Daniel J Kaser

Harvard Medical School, Boston, Massachusetts, United States

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Publications (16)53.12 Total impact

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    ABSTRACT: To explore the association between cryopreserved embryo transfer (CET) and risk of placenta accreta among patients utilizing in vitro fertilization (IVF) and/or intracytoplasmic sperm injection (ICSI). Case-control study. Academic medical center. All patients using IVF and/or ICSI, with autologous or donor oocytes, undergoing fresh or cryopreserved transfer, who delivered a live-born fetus at ≥24 weeks of gestation at our center, from 2005 to 2011 (n = 1,571), were reviewed for placenta accreta at delivery. Cases of accreta (n = 50) were matched by age and prior cesarean section to controls (1:3) without accreta. The association between CET and accreta was modeled using conditional logistic regression, controlling a priori for age and placenta previa. Receiver operating characteristic curves were used to determine thresholds of endometrial thickness and peak serum E2 levels related to accreta. Placenta accreta. Univariate predictors of accreta were non-Caucasian race (odds ratio [OR] 2.85, 95% confidence interval [CI] 1.25-6.47); uterine factor infertility (OR 5.80, 95% CI 2.49-13.50); prior abdominal or laparoscopic myomectomy (OR 7.24, 95% CI 1.92-27.28); and persistent or resolved placenta previa (OR 4.25, 95% CI 1.94-9.33). In multivariate analysis, we observed a significant association between CET and accreta (adjusted OR 3.20, 95% CI 1.14-9.02), which remained when analyses were restricted to cases of accreta with morbid complications (adjusted OR 3.87, 95% CI 1.08-13.81). Endometrial thickness and peak serum E2 level were each significantly lower in CET cycles and those with accreta. Cryopreserved ET is a strong independent risk factor for accreta among patients using IVF and/or ICSI. A threshold endometrial thickness and a "safety window" of optimal peak E2 level are proposed for external validation. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
    Fertility and Sterility 03/2015; 103(5). DOI:10.1016/j.fertnstert.2015.01.021 · 4.59 Impact Factor
  • Serene S. Srouji · Daniel J. Kaser · Antonio R. Gargiulo
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    ABSTRACT: To demonstrate 2 step-by-step techniques for contained morcellation of uterine tissue. Instructional video showing laparoscopic electromechanical morcellation within an endoscopic pouch, and alternatively, tissue extraction via ultra-minilaparotomy. Academic medical center. Women undergoing laparoscopic myomectomy or hysterectomy. For contained electromechanical morcellation, the specimen is placed within an endoscopic pouch, the edges of which are exteriorized through a 15-mm cannula. The cannula is repositioned inside the pouch for insufflation. A bladed fixation trocar enters the pouch through an assistant port and is secured by its retention disk and balloon tip. Gas inflow is changed to this assistant port, through which the laparoscope is inserted. A power morcellator is introduced via the 15-mm port site, and morcellation thus proceeds within the containment system. Residual fragments of tissue are collectively retrieved by withdrawing the endoscopic pouch. For tissue extraction via ultra-minilaparotomy, the specimen is placed within a pouch that is drawn up through a flexible, self-retaining retractor seated in a 2 to 3-cm incision. The specimen is cored out sharply with a scalpel. None. Contained morcellation is technically feasible, efficient (mean additional operative time is approximately 30 minutes), and prevents intraperitoneal dispersion of tissue fragments. Our group has safely performed >100 such procedures and removed specimens weighing nearly 1,500 grams. Potential complications include viscous injury upon insertion of the bladed trocar, and pouch failure. These techniques allow surgeons to adopt the new standard of contained morcellation and permit removal of extensive pathology with a minimally invasive approach. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
    Fertility and Sterility 02/2015; 103(4). DOI:10.1016/j.fertnstert.2015.01.022 · 4.59 Impact Factor
