Bio

Clinical Focus


  • Primary Ovarian Insufficiency
  • Assisted Reproductive Technology
  • Reprod. Endocrinology and Infertility

Academic Appointments


Administrative Appointments


  • Division Chief, Div. Reproductive Endocrinology and Infertility, Dept. Obstetrics and Gynecology Stanford University (2012 - Present)
  • Acting Division Chief, Div. Reproductive Endocrinology and Infertility, Dept. Obstetrics and Gynecology Stanford University (2008 - 2012)
  • Membership Services Committee Co-Chair, Society for Reproductive Endocrinology and Infertility (2011 - Present)
  • Members Practice Retreat Co-Chair, Society for Reproductive Endocrinology and Infertility (2011 - Present)
  • Research Committee Chair, Society for Assisted Reproductive Technologies (2010 - Present)
  • Executive Council, Society for Assisted Reproductive Technologies (2009 - Present)
  • Vice President/ Board of Directors, Rachel's Well (2009 - Present)
  • Medical Director, Stanford Fertility and Reproductive Medicine Center (2007 - Present)
  • Director, Primary Ovarian Insufficiency Program, Stanford Fertility and Reproductive Medicine Center (2009 - Present)
  • Board of Directors, Society for Reproductive Endocrinology and Infertility (2006 - Present)
  • Board of Directors, Pacific Coast Reproductive Society (2006 - 2009)
  • Practice Committee, Society for Reproductive Endocrinology and Infertility (2008 - 2011)
  • Postgraduate Program Chair, American Society for Reproductive Medicine (2007 - 2008)
  • Postgraduate Program Co-Chair, American Society for Reproductive Medicine (2006 - 2007)
  • Postgraduate Program Coordinating Chair, American Society for Reproductive Medicine (2005 - 2006)
  • Stem Cell Research Oversight Committee, Stanford University (2007 - 2009)
  • Medical Director, Fertility Physicians of Northern California (2004 - 2007)
  • Medical Director, University of Washington Assisted Reproductive Technology Program (1999 - 2000)
  • Patient Education Committee, American Society for Reproductive Medicine (1999 - 2005)
  • President, American Medical Women's Association of the South Bay (2004 - 2005)
  • Treasurer, American Medical Women's Association of the South Bay (2003 - 2004)

Honors & Awards


  • Selected for the Stanford Advanced Leadership Program, Stanford University (2012-2013)
  • Selected for the 2012 School of Medicine Faculty Fellows Program, Office of Diversity and Leadership Stanford University (2012)
  • American Society for Reproductive Medicine Star Award, American Society for Reproductive Medicine (2011)
  • American Society for Reproductive Medicine Service Award, American Society for Reproductive Medicine (2010)
  • National Register's Who's Who, National Register's Who's Who (2004)
  • Best Doctors in America, Best Doctors in America (2004-2011)
  • Clinical Research/Reproductive Endocrinology Scientist Scholar, National Institute of Health (2005-2006)
  • American College of Obstetricians and Gynecologists/Ortho Fellowship, American College of Obstetricians and Gynecologists (1994-1995)
  • American College of Obstetricians and Gynecologists/Mead Johnson Fellowship, American College of Obstetricians and Gynecologists (1993-1994)

Professional Education


  • Board Certification: Reprod. Endocrinology and Infertility, American Board of Obstetrics and Gynecology (1998)
  • Fellowship:UCSF Medical Center (1995) CA
  • Residency:UCSF - Department of OB/GYN and REI (1992) CA
  • Board Certification: Obstetrics and Gynecology, American Board of Obstetrics and Gynecology (1996)
  • Medical Education:Harvard Medical School (1988) MA
  • MD, Harvard Medical School, Medicine (1988)
  • Master's, Harvard (Kennedy School of Government), Health Policy (1988)

Research & Scholarship

Current Research and Scholarly Interests


primary ovarian insufficiency, premature ovarian failure, health policy, infertilty, assisted reproductive technology, ovulation induction, hormone therapy

Clinical Trials


  • 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


  • Preimplantation diagnosis for single gene disorders. Seminars in reproductive medicine Berger, V. K., Baker, V. L. 2014; 32 (2): 107-113

    Abstract

    Preimplantation genetic diagnosis (PGD) allows patients who are carriers or who are affected by genetic diseases to select unaffected embryos for transfer before becoming pregnant. The practice of PGD is evolving with rapid advances in technology and biopsy methods. Testing for a specific gene mutation can be performed in combination with 24-chromosome aneuploidy screening. Several unique applications of PGD are reviewed, including exclusion diagnosis for couples from Huntington disease families, testing for fragile X premutations, and human leukocyte antigen matching for stem cell donor siblings. Although PGD for single gene mutations allows patients to gain information about their embryos and perhaps avoid a difficult decision about whether or not to terminate an ongoing pregnancy, this technique also provides for much ethical debate encompassing the well-being of the prospective couple, embryo, child, and people in the community affected by the diseases being screened.

    View details for DOI 10.1055/s-0033-1363552

    View details for PubMedID 24515905

  • Second try: who returns for additional assisted reproductive technology treatment and the effect of a prior assisted reproductive technology birth FERTILITY AND STERILITY Luke, B., Brown, M. B., Wantman, E., Baker, V. L., Grow, D. R., Stern, J. E. 2013; 100 (6): 1580-1584

    Abstract

    To evaluate the effect of a prior assisted reproductive technology (ART) live birth on subsequent live-birth rates.Historical cohort study.Clinic-based data.The study population included 297,635 women with 549,278 cycles from 2004 to 2010 from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System. Try 1 refers to ART cycles up to and including the first live birth, try 2 to ART cycles after a first live birth.None.Live-birth rates by cycle number, try number, and oocyte source.Younger women at try 1 are more likely to return for try 2. Women returning for try 2 were more likely to have had an ART singleton versus multiple birth (33.2% after a try 1 singleton versus 8.1% after twins and 4.9% after triplets) and were less likely to have a diagnosis of diminished ovarian reserve or tubal factors. Live-birth rates were significantly higher for try 2 compared with try 1 for autologous fresh cycles, averaging 7.7 percentage points higher over five cycles. Live-birth rates were not significantly different for try 2 versus try 1 with thawed autologous cycles or either fresh or thawed donor cycles.These results indicate that when fresh autologous oocytes can be used, live-birth rates per cycle are significantly greater after a prior history of an ART live birth.

    View details for DOI 10.1016/j.fertnstert.2013.07.1993

    View details for Web of Science ID 000327533000024

    View details for PubMedID 23987515

  • Primary ovarian insufficiency in the adolescent CURRENT OPINION IN OBSTETRICS & GYNECOLOGY Baker, V. L. 2013; 25 (5): 375-381

    Abstract

    To raise awareness about the importance of early diagnosis of primary ovarian insufficiency (POI) in the adolescent.Menstrual cycle irregularity or amenorrhea in the adolescent has historically been treated with oral contraceptives or ignored, with no evaluation done to determine the cause. However, it is now becoming clear that the health consequences of menstrual irregularities differ depending on the cause, and evaluation to determine the cause of menstrual irregularity is warranted. Although POI is classically diagnosed when menstrual cycle irregularity is accompanied by high circulating levels of gonadotropins and low estradiol, anti-Mullerian hormone is emerging as a biomarker of increasing importance. When POI is diagnosed, further evaluation including karyotype, FMR1 premutation analysis, and 21-hydroxylase or adrenal antibody is warranted. Girls at high risk for the development of POI (e.g. because of planned cancer treatment) should be offered the option of oocyte or ovarian tissue cryopreservation.POI should be ruled out in adolescents with menstrual cycle irregularity. Early diagnosis of POI facilitates the individualization of therapy, as the health consequences of POI differ from those of other causes of menstrual cycle irregularity. In addition, recognition of premature oocyte depletion allows for the option of fertility preservation to be discussed when oocytes are still present.

    View details for DOI 10.1097/GCO.0b013e328364ed2a

    View details for Web of Science ID 000326586300006

    View details for PubMedID 24018874

  • 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

  • Mild ovarian stimulation for in vitro fertilization: one perspective from the USA JOURNAL OF ASSISTED REPRODUCTION AND GENETICS Baker, V. L. 2013; 30 (2): 197-202

    Abstract

    To provide a perspective regarding mild ovarian stimulation, taking into account particular issues relevant in the United StatesLiterature review and editorial commentaryMild ovarian stimulation for IVF has some proven and some theoretical advantages over conventional stimulation, such as lower risk of ovarian hyperstimulation syndrome and lower cost per fresh IVF cycle. However, cumulative live birth rate, including transfers from fresh and frozen embryos, is likely to be lower with mild stimulation. The cost-effectiveness of mild stimulation IVF in the United States has not been established.Mild ovarian stimulation is an appropriate option to consider for certain patient groups or based on patient preference. However, significant potential disadvantages limit its widespread acceptability for patients in the United States at this time.

    View details for DOI 10.1007/s10815-013-9946-8

    View details for Web of Science ID 000315576000005

    View details for PubMedID 23381553

  • Corpus luteal contribution to maternal pregnancy physiology and outcomes in assisted reproductive technologies\ AMERICAN JOURNAL OF PHYSIOLOGY-REGULATORY INTEGRATIVE AND COMPARATIVE PHYSIOLOGY Conrad, K. P., Baker, V. L. 2013; 304 (2): R69-R72

    Abstract

    Investigations in the rat model of pregnancy indicate an important role for the corpus luteal (CL) hormone relaxin in the maternal circulatory and osmoregulatory changes in pregnancy, which are epitomized by profound vasodilation and modest hypoosmolality, respectively. In a pilot study of infertile women who became pregnant through donor eggs, in vitro fertilization, and embryo transfer, the gestational rise in glomerular filtration and fall in plasma osmolality were markedly subdued. Because these women were infertile, they lacked a CL and circulating relaxin (and possibly other vasoactive CL hormones). Based on these findings in pregnant rats and women, we hypothesize that infertile women conceiving through donor eggs will have overall subdued circulatory changes (e.g., attenuated reduction in systemic vascular resistance and subdued increase in cardiac output) particularly during early pregnancy when CL hormones predominate before the full development and maturation of the placenta. In contrast, infertile women conceiving by autologous eggs retrieved after ovarian stimulation and fresh embryo transfer may have a relatively hyperdynamic circulation due to the presence of many CL (up to 20 or more) and higher circulating levels of vasodilatory ovarian hormones such as relaxin. Emerging evidence suggests that women undergoing Assisted Reproductive Technologies (ART) have increased risk for adverse pregnancy outcomes such as preeclampsia and small for gestational-age babies. This increased risk may be partly caused by the maternal milieu, which is not physiological in ART pregnancies due to the abnormal status of the CL.

    View details for DOI 10.1152/ajpregu.00239.2012

    View details for Web of Science ID 000313738800001

    View details for PubMedID 23100030

  • 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

  • Elevated Prevalence of 35-44 FMR1 Trinucleotide Repeats in Women With Diminished Ovarian Reserve REPRODUCTIVE SCIENCES Pastore, L. M., Young, S. L., Baker, V. L., Karns, L. B., Williams, C. D., Silverman, L. M. 2012; 19 (11): 1226-1231

    Abstract

    Fragile X premutations are associated with primary ovarian insufficiency when the patient presents with amenorrhea, but the fragile X mental retardation 1 (FMR1) CGG repeat count among cycling women with low ovarian reserve (diminished ovarian reserve [DOR]) is not yet established.Sixty-two infertile DOR patients were recruited from 4 US private and academic fertility centers.The prevalence of 35-44 FMR1 CGG repeats was 14.5%. Compared with the general female population estimate from the literature, infertile women with DOR were more likely to have 35-44 FMR1 CGG repeats (14.5% and 3.9%, respectively, P = .0003). Similar findings were noted by 5-repeat bandwidth: 35-39 CGG repeats (9.7% DOR vs 3.2% comparison, P = .012) or 40-44 CGG repeats (4.8% DOR vs 0.7% comparison, P = .024).These data suggest that CGG repeats of 35-44 may be markedly overrepresented in women with DOR, whereas the current FMR1 reference range indicates that there is no clinical phenotype with <45 CGG repeats.

    View details for DOI 10.1177/1933719112446074

    View details for Web of Science ID 000309713300011

    View details for PubMedID 22581803

  • High frequency of discordance between antimullerian hormone and follicle-stimulating hormone levels in serum from estradiol-confirmed days 2 to 4 of the menstrual cycle from 5,354 women in U.S. fertility centers FERTILITY AND STERILITY Leader, B., Hegde, A., Baca, Q., Stone, K., Lannon, B., Seifer, D. B., Broekmans, F., Baker, V. L. 2012; 98 (4): 1037-1042

    Abstract

    To determine the frequency of clinical discordance between antimüllerian hormone (AMH, ng/mL) and follicle-stimulating hormone (FSH, IU/L) by use of cut points defined by response to controlled ovarian stimulation in the same serum samples drawn on estradiol-confirmed, menstrual cycle days 2 to 4.Retrospective analysis.Fertility centers in 30 U.S. states and a single reference laboratory with uniform testing protocols.5,354 women, 20 to 45 years of age.None.Frequency of discordance between serum AMH and FSH values.Of the 5,354 women tested, 1 in 5 had discordant AMH and FSH values defined as AMH <0.8 (concerning) with FSH <10 (reassuring) or AMH ? 0.8 (reassuring) with FSH ? 10 (concerning). Of the women with reassuring FSH values (n = 4,469), the concerning AMH values were found in 1 in 5 women in a highly age-dependent fashion, ranging from 1 in 11 women under 35 years of age to 1 in 3 women above 40 years of age. On the other hand, of the women with reassuring AMH values (n = 3,742), 1 in 18 had concerning FSH values, a frequency that did not vary in a statistically significant fashion by age.Clinical discordance in serum AMH and FSH values was frequent and age dependent using common clinical cut points, a large patient population, one reference laboratory, and uniform testing methodology. This conclusion is generalizable to women undergoing fertility evaluation, although AMH testing has not been standardized among laboratories, and the cut points presented are specific to the laboratory in this study.

    View details for DOI 10.1016/j.fertnstert.2012.06.006

    View details for Web of Science ID 000309553500050

    View details for PubMedID 22771028

  • Race matters: a systematic review of racial/ethnic disparity in Society for Assisted Reproductive Technology reported outcomes FERTILITY AND STERILITY Wellons, M. F., Fujimoto, V. Y., Baker, V. L., Barrington, D. S., Broomfield, D., Catherino, W. H., Richard-Davis, G., Ryan, M., Thornton, K., Armstrong, A. Y. 2012; 98 (2): 406-409

    Abstract

    To systematically review the reporting of race/ethnicity in Society for Assisted Reproductive Technology (SART) Clinic Outcome Reporting System (CORS) publications.Systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology of literature published in PubMed on race/ethnicity that includes data from SART CORS.Not applicable.Not applicable.In vitro fertilization cycles reported to SART.Any outcomes reported in SART CORS.Seven publications were identified that assessed racial/ethnic disparities in IVF outcomes using SART data. All reported a racial/ethnic disparity. However, more than 35% of cycles were excluded from analysis because of missing race/ethnicity data.Review of current publications of SART data suggests significant racial/ethnic disparities in IVF outcomes. However, the potential for selection bias limits confidence in these findings, given that fewer than 65% of SART reported cycles include race/ethnicity. Our understanding of how race/ethnicity influences ART outcome could be greatly improved if information on race/ethnicity was available for all reported cycles.

    View details for DOI 10.1016/j.fertnstert.2012.05.012

    View details for Web of Science ID 000306975400026

    View details for PubMedID 22698638

  • Executive summary of the Stages of Reproductive Aging Workshop+10: addressing the unfinished agenda of staging reproductive aging FERTILITY AND STERILITY Harlow, S. D., Gass, M., Hall, J. E., Lobo, R., Maki, P., Rebar, R. W., Sherman, S., Sluss, P. M., de Villiers, T. J. 2012; 97 (4): 843-851

    Abstract

    The aim of this article is to summarize the recommended updates to the 2001 Stages of Reproductive Aging Workshop (STRAW) criteria. The 2011 STRAW + 10 reviewed advances in understanding of the critical changes in hypothalamic-pituitary-ovarian function that occur before and after the final menstrual period.Scientists from five countries and multiple disciplines evaluated data from cohort studies of midlife women and in the context of chronic illness and endocrine disorders on change in menstrual, endocrine, and ovarian markers of reproductive aging including antimüllerian hormone, inhibin-B, follicle-stimulating hormone, and antral follicle count. Modifications were adopted by consensus.STRAW + 10 simplified bleeding criteria for the early and late menopausal transition, recommended modifications to criteria for the late reproductive stage (Stage -3) and the early postmenopause stage (Stage +1), provided information on the duration of the late transition (Stage -1) and early postmenopause (Stage +1), and recommended application regardless of women's age, ethnicity, body size, or lifestyle characteristics.STRAW + 10 provides a more comprehensive basis for assessing reproductive aging in research and clinical contexts. Application of the STRAW + 10 staging system should improve comparability of studies of midlife women and facilitate clinical decision making. Nonetheless, important knowledge gaps persist, and seven research priorities are identified.

    View details for DOI 10.1016/j.fertnstert.2012.01.128

    View details for Web of Science ID 000302143500013

    View details for PubMedID 22341880

  • Executive summary of the Stages of Reproductive Aging Workshop+10: addressing the unfinished agenda of staging reproductive aging MENOPAUSE-THE JOURNAL OF THE NORTH AMERICAN MENOPAUSE SOCIETY Harlow, S. D., Gass, M., Hall, J. E., Lobo, R., Maki, P., Rebar, R. W., Sherman, S., Sluss, P. M., de Villiers, T. J. 2012; 19 (4): 387-395

    Abstract

    The aim of this article is to summarize the recommended updates to the 2001 Stages of Reproductive Aging Workshop (STRAW) criteria. The 2011 STRAW + 10 reviewed advances in understanding of the critical changes in hypothalamic-pituitary-ovarian function that occur before and after the final menstrual period.Scientists from five countries and multiple disciplines evaluated data from cohort studies of midlife women and in the context of chronic illness and endocrine disorders on change in menstrual, endocrine, and ovarian markers of reproductive aging including antimüllerian hormone, inhibin-B, follicle-stimulating hormone, and antral follicle count. Modifications were adopted by consensus.STRAW + 10 simplified bleeding criteria for the early and late menopausal transition, recommended modifications to criteria for the late reproductive stage (Stage -3) and the early postmenopause stage (Stage +1), provided information on the duration of the late transition (Stage -1) and early postmenopause (Stage +1), and recommended application regardless of women's age, ethnicity, body size, or lifestyle characteristics.STRAW + 10 provides a more comprehensive basis for assessing reproductive aging in research and clinical contexts. Application of the STRAW + 10 staging system should improve comparability of studies of midlife women and facilitate clinical decision making. Nonetheless, important knowledge gaps persist, and seven research priorities are identified.

    View details for DOI 10.1097/gme.0b013e31824d8f40

    View details for Web of Science ID 000302141700005

    View details for PubMedID 22343510

  • Executive summary of the Stages of Reproductive Aging Workshop+10: addressing the unfinished agenda of staging reproductive aging CLIMACTERIC Harlow, S. D., Gass, M., Hall, J. E., Lobo, R., Maki, P., Rebar, R. W., Sherman, S., Sluss, P. M., de Villiers, T. J. 2012; 15 (2): 105-114

    Abstract

    The aim of this article is to summarize the recommended updates to the 2001 Stages of Reproductive Aging Workshop (STRAW) criteria. The 2011 STRAW +10 reviewed advances in understanding of the critical changes in hypothalamic-pituitary-ovarian function that occur before and after the final menstrual period.Scientists from five countries and multiple disciplines evaluated data from cohort studies of midlife women and in the context of chronic illness and endocrine disorders on change in menstrual, endocrine, and ovarian markers of reproductive aging including antimüllerian hormone, inhibin-B, follicle-stimulating hormone, and antral follicle count. Modifications were adopted by consensus.STRAW +10 simplified bleeding criteria for the early and late menopausal transition, recommended modifications to criteria for the late reproductive stage (Stage -3) and the early postmenopause stage (Stage +1), provided information on the duration of the late transition (Stage -1) and early postmenopause (Stage +1), and recommended application regardless of women's age, ethnicity, body size, or lifestyle characteristics.STRAW +10 provides a more comprehensive basis for assessing reproductive aging in research and clinical contexts. Application of the STRAW +10 staging system should improve comparability of studies of midlife women and facilitate clinical decision making. Nonetheless, important knowledge gaps persist, and seven research priorities are identified.

    View details for DOI 10.3109/13697137.2011.650656

    View details for Web of Science ID 000301532500002

    View details for PubMedID 22338612

  • Executive Summary of the Stages of Reproductive Aging Workshop+10: Addressing the Unfinished Agenda of Staging Reproductive Aging JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM Harlow, S. D., Gass, M., Hall, J. E., Lobo, R., Maki, P., Rebar, R. W., Sherman, S., Sluss, P. M., de Villiers, T. J. 2012; 97 (4): 1159-1168

    Abstract

    The aim of this article is to summarize the recommended updates to the 2001 Stages of Reproductive Aging Workshop (STRAW) criteria. The 2011 STRAW + 10 reviewed advances in understanding of the critical changes in hypothalamic-pituitary-ovarian function that occur before and after the final menstrual period.Scientists from five countries and multiple disciplines evaluated data from cohort studies of midlife women and in the context of chronic illness and endocrine disorders on change in menstrual, endocrine, and ovarian markers of reproductive aging including antimüllerian hormone, inhibin-B, follicle-stimulating hormone, and antral follicle count. Modifications were adopted by consensus.STRAW + 10 simplified bleeding criteria for the early and late menopausal transition, recommended modifications to criteria for the late reproductive stage (Stage -3) and the early postmenopause stage (Stage +1), provided information on the duration of the late transition (Stage -1) and early postmenopause (Stage +1), and recommended application regardless of women's age, ethnicity, body size, or lifestyle characteristics.STRAW + 10 provides a more comprehensive basis for assessing reproductive aging in research and clinical contexts. Application of the STRAW + 10 staging system should improve comparability of studies of midlife women and facilitate clinical decision making. Nonetheless, important knowledge gaps persist, and seven research priorities are identified.

