Jacobson, M. T., Milki, A. A., Westphal, L. M., Lathi, R. B. ELSEVIER SCIENCE INC. 2006: S275-S275
  • Comparison of letrozole to gonadotropins (FSH) for ovulation induction in clomiphene (CC) failures. Wen, Y., Quintero, R. B., Urban, R., Westphal, L. M., Lathi, R. B., Dahan, M. H. ELSEVIER SCIENCE INC. 2006: S24-S25
  • Ruptured ectopic pregnancy with minimally detectable Beta-HCG level. Fu, J., Henne, M. B., Blumstein, S. L., Lathi, R. B. ELSEVIER SCIENCE INC. 2005: S25-S26
  • Changes in cytokine expression in peripheral leukocytes, detected by microarray analysis, in the secretory vs proliferative phase of the menstrual cycle. Lathi, R. B., Tulac, S., Lobo, S. C., Huang, S. T., Giudice, L. C. ELSEVIER SCIENCE INC. 2002: S109-S109

Stanford Medicine Resources: