J Ryan Martin

Yale University, New Haven, CT, United States

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Publications (9)31.7 Total impact

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    ABSTRACT: To compare the impact of mandated IVF insurance coverage on ET practices and resulting multiple pregnancy rates. Retrospective analysis of all fresh, nondonor IVF cycles performed in the United States in 2006. United States. A total of 91,753 fresh, nondonor IVF cycles in the United States. None. Pregnancy rate, live-birth rate, embryos transferred, multiple pregnancy rate. Overall, nonmandated states had a significantly higher pregnancy rate (38.8% vs. 35%) and live-birth rate (32.2% vs. 29.1%) than mandated states. Nonmandated states also had a significantly higher twin rate (28.1% vs. 26%) and triplet rate (3.9% vs. 3.4%). The average number of embryos transferred was also significantly higher in nonmandated states (2.6 vs. 2.2). These findings were more pronounced in the <35 and 35-37 age groups. In the last 8 years, despite a reduction in the average number of embryos transferred and multiple pregnancy rates, there is a continued association between mandated IVF coverage, the transfer of fewer embryos, and lower rates of multiple pregnancies and births, particularly in the younger age groups.
    Fertility and sterility 03/2011; 95(3):964-9. · 3.97 Impact Factor
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    ABSTRACT: Ghrelin has a well-known role in the regulation of appetite, satiety, energy metabolism, and reproduction; however ghrelin has not been implicated in reproductive tract development. We examined the effect of ghrelin deficiency on the developmental programming of female fertility. We observed that female wild-type mice born of ghrelin heterozygote dams (i.e. exposed in utero to ghrelin deficiency) had diminished fertility and produced smaller litters. We demonstrate that exposure to in utero ghrelin deficiency led to altered developmental programming of the reproductive tract. The number of ovarian follicles, corpora lutea, and embryos produced were identical in both exposed and unexposed mice. However wild-type embryos transferred to uteri of mice exposed to in utero ghrelin deficiency had a 60% reduction in the rate of embryo implantation compared with those transferred to wild-type unexposed uteri. We identified significant alterations in the uterine expression of four genes critical for implantation and a defect in uterine endometrial proliferation. Taken together, these results demonstrate that the mechanism of subfertility was abnormal endometrial function. In utero exposure to decreased levels of ghrelin led to defects in developmental programming of the uterus and subsequent subfertility in wild-type offspring.
    Endocrinology 02/2011; 152(5):2060-6. · 4.72 Impact Factor
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    ABSTRACT: Klippel-Trenaunay Syndrome (KTS) is a rare, sporadic triad of congenital malformations involving an extensive port wine stain, soft tissue or bone hypertrophy and underlying venous and/or lymphatic malformation involving an extremity. Pregnancy is known to exacerbate KTS complications and can put women at increased obstetrical risk due to deep venous thrombosis and other thromboembolic events. Here we report a case of a patient with KTS who achieved a pregnancy through in vitro fertilization (IVF) using her own eggs and a gestational surrogate in the setting of hypercoagulability and chronic consumptive coagulopathy.
    Journal of Assisted Reproduction and Genetics 12/2010; 28(3):217-9. · 1.82 Impact Factor
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    ABSTRACT: To investigate the oocyte-to-baby rate when controlled ovarian stimulation was performed on a highly successful donor population and to evaluate whether they produce a higher proportion of reproductively competent oocytes compared with standard donors. Retrospective analysis of clinical and embryological database. University center. A total of 191 oocyte donation cycles were analyzed from 53 donors (28 best-prognosis donors and 23 standard donors). None. Total number of oocytes collected, the number of embryos transferable (fresh and frozen). and corresponding oocyte to live baby born (LBB) rates. In patients with remaining frozen embryos, the final LBB rate was estimated according to our reported rates. A total of 130 oocyte retrievals from the best-prognosis donors yielded 2,470 oocytes. The total LBB per oocyte retrieved and LBB per embryo transferred was 7.3% and 24.6%, respectively. A total of 61 oocyte retrievals from the standard donors yielded 1,044 oocytes. The total LBB per oocyte and LBB per embryo transferred was 5.0% and 16.6%, respectively. This is significantly different from the best-prognosis donor group. Success rates were also analyzed after grouping donors based on the number of oocytes retrieved per cycle. In the best-prognosis group, the oocyte use rate increased significantly when fewer oocytes were retrieved, whereas the oocyte-to-baby rate was similar regardless of the number of oocytes for the standard donor group. This retrospective analysis revealed the existence of a subset of good-prognosis donors who produce a higher oocyte-to-baby rate that is indicative of a more biologically efficient reproductive system. Their identification, albeit a posteriori, has clinical implications for safety, by reducing ovarian hyperstimulation syndrome and multiple pregnancies, as well as for assisted reproductive technology success.
    Fertility and sterility 03/2010; 94(6):2064-8. · 3.97 Impact Factor
  • Nicole Kummer, J Ryan Martin, Lubna Pal
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    ABSTRACT: To present the a case of decreased ovarian reserve in a patient with a balanced 13;21 translocation. Case report. Reproductive endocrinology and infertility practice in a university teaching hospital. A 33-year-old caucasian woman with primary infertility. Laboratory evaluation, hysterosalpingogram, karyotype analysis, semen analysis. Endocrinologic evaluation and genetic analysis. A diagnosis of decreased ovarian reserve based upon laboratory evaluation with concomitant findings of a balanced translocation between the long arms of chromosomes 13 and 21. A diagnosis of primary infertility secondary to decreased ovarian reserve of unknown etiology, but with karyotype evidence of a balanced autosomal translocation and a familial history of early menopause, suggested possible roles of autosomal genes in mechanisms of ovarian follicular attrition.
    Fertility and sterility 10/2008; 91(3):931.e3-5. · 3.97 Impact Factor
  • J Ryan Martin, Aydin Arici
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    ABSTRACT: To review the recent literature on fragile X and the genotypic and phenotypic implications on human reproduction. Fragile X syndrome is the most common inherited cause of mental retardation and the most common genetic cause of autism. The fully expanded form of the mutation leads to mental retardation and autism, whereas the premutation can lead to a neurological disorder called fragile X-associated tremor/ataxia, macroorchidism after puberty and premature ovarian failure. Fragile X is also a major cause of premature ovarian failure and irregular menses, and it can subsequently affect fertility. Couples who carry the premutation or full mutation should be offered genetic and preconceptual counseling prior to attempting to conceive. This allows the patient full disclosure about the risks of transmitting the mutation and possible preventive measures, which allows them to formulate educated decisions about their reproductive future. Clinicians should identify and recognize clinical situations that warrant fragile X testing to properly counsel and inform patients about their reproductive possibilities and ways to increase their chances of a successful reproductive outcome.
    Current Opinion in Obstetrics and Gynecology 07/2008; 20(3):216-20. · 2.64 Impact Factor
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    J Ryan Martin, Anne Wold, Hugh S Taylor
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    ABSTRACT: To describe an unusual presentation of ring chromosome 12, which manifested as severe azoospermia, resulting in male infertility. Case report. In vitro fertilization center at a tertiary care hospital. A 27-year-old man diagnosed with unexplained azoospermia and ring chromosome 12 abnormality during a workup for primary infertility. In vitro fertilization with preimplantation genetic diagnosis. To confirm the importance of obtaining karyotypes in individuals with severe oligospermia. Full-term pregnancy after IVF using donor sperm. Severe oligospermia and male infertility should be included in the spectrum of findings found in ring chromosome 12.
    Fertility and sterility 10/2007; 90(2):443.e13-5. · 3.97 Impact Factor
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    ABSTRACT: To describe a technique of fertility preservation by ovarian transposition combined with ovarian cryopreservation in the setting of oncologic pelvic radiation for a reproductive age woman. Case report. IVF center at a tertiary care hospital. Thirty-year-old nulligravid women who previously underwent lumbar spinal cord tumor debulking requested fertility preservation before pelvic radiation. Laparoscopic ovarian transposition with cryopreservation of the contralateral ovary. New technique in fertility preservation. Laparoscopic surgery was used to evaluate, select, and remove a single ovary that then underwent cryopreservation. Transposition of the remaining ovary was subsequently successfully performed, placing it of out of the pelvis. The combination of ovarian cryopreservation and ovarian transposition may maximize future fertility options for women facing pelvic irradiation. This combined approach should be included among the options offered to reproductive age women before pelvic radiation.
    Fertility and sterility 02/2007; 87(1):189.e5-7. · 3.97 Impact Factor
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    ABSTRACT: In order to examine whether the duration of the follicular phase and changes in daily gonadotrophin dosages impact IVF outcome, a retrospective analysis of women who underwent oocyte retrieval and fresh embryo transfer was performed. Among the parameters assessed were the number of days of gonadotrophin stimulation, changes in the daily dosage of gonadotrophins, total ampoules of gonadotrophins, embryo implantation rates, clinical pregnancy rates and ongoing pregnancy rates. The number of days of gonadotrophin stimulation, as determined by standard follicular size criteria did not appear to influence IVF outcomes. There was no significant difference in pregnancy rates between women who were stimulated for <9 days, 10-11 days or >12 days. When grouped by amount of starting daily dose of gonadotrophins there was a significant inverse relationship between gonadotrophin requirements and pregnancy rates (P=0.02). The data suggest that the success of an IVF cycle depends on the ovaries' ability to develop follicles of the appropriate size, not the speed at which the ovaries perform this function.
    Reproductive biomedicine online 12/2006; 13(5):645-50. · 2.68 Impact Factor

Publication Stats

50 Citations
31.70 Total Impact Points

Institutions

  • 2006–2011
    • Yale University
      • Department of Obstetrics, Gynecology and Reproductive Sciences
      New Haven, CT, United States
  • 2006–2010
    • Yale-New Haven Hospital
      • Reproductive Endocrinology Services
      New Haven, Connecticut, United States