    View details for DOI 10.1210/jc.2011-3362

    View details for Web of Science ID 000302787800041

    View details for PubMedID 22344196

  • 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

  • An assessment of female university students' attitudes toward screening technologies for ovarian reserve FERTILITY AND STERILITY Bavan, B., Porzig, E., Baker, V. L. 2011; 96 (5): 1195-1199

    Abstract

    To assess female university students' attitudes toward screening technologies for ovarian reserve and their potential influence on career and family planning decisions.Online survey.Not applicable.Respondents from 4 universities in Northern California.None.Proportion with interest in screening technologies for ovarian reserve.Of the 328 respondents, 79% were interested in learning about the current status of their ovarian reserve. Hypothetically, if informed that ovarian reserve was very low, 53% would consider oocyte cryopreservation (even when informed that it is experimental); however, only 29% would consider stopping educational or professional pursuits to focus on conceiving. Participants also demonstrated gaps in knowledge, believing that the decline in ovarian reserve starts later than it actually does, that diet and nutrition can preserve ovarian reserve, and that infertility treatments are highly effective regardless of how severe the depletion of the egg supply is.Women attending universities are interested in assessing their own ovarian reserve. Gaps in knowledge about ovarian reserve exist among these reproductive-aged women.

    View details for DOI 10.1016/j.fertnstert.2011.08.018

    View details for Web of Science ID 000296572000031

    View details for PubMedID 21924717

  • Use of preimplantation genetic diagnosis and preimplantation genetic screening in the United States: a Society for Assisted Reproductive Technology Writing Group paper FERTILITY AND STERILITY Ginsburg, E. S., Baker, V. L., Racowsky, C., Wantman, E., Goldfarb, J., Stern, J. E. 2011; 96 (4): 865-868

    Abstract

    To comprehensively report Society for Assisted Reproductive Technology (SART) member program usage of preimplantation genetic testing (PGT), preimplantation genetic diagnosis (PGD) for diagnosis of specific conditions, and preimplantation genetic screening for aneuploidy (PGS).Retrospective study.United States SART cohort data.Women undergoing a PGT cycle in which at least one embryo underwent biopsy.PGT.PGT use, indications, and delivery rates.Of 190,260 fresh, nondonor assisted reproductive technology (ART) cycles reported to SART CORS in 2007-2008, 8,337 included PGT. Of 6,971 cycles with a defined indication, 1,382 cycles were for genetic diagnosis, 3,645 for aneuploidy screening (PGS), 527 for translocation, and 1,417 for elective sex election. Although the total number of fresh, autologous cycles increased by 3.6% from 2007 to 2008, the percentage of cycles with PGT decreased by 5.8% (4,293 in 2007 and 4,044 in 2008). As a percentage of fresh, nondonor ART cycles, use dropped from 4.6% (4,293/93,433) in 2007 to 4.2% (4,044/96,827) in 2008. The primary indication for PGT was PGS: cycles performed for this indication decreased (-8.0%). PGD use for single-gene defects (+3.2%), elective sex selection (+5.3%), and translocation analysis (+0.5%) increased. PGT usage varied significantly by geographical region.PGT usage in the United States decreased between 2007 and 2008 owing to a decrease in PGS. Use of elective sex selection increased. High transfer cancellation rates correlated with reduced live-birth rates for some PGT indications.

    View details for DOI 10.1016/j.fertnstert.2011.07.1139

    View details for Web of Science ID 000295938800022

    View details for PubMedID 21872229

  • Life Plans and Family-Building Options for Women with Primary Ovarian Insufficiency SEMINARS IN REPRODUCTIVE MEDICINE Baker, V. 2011; 29 (4): 362-372

    Abstract

    Primary ovarian insufficiency (POI) compromises a woman's chance of conceiving with her own oocytes. Although biomarkers such as serum follicle-stimulating hormone, serum antimüllerian hormone, and assessment of antral follicle count by transvaginal ultrasound can give some general idea about ovarian activity and perhaps fertility potential, no marker will definitively predict if and when childbearing will be possible for women with POI. No medical therapy has yet been definitively proven to improve ovarian function and fertility for women with overt POI. Fertility preservation, with cryopreservation of ovarian tissue, oocytes, or embryos, can be considered for some women with POI if oocytes are retrievable and current childbearing is not desired, with the caveat that data regarding long-term safety and efficacy are not available for women with POI. Options with a high chance of success are oocyte donation, embryo donation, and adoption. Child-free living may be a reasonable choice for some women. It is beneficial for women with POI to hear all life-plan and family-building options presented in a balanced manner.

    View details for DOI 10.1055/s-0031-1280921

    View details for Web of Science ID 000294138600010

    View details for PubMedID 21969270

  • The time is now for a new approach to primary ovarian insufficiency FERTILITY AND STERILITY Cooper, A. R., Baker, V. L., Sterling, E. W., Ryan, M. E., Woodruff, T. K., Nelson, L. M. 2011; 95 (6): 1890-1897

    Abstract

    To articulate the need for a new approach to primary ovarian insufficiency. The condition, also known as premature menopause or premature ovarian failure, is defined by the presence of menopausal-level serum gonadotropins in association with irregular menses in adolescent girls or women younger than 40 years. It can be iatrogenic as related to cancer therapy or may arise spontaneously, either alone or as part of a host of ultrarare syndromes. In a large percentage of spontaneous cases no pathogenic mechanism can be identified.Literature review and consensus building at a multidisciplinary scientific workshop.There are major gaps in knowledge regarding the etiologic mechanisms, psychosocial effects, natural history, and medical and psychosocial management of primary ovarian insufficiency. An international research consortium and disease registry formed under the guidance of an umbrella organization would provide a pathway to comprehensively increase basic and clinical knowledge about the condition. Such a consortium and patient registry also would provide clinical samples and clinical data with a goal toward defining the specific pathogenic mechanisms. An international collaborative approach that combines the structure of a patient registry with the principles of integrative care and community-based participatory research is needed to advance the field of primary ovarian insufficiency.

    View details for DOI 10.1016/j.fertnstert.2010.01.016

    View details for Web of Science ID 000289620900007

    View details for PubMedID 20188353

  • Age-specific serum anti-Mullerian hormone values for 17,120 women presenting to fertility centers within the United States FERTILITY AND STERILITY Seifer, D. B., Baker, V. L., Leader, B. 2011; 95 (2): 747-750

    Abstract

    To determine age-specific serum anti-Müllerian hormone (AMH) values for women presenting to U.S. fertility clinics.Retrospective study.Single clinical reference laboratory.A total of 17,120 women of reproductive age ranging from 24 to 50 years old.None.Determination of single-year median and mean AMH values with SDs.Single-year-specific median, mean, and SD values are summarized in Table 1. Both median and mean AMH values decreased steadily in a manner highly correlated with advancing age. The average yearly decrease in the median serum AMH value was 0.2 ng/mL/year through age 35 and then diminished to 0.1 ng/mL/year after age 35. The rate of decline in mean AMH values was 0.2 ng/mL/year through age 40 and then diminished to 0.1 ng/mL/year thereafter.Median and mean AMH levels decreased steadily with increasing age from 24 to 50 years of age. Such data may be of value to physicians and their patients who are considering reproductive options.

    View details for DOI 10.1016/j.fertnstert.2010.10.011

    View details for Web of Science ID 000286419000066

    View details for PubMedID 21074758

  • 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

  • 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

  • Inter-laboratory validation of the measurement of follicle stimulating hormone (FSH) after various lengths of frozen storage REPRODUCTIVE BIOLOGY AND ENDOCRINOLOGY Scriver, J., Baker, V. L., Young, S. L., Behr, B., Pastore, L. M. 2010; 8

    Abstract

    Serum follicle stimulating hormone (FSH) levels are used clinically to evaluate infertility, pituitary and gonadal disorders. With increased frequency of research collaborations across institutions, it is essential that inter-laboratory validation is addressed.An inter-laboratory validation of three commercial FSH immunoassays was performed with human serum samples of varying frozen storage length (2 batches of 15 samples each) at -25 degree C. Percentage differences and Bland-Altman limits of agreement were calculated.The inter- and intra-laboratory consistency of FSH values with the same assay manufacturer was much higher after shorter-term storage (frozen for less than 11 months, mean percentage degradation less than 4%) than after long-term storage (2-3 years, mean percentage degradation = 23%). Comparing assay results from different manufacturers, there was similar overall long term degradation as seen with the same manufacturer (-25%), however the degradation was greater when the original FSH was greater than 20 mIU/mL relative to less than 10 mIU/mL (p < 0.001 trend test).The findings suggest that degradation of serum samples stored between 11 months and 2-3 years at -25 degrees C can lead to unstable FSH measurements. Inter-laboratory variability due to frozen storage time and manufacturer differences in assay results should be accounted for when designing and implementing research or clinical quality control activities involving serum FSH at multiple study sites.

    View details for DOI 10.1186/1477-7827-8-145

    View details for Web of Science ID 000285635900001

    View details for PubMedID 21114859

  • The impact on ovarian reserve after laparoscopic ovarian cystectomy versus three-stage management in patients with endometriomas: a prospective randomized study FERTILITY AND STERILITY Lewis, M., Baker, V., Nezhat, C. 2010; 94 (6): E81-E82
  • Multivariate analysis of factors affecting probability of pregnancy and live birth with in vitro fertilization: an analysis of the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System FERTILITY AND STERILITY Baker, V. L., Luke, B., Brown, M. B., Alvero, R., Frattarelli, J. L., Usadi, R., Grainger, D. A., Armstrong, A. Y. 2010; 94 (4): 1410-1416

    Abstract

    To evaluate factors predictive of clinical pregnancy and of pregnancy loss from assisted reproductive technology (ART) using data from the Society for Assisted Reproductive Technology database for 2004-2006.Retrospective cohort.Clinic-based data.The study population included 225,889 fresh embryo transfer cycles using autologous oocytes and partner semen.None.Clinical intrauterine gestation (presence of gestational sac) and live birth (>or=22 weeks gestation and >or=300 g birth weight).Increasing maternal age was significantly associated with a reduced odds of conception and increased fetal loss until 19 weeks gestation, but not with later pregnancy loss. Intracytoplasmic sperm injection (ICSI), assisted hatching, and increasing number of embryos transferred had significant positive effects on the odds of conception and pregnancy continuation through the first trimester, but did not affect the risk of later loss. Blacks, Asians, and Hispanics had significantly lower odds of clinical pregnancy compared with whites. Also compared with whites, Hispanics and Asians had a significantly greater risk of pregnancy loss in the second and third trimesters, and blacks had a significantly greater risk of pregnancy loss in all trimesters.Certain demographic and ART treatment parameters influenced chance of conception and early pregnancy loss, whereas black race and Hispanic ethnicity were also significantly associated with late pregnancy loss in ART-conceived pregnancies.

    View details for DOI 10.1016/j.fertnstert.2009.07.986

    View details for Web of Science ID 000281674600041

    View details for PubMedID 19740463

  • Factors affecting success rates in two concurrent clinical IVF trials: an examination of potential explanations for the difference in pregnancy rates between the United States and Europe FERTILITY AND STERILITY Baker, V. L., Jones, C. E., Cometti, B., Hoehler, F., Salle, B., Urbancsek, J., Soules, M. R. 2010; 94 (4): 1287-1291

    Abstract

    To compare a US clinical trial of gonadotropin therapy for IVF with a similar European trial to determine what factors may explain the higher clinical pregnancy rate in the US trial.Comparison of baseline, treatment, and outcome variables in the United States (US) and European trials.IVF practices in the US (n=4) and Europe (n=6).297 women undergoing IVF.None.Clinical pregnancy rate.Clinical pregnancy rates were 43.4% in the US compared with 29.7% in Europe (p=0.016), with a live birth rate of 38.2% versus 27.6% (p=0.064). This difference in clinical pregnancy rate could not be explained by differences in the US versus Europe for number of embryos transferred (2.3 vs. 2.6) or female age (34.6 vs. 30.4). Although the starting dose of gonadotropin was higher in the US trial compared with the European trial (300 versus 225 IU), the total dose of gonadotropin was only slightly higher in the US. In multiple logistic regression analysis of 81 pretransfer variables on clinical pregnancy, the only two found to be significant predictors of outcome were baseline endometrial thickness following down-regulation and number of days of gonadotropin treatment.This study suggests the possibility that US pregnancy rates may be higher in part because of differences in down-regulation or gonadotropin dosing. Other factors not assessed in these studies or in national datasets likely also contribute to the difference in pregnancy rates.

    View details for DOI 10.1016/j.fertnstert.2009.07.1673

    View details for Web of Science ID 000281674600021

    View details for PubMedID 19815197

  • A cost-benefit analysis of preimplantation genetic diagnosis for carrier couples of cystic fibrosis FERTILITY AND STERILITY Davis, L. B., Champion, S. J., Fair, S. O., Baker, V. L., Garber, A. M. 2010; 93 (6): 1793-1804

    Abstract

    To perform a cost-benefit analysis of preimplantation genetic diagnosis (PGD) for carrier couples of cystic fibrosis (CF) compared with the alternative of natural conception (NC) followed by prenatal testing and termination of affected pregnancies.Cost-benefit analysis using a decision analytic model.Outpatient reproductive health practices.A simulated cohort of 1,000 female patients.We calculated the net benefit of giving birth to a child as the present value of lifetime earnings minus lifetime medical costs.Net benefits in dollars.When used for women younger than 35 years of age, the net benefit of PGD over NC was $182,000 ($715,000 vs. $532,000, respectively). For women aged 35-40 years, the net benefit of PGD over NC was $114,000 ($634,000 vs. $520,000, respectively). For women older than 40 years, however, the net benefit of PGD over NC was -$148,000 ($302,000 vs. $450,000, respectively).Preimplantation genetic diagnosis provides net economic benefits when used by carrier couples of CF. Although there is an upper limit of maternal age at which economic benefit can be demonstrated, carrier couples of CF should be offered PGD for prevention of an affected child.

    View details for DOI 10.1016/j.fertnstert.2008.12.053

    View details for Web of Science ID 000276678100010

    View details for PubMedID 19439290

  • The sex ratio of singleton offspring in assisted-conception pregnancies FERTILITY AND STERILITY Luke, B., Brown, M. B., Grainger, D. A., Baker, V. L., Ginsburg, E., Stern, J. E. 2009; 92 (5): 1579-1585

    Abstract

    To evaluate the effect of intracytoplasmic sperm injection (ICSI) and male factor infertility on the sex ratio in births from assisted reproductive technology.Historic cohort study.Clinic-based data.The study population included 15,164 singleton live births in the Society for Assisted Reproductive Technology national database for 2005 from cycles using ejaculated sperm, categorized by the use of insemination or ICSI and the absence or presence of male factor infertility, and cleavage- versus blastocyst-stage embryo transfers (ETs).None.The probability of a male infant with and without the use of ICSI and in the presence or absence of male factor infertility.The sex ratio for all U.S. live births in 2005 was 52.5%, versus 48.9% for cleavage-stage and 51.6% for blastocyst-stage embryos. With blastocyst-stage embryos, the sex ratios were 49.6% and 54.9% with and without ICSI and 52.6% and 50.0% with and without male factor infertility, respectively. With cleavage-stage embryos, the sex ratio was not significantly affected by ICSI or male factor infertility, singly or in combination.The use of ICSI, particularly with blastocyst-stage embryos, is associated with a decrease in the sex ratio of male infants.

    View details for DOI 10.1016/j.fertnstert.2008.08.107

    View details for Web of Science ID 000271710200015

    View details for PubMedID 18950756

  • 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

  • Instructing an Embryonic Stem Cell-Derived Oocyte Fate: Lessons from Endogenous Oogenesis ENDOCRINE REVIEWS Nicholas, C. R., Chavez, S. L., Baker, V. L., Pera, R. A. 2009; 30 (3): 264-283

    Abstract

    Female reproductive potential is limited in the majority of species due to oocyte depletion. Because functional human oocytes are restricted in number and accessibility, a robust system to differentiate oocytes from stem cells would enable a thorough investigation of the genetic, epigenetic, and environmental factors affecting human oocyte development. Also, the differentiation of functional oocytes from stem cells may permit the success of human somatic cell nuclear transfer for reprogramming studies and for the production of patient-specific embryonic stem cells (ESCs). Thus, ESC-derived oocytes could ultimately help to restore fertility in women. Here, we review endogenous and ESC-derived oocyte development, and we discuss the potential and challenges for differentiating functional oocytes from ESCs.

    View details for DOI 10.1210/er.2008-0034

    View details for Web of Science ID 000265979000006

    View details for PubMedID 19366753

  • Clinical efficacy of highly purified urinary FSH versus recombinant FSH in volunteers undergoing controlled ovarian stimulation for in vitro fertilization: a randomized, multicenter, investigator-blind trial FERTILITY AND STERILITY Baker, V. L., Fujimoto, V. Y., Kettel, L. M., Adamson, G. D., Hoehler, F., Jones, C. E., Soules, M. R. 2009; 91 (4): 1005-1011

    Abstract

    To compare the efficacy of highly purified human urinary follicle stimulating hormone (HP-hFSH) versus human recombinant follitropin-alpha (rFSH) in volunteers undergoing controlled ovarian stimulation for IVF.A randomized, controlled, investigator-blind trial.Four assisted reproductive technology centers.One hundred fifty-two IVF patients.Volunteers, aged 18-39, were randomized to HP-hFSH (n = 76) versus rFSH (n = 76) at a starting dose of 300 IU in down-regulated cycles.Number of oocytes, clinical pregnancy rate, and live birth rate with HP-hFSH versus rFSH.The total IU of gonadotropin used did not differ between the two groups. There was no difference in number of oocytes retrieved with HP-hFSH (mean = 16.3) compared with rFSH (mean = 17.1), confidence interval (CI) of difference = -3.79 to +2.18. Clinical pregnancy rate, as defined by the presence of a gestational sac, was 48.7% (CI = 37.0%-60.4%) with HP-hFSH versus 44.7% (CI = 33.3%-56.6%) with rFSH (CI of difference = -11.9% to +19.8%). Live birth rate was 38.2% (29 of 76) in both groups (CI = 27.2%-50.0%), for a difference between groups of 0.0% (CI of the difference = -15.4% to +15.4%).There were no statistically significant differences in mean oocyte number, clinical pregnancy rate, or live birth rate between HP-hFSH versus rFSH.

    View details for DOI 10.1016/j.fertnstert.2008.01.064

    View details for Web of Science ID 000265132300007

    View details for PubMedID 18367182

  • Balancing the professional and personal FERTILITY AND STERILITY Armstrong, A. Y., Alvero, R. J., Dunlow, S., Nace, M. C., Baker, V., Stewart, E. A. 2009; 91 (1): 18-21

    Abstract

    To review the common roles that physicians pursue away from work and identify related challenges and potential solutions, so that individuals can develop a personalized plan for success in each of the areas.Literature review.University-based and university-affiliated medical centers.No subjects were involved in this literature review.Literature searches in Entrez PubMed and the following Websites: http://www.apgo.org, http://www.psychiatrictimes.com, as well as other data sources.Results of physician surveys and summaries of strategies for achieving work-personal life balance.According to surveys of physicians in various specialties, a majority of physicians have high levels of job, marital, and parental satisfaction. However, professional and personal challenges faced by physicians include struggle with time management, lack of mentorship, and difficulty maintaining intimate relationships. Multiple potentially effective strategies have been described in the literature, including exerting control over hours worked, taking a long view of life that acknowledges the need for changing priorities over time, developing communication skills, seeking counseling services if needed that focus on physician relationships, and simplifying home life whenever possible.Although there are unique challenges in being a physician, partner, and parent, many of the professional challenges faced by physicians are common to many adults in the United States. Self-assessment may help individuals to clarify priorities and develop strategies that can lead to improved personal satisfaction.

    View details for DOI 10.1016/j.fertnstert.2007.10.064

    View details for Web of Science ID 000262396700002

    View details for PubMedID 18191125

  • Genetic evaluation of oocyte donors: recipient couple preferences and outcome of testing FERTILITY AND STERILITY Baker, V. L., Rone, H. M., Adamson, G. D. 2008; 90 (6): 2091-2098

    Abstract

    To report preferences of recipient couples for genetic testing of their oocyte donors.Observational report of results from a genetic testing-options form implemented as part of routine care.Private practice.Recipients and oocyte donors.Recipient couples completed a form before screening of their oocyte donor that outlined required screening and recommended tests that the couple could accept or decline. Couples were given information about carrier frequency, risk to their child if results were abnormal, and cost.Percentage of couples accepting optional testing.Of the 63 couples with data available from their first testing-options form, 42 (67%) accepted and 21 (33%) declined fragile X testing, whereas 34 (54%) accepted and 29 (46%) declined karyotyping. When asked whether they would accept additional testing of their donor if it was recommended by a genetic counselor, 15 (24%) said that they would accept additional testing regardless of cost, 35 (56%) declined, and 13 (20%) indicated that their decision would depend on the cost. In many cases, history was elicited by the genetic counselor or test results were obtained that influenced further testing, decisions to proceed, or provided information important for the child.Recipient couples sometimes chose to decline tests that we recommended but did not require, despite the relatively low cost of this testing compared with the total cost of the oocyte donation cycle.

    View details for DOI 10.1016/j.fertnstert.2007.10.069

    View details for Web of Science ID 000261566800008

    View details for PubMedID 18249390

  • Economic cost for implementation of the US Food and Drug Administration's Code of Federal Regulations Title 21, Part 1271 in an egg donor program FERTILITY AND STERILITY Baker, V. L., Gvakharia, M. O., Rone, H. M., Manalad, J. R., Adamson, D. 2008; 90 (3): 537-545

    Abstract

    To assess the economic cost of implementing the U.S. Food and Drug Administration's Code of Federal Regulations Title 21, Part 1271 for infectious screening of egg donors in our practice during the first year.Physicians and employees of our practice were surveyed to ascertain the scope of duties and the number of hours spent to implement the regulations. The economic cost to the practice and the cost of additional laboratories were calculated.Private practice.Egg donors and recipient couples who underwent treatment in our center from May 25, 2005 (the day regulations became effective) to May 25, 2006; and physicians, administrators, and staff who were employed by the practice during this time frame.Using a questionnaire, structured interviews were conducted for all physicians and employees of our practice. The information regarding number of hours was provided to our chief financial officer, who calculated the cost to the practice. The cost that recipient couples paid for laboratory tests that would not otherwise be required to meet American Society for Reproductive Medicine guidelines and the cost of an external audit were also added to the overall practice costs to determine a total cost associated with the regulations in the first year.List of activities associated with implementation of the regulations, personnel hours involved to implement the regulations, and economic cost to the practice and to recipient couples.The total number of personnel hours spent by our practice in preparation for implementation of the regulations was 623.3 hours. In the first year, 675.2 additional hours were required to implement the regulations for 40 donors who cycled during this time. The economic cost to the practice for both preparation and implementation of the regulations was $219, 838, and the cost of additional laboratory work borne by the recipient couples was $15,880. Thus, the total cost was calculated to be $235,718 at 1 year after implementation of the regulations.Implementation of the FDA 21 CFR, Part 1271 was associated with a very high economic cost, even if the costs incurred by the government to develop and implement the regulation are excluded.

    View details for DOI 10.1016/j.fertnstert.2007.06.100

    View details for Web of Science ID 000259317200011

    View details for PubMedID 17953961

  • Use of progesterone in three challenging cases. Sexuality, Reproduction, and Menopause Carson S, Baker VL, Liu J, Wysocki S 2008: S30-36
  • A new SERM on the horizon. Female Patient Baker VL 2008; 33: 15-19
  • Correlation of thyroid stimulating hormone (TSH) level with pregnancy outcome in women undergoing in vitro fertilization AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY Baker, V. L., Rone, H. M., Pasta, D. J., Nelson, H. P., Gvakharia, M., Adamson, G. D. 2006; 194 (6): 1668-1674

    Abstract

    The aim of this study was to determine if pregnancy outcome for women undergoing in vitro fertilization is correlated with pre-conception thyroid-stimulating hormone level.We performed a retrospective cohort study of in vitro fertilization cycles in our private practice with an initial positive serum human chorionic gonadotropin level and thyroid-stimulating hormone level available (n = 364). We examined whether or not birth outcome differed between cycles in which the thyroid-stimulating hormone was > 2.5 mIU/L compared with cycles with a thyroid-stimulating hormone level of < or = 2.5 mIU/L. Logistic regression was used to determine the association between thyroid-stimulating hormone level and spontaneous abortion rate.Delivery outcome was available for 195 cycles, 36% of which had a thyroid-stimulating hormone level > 2.5. The gestational age at delivery was higher in cycles with a thyroid-stimulating hormone < or = 2.5 than for cycles with a thyroid-stimulating hormone > 2.5 (38.5 vs 38.0 weeks for singletons, 36.0 vs 34.6 weeks for twins, overall P = .012 for thyroid-stimulating hormone level). The mean birth weight for cycles with a thyroid-stimulating hormone < or = 2.5 was higher than for cycles with a thyroid-stimulating hormone > 2.5 (7.33 vs 6.78 lbs for singletons, P = .024 and 5.36 vs 4.83 lbs for twins, P = .023). Restricting analysis to cycles where the woman was not taking thyroid replacement did not change the overall conclusions. There was a trend toward increasing risk of miscarriage with increasing thyroid-stimulating hormone level in nondonor cycles, controlling for age and day 3 follicle-stimulating hormone level, but this trend did not reach statistical significance.A pre-conception thyroid-stimulating hormone level > 2.5 mIU/L is associated with a lower gestational age at delivery and lower birth weight in women undergoing in vitro fertilization.

    View details for DOI 10.1016/j.ajog.2006.03.040

    View details for Web of Science ID 000238055100039

    View details for PubMedID 16731084

  • Multiple births from assisted reproductive technologies: a challenge that must be met FERTILITY AND STERILITY Adamson, D., Baker, V. 2004; 81 (3): 517-522

    Abstract

    The success of assisted reproductive technologies (ART) has been accompanied by dramatic increases in multiple births and their associated costs. Physicians who perform ART must develop effective treatment paradigms to reduce multiple births or risk regulatory intervention.

    View details for DOI 10.1016/j.fertnstert.2003.09.041

    View details for Web of Science ID 000220180300008

    View details for PubMedID 15037394

  • Subfertility: causes, treatment and outcome BEST PRACTICE & RESEARCH IN CLINICAL OBSTETRICS & GYNAECOLOGY Adamson, G. D., Baker, V. L. 2003; 17 (2): 169-185

    Abstract

    Common causes of subfertility include ovulatory disorders, tubal disease, peritoneal adhesions, endometriosis, uterine abnormalities, abnormalities of sperm and advancing female age. Infertility is unexplained after thorough evaluation in about 5-10% of cases. Significant caveats must be attached to the interpretation of available data regarding infertility treatments. Successful ovulation induction in anovulatory women is possible for nearly all women except in cases of ovarian failure. Surgery is an option for some patients with tubal damage, adhesions, endometriosis and uterine abnormalities. Male factor infertility may be amenable to treatment of a specific cause, but is often empirical with the use of intra-uterine insemination (IUI) or in vitro fertilization (IVF). Egg donation is currently the most effective treatment available for age-related infertility when other treatments have not been successful. Couples with unexplained infertility may be effectively treated with ovulation induction plus IUI or IVF.

    View details for DOI 10.1053/ybeog.2003.358

    View details for Web of Science ID 000183225600002

    View details for PubMedID 12758094

  • Selective estrogen receptor modulators in reproductive medicine and biology OBSTETRICAL & GYNECOLOGICAL SURVEY Baker, V. L., Leitman, D., Jaffe, R. B. 2000; 55 (7): S21-S47

    Abstract

    Estrogen replacement therapy has significant potential benefits for postmenopausal women, such as improvement of menopausal symptoms and protection from osteoporosis, but it may also increase a woman's risk of breast cancer. Also, some women do not take hormone replacement therapy because of such undesirable side effects as breast tenderness and uterine bleeding. Therefore, there is much interest in the development of compounds that provide the benefits of estrogen replacement therapy without the risks and side effects. The selective estrogen receptor modulators make up one class of compounds with both estrogen agonist and antagonist activity. This review discusses the clinical indications, risks, benefits, and mechanisms of action of selective estrogen receptor modulators and related compounds.

    View details for Web of Science ID 000166318500001

    View details for PubMedID 10890575

  • Downregulation of protein kinase C by phorbol ester increases expression of epidermal growth factor receptors in transformed trophoblasts and amplifies human chorionic gonadotropin production PLACENTA Baker, V. L., Murai, J. T., Taylor, R. N. 1998; 19 (7): 475-482

    Abstract

    Epidermal growth factor (EGF) and its homologue, transforming growth factor-alpha (TGF-alpha), regulate human chorionic gonadotropin (hCG) synthesis in the human placenta. The current study was designed to investigate the involvement of the protein kinase C pathway in EGF-mediated hCG-beta production by JAr choriocarcinoma cells. Downregulation of protein kinase C activity by chronic exposure to the phorbol ester, phorbol 12,13-dibutyrate (PDB), produced a greater increase in hCG-beta secretion than did activation of protein kinase C activity by short-term exposure to PDB. Pretreatment with the protein kinase C inhibitors calphostin and chelerythrine also resulted in enhanced basal and EGF-stimulated hCG-beta production. Individual concentrations (5 nM EGF and 500 nM PDB) that maximally stimulated hCG production, were additive in combination. The additive effect of PDB on EGF-induced hCG-beta secretion was mediated in part by increased JAr cell EGF-receptor concentrations detected by Western blot and Scatchard analyses. The results suggest that EGF and PDB stimulate hCG production in JAr cells by different but interactive mechanisms. It is speculated that downregulation of protein kinase C stimulates basal and EGF-mediated hCG-beta production by uninhibiting other signalling pathways that regulate hCG-beta secretion in trophoblasts.

    View details for Web of Science ID 000076134300004

    View details for PubMedID 9778120

  • Minimum intrauterine pressure required for uterine distention JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS Baker, V. L., Adamson, G. D. 1998; 5 (1): 51-53

    Abstract

    Study Objective. To determine the minimum intrauterine pressure required to distend the uterine cavity during hysteroscopy using saline as a distending medium. Design. Nonrandomized, prospective study (Canadian Task Force classification II-2). Setting. Ambulatory surgery suites. Patients. Seven women from the practice of the principal investigator. Intervention. Hysteroscopy was performed and intrauterine perfusion pressure was measured. Measurements and Main Results. Intrauterine perfusion pressure required to separate the anterior and posterior uterine walls was measured using a Cobe CDX pressure transducer kit. The uterine cavity was distended when intrauterine perfusion pressure reached a median of 40 mm Hg (range 25-50 mm Hg). Conclusion. This preliminary study suggests that a liquid with the same viscosity as normal saline distends the uterine cavity at a pressure of approximately 40 mm Hg. This pressure is lower than that at which spillage from fallopian tubes occurs, suggesting that it may theoretically be possible to ablate the endometrial lining with heated liquid without spilling liquid into the peritoneal cavity. Further study with larger numbers of patients is required to verify this finding.

    View details for Web of Science ID 000073163000010

    View details for PubMedID 9454877

  • Reproductive endocrine and endometrial effects of raloxifene hydrochloride, a selective estrogen receptor modulator, in women with regular menstrual cycles JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM Baker, V. L., Draper, M., Paul, S., Allerheiligen, S., Glant, M., Shifren, J., Jaffe, R. B. 1998; 83 (1): 6-13

    Abstract

    Previous studies of raloxifene conducted in animal models and postmenopausal women have demonstrated antiestrogenic action on the endometrium. The purpose of this first study of raloxifene in women with normal menstrual cycles was to determine its reproductive endocrine and endometrial effects. In part I, raloxifene (400 mg) was administered for 5 days in the follicular, periovulatory, or luteal phase of the menstrual cycle (n = 12). In part II, women were randomized to receive raloxifene (100 or 200 mg) for 28 days beginning on day 3 of the cycle (n = 19). All women ovulated in both parts of the study. Raloxifene did not alter the length of the menstrual cycle or the day of the LH surge. A 5-day course of raloxifene administered in any phase of the cycle elevated FSH area under the curve (AUC) for the entire cycle and estradiol AUC for the second half of the cycle compared with those in control cycles. In part II, raloxifene also appeared to increase the FSH AUC and estradiol AUC. Raloxifene decreased the number of gland mitoses in follicular phase endometrial biopsies. Subtle effects suggestive of gland-stromal dysynchrony were noted in a limited number of the secretory phase endometrial biopsies. This study has demonstrated that 1) raloxifene does not prevent ovulation in women with normal menstrual cycles; 2) ovarian estrogen production will continue, and in some cases increase, in response to raloxifene; and 3) antiestrogenic effects of raloxifene on the endometrium are subtle in the endocrine milieu of normal to high circulating estradiol concentrations.

    View details for Web of Science ID 000071270600003

    View details for PubMedID 9435408

  • Human umbilical vessels and cultured umbilical vein endothelial and smooth muscle cells lack detectable protein and mRNA encoding estrogen receptors JOURNAL OF THE SOCIETY FOR GYNECOLOGIC INVESTIGATION Baker, V. L., Chao, V. A., Murai, J. T., Zaloudek, C. J., Taylor, R. N. 1997; 4 (6): 316-324

    Abstract

    To identify and characterize estrogen receptors in human umbilical vascular tissues and in cultured cells derived from the human umbilical vein.Human umbilical vein endothelial (HUVE) and human umbilical vein smooth muscle (HUVSM) cells were isolated. Immunohistochemical, radioligand binding. Western immunoblotting, and reverse transcription-polymerase chain reaction (RT-PCR) methods were used to detect estrogen receptors in vascular tissues and in cells derived from the umbilical cord.Estrogen receptor protein was not detected in either umbilical vessel tissue or in isolated HUVE or HUVSM cells. Messenger RNAs for the classic estrogen receptor (alpha) and estrogen receptor beta isoforms also were undetectable by RT-PCR.These findings suggest that the effects of estradiol observed in this widely used vascular model are mediated by very low concentrations of receptors that evade standard methods of detection. Alternatively, this steroid may affect umbilical vascular cells through mechanisms that do not involve the classic genomic estrogen-receptor pathway.

    View details for Web of Science ID A1997YJ29000009

    View details for PubMedID 9408888

  • Clinical uses of antiestrogens. Obstetrical & gynecological survey Baker, V. L., Jaffe, R. B. 1996; 51 (1): 45-59

    Abstract

    An antiestrogen is a compound that blocks the action of estrogen. Most synthetic antiestrogens have agonistic or antagonistic activity depending on the tissue and the endogenous estrogen mileu. The triphenylethylene derivatives, clomiphene and tamoxifen, are the antiestrogens in greatest clinical use. Their biologic effects, clinical indications, and risks are reviewed. Novel antiestrogens which are beginning to be studied clinically include the benzothiophene derivative, raloxifene and the "pure" antiestrogens such as ICI 182,780. New clinical indications for existing compounds as well as the development of novel antiestrogens may lead to better treatment options for endocrine-dependent conditions.

    View details for PubMedID 8657397

  • THRESHOLD INTRAUTERINE PERFUSION PRESSURES FOR INTRAPERITONEAL SPILL DURING HYDROTUBATION AND CORRELATION WITH TUBAL ADHESIVE DISEASE FERTILITY AND STERILITY Baker, V. L., Adamson, G. D. 1995; 64 (6): 1066-1069

    Abstract

    To determine the minimum intrauterine perfusion pressure that will produce spill from the fallopian tubes into the peritoneal cavity and to correlate this pressure with the extent of tubal adhesive disease.Hydrotubation was performed at laparoscopy and intrauterine perfusion pressure was measured. The extent of peritubal and fimbrial adhesions was graded at laparoscopy.Ambulatory surgery suites.Ten patients with infertility and/or pelvic pain were enrolled in the study. Data from nine patients were analyzed.Measurement of intrauterine perfusion pressures.The minimum pressure that produced spill of dye from each fallopian tube and the correlation between extent of external tubal pathology and this threshold pressure.The median threshold pressure at which dye spilled from at least one fallopian tube was 100 mm Hg, and no spill occurred at pressures < 70 mm Hg. The threshold pressure was correlated negatively with the extent of tubal disease.Fluid with the same viscosity as hydrotubation dye will not spill into the peritoneal cavity through normal fallopian tubes until the intrauterine perfusion pressure exceeds 70 mm Hg. The threshold pressure is higher when tubal adhesive disease that can be visualized by laparoscopy is present.

    View details for Web of Science ID A1995TF35400004

    View details for PubMedID 7589653

  • ALTERNATIVES TO ORAL ESTROGEN REPLACEMENT - TRANSDERMAL PATCHES, PERCUTANEOUS GELS, VAGINAL CREAMS AND RINGS, IMPLANTS, AND OTHER METHODS OF DELIVERY OBSTETRICS AND GYNECOLOGY CLINICS OF NORTH AMERICA Baker, V. L. 1994; 21 (2): 271-297

    Abstract

    Alternatives to oral estrogen replacement, including the transdermal patch, deliver estradiol in a constant manner, produce more physiologic estrone and estradiol levels than oral therapy, and avoid the first-pass effect on hepatic protein synthesis. Transdermal patches and estradiol implants have been demonstrated to produce favorable lipid profiles, prevent bone loss, relieve vasomotor symptoms, and improve urogenital atrophy. Vaginal estrogen is an effective treatment for vaginal atrophy. The advantages and disadvantages of each of the hormonal alternatives to oral estrogen replacement are discussed.

    View details for Web of Science ID A1994NR24300005

    View details for PubMedID 7936545

  • Surrogacy: one physician's view of the role of law. University of San Francisco law review. University of San Francisco. School of Law Baker, V. L. 1994; 28 (3): 603-612

    View details for PubMedID 11655177

Conference Proceedings


  • Transvaginal reduction of an interstitial heterotopic pregnancy with preservation of the intrauterine gestation Baker, V. L., Givens, C. R., Cadieux, M. C. MOSBY-YEAR BOOK INC. 1997: 1384-1385

    Abstract

    With use of transvaginal ultrasonographic guidance, cardiac activity in an interstitial heterotopic pregnancy at 7 weeks' gestation was terminated. The interstitial pregnancy resolved, and a healthy term infant was delivered. If an early diagnosis of an interstitial heterotopic pregnancy is made, selective reduction may allow preservation of the intrauterine gestation without surgery.

    View details for Web of Science ID A1997XH73400106

    View details for PubMedID 9215203

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