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    ABSTRACT: Objective: To determine whether day 3 FSH and E-2 levels at the upper limits of normal affect live- birth rates and treatment trajectory in a conventional versus "fast track'' treatment program for IVF. Design: Secondary analysis of two randomized controlled trials, FASTT and FORT-T. Setting: Not applicable. Patient(s): Infertile women ages 21-42 years randomized to conventional or accelerated treatment with controlled ovarian hyperstimulation (COH)-IUI and/or IVF (n = 603 patients contributing 2,717 total cycles). Intervention(s): Patients were stratified according to basal FSH and E-2: FSH <10 mIU/mL and E-2 <40 pg/mL (group 1A), FSH <10 mIU/mL and E-2 >= 40 pg/mL (group 1B), FSH, 10-15 mIU/mL and E-2 <40 pg/mL (group 2A), and FSH, 10-15 mIU/mL and E-2 >= 40 pg/mL (group 2B). Main Outcome Measure(s): Number of cancelled cycles, disenrollment for poor response, and cumulative live-birth rates per couple. Result(s): Women in groups 2A and 2B were more likely to have cancelled cycles and be disenrolled for poor response. While no live births occurred in group 2B during COH-IUI (0/19 couples, 0/58 cycles), IVF still afforded these patients a reasonable chance of success (6/18 couples, 6/40 cycles, 33.3% live-birth rate per couple). The specificity and positive predictive value of basal FSH of 10-15 mIU/mL and E-2 >= 40 pg/mL for no live birth during COH-IUI treatment were both 100%. Conclusion(s): Women who initiated infertility treatment with FSH of 10-15 mIU/mL and E-2 >= 40 pg/mL on day 3 testing were unlikely to achieve live birth after COH-IUI treatment. (C) 2014 by American Society for Reproductive Medicine.
    Fertility and Sterility 09/2014; 102(5). DOI:10.1016/j.fertnstert.2014.07.1239 · 4.59 Impact Factor
  • Daniel J Kaser · Catherine Racowsky
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    ABSTRACT: BACKGROUND Time-lapse monitoring (TLM) has emerged as a novel technology to perform semi-quantitative evaluation of embryo morphology and developmental kinetics in assisted reproduction. While this method has already been introduced into clinical practice in many laboratories, it is unclear whether it adds value to conventional morphology. Most studies only report blastocyst formation as the primary end-point. The aim of this systematic review is to provide a critical evaluation of the available studies that report clinical outcomes following embryo selection with TLM.
    Human Reproduction Update 06/2014; 20(5). DOI:10.1093/humupd/dmu023 · 8.66 Impact Factor
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    ABSTRACT: To evaluate the association between serum progesterone (P) levels on the day of embryo transfer (ET) and pregnancy rates in fresh donor IVF/ICSI cycles. Fresh donor cycles with day 3 ET from 10/2007 to 8/2012 were included (n = 229). Most cycles (93 %) were programmed with a gonadotropin releasing hormone (GnRH) agonist; oral, vaginal or transdermal estradiol was used for endometrial priming, and intramuscular P was used for luteal support (50-100 mg/day). Recipient P levels were measured at ET, and P dose was increased by 50-100 % if <20 ng/mL per clinic practice. The main outcome measure was rate of live birth (> = 24 weeks gestational age). Generalized estimating equations were used to account for multiple cycles from the same recipient, adjusted a priori for recipient and donor age. Mean recipient serum P at ET was 25.5 ± 10.1 ng/mL. Recipients with P < 20 ng/mL at ET, despite P dose increases after ET, were less likely to achieve clinical pregnancy (RR = 0.75, 95 % CI = 0.60-0.94, p = 0.01) and live birth (RR = 0.77, 95 % CI = 0.60-0.98, p = 0.04), as compared to those with P ≥ 20 ng/mL. P dose increases were more often required in overweight and obese recipients. Serum P levels on the day of ET in fresh donor IVF/ICSI cycles were positively correlated with clinical pregnancy and live birth rates. An increase in P dose after ET was insufficient to rescue pregnancy rates. Overweight and obese recipients may require higher initial doses of P supplementation. Future research is needed to define optimal serum P at ET and the interventions to achieve this target.
    Journal of Assisted Reproduction and Genetics 03/2014; 31(5). DOI:10.1007/s10815-014-0199-y · 1.77 Impact Factor
  • Daniel J Kaser · Elizabeth S Ginsburg
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    ABSTRACT: Since report of the first live birth following preimplantation genetic screening (PGS) in 1995, the procedure and available technologies for aneuploidy detection have rapidly evolved. Through these efforts, the biology of meiotic and mitotic segregation errors has been partially elucidated. A process that began with polar body biopsy and four-color fluorescence in situ hybridization to detect copy number in a limited number of chromosomes is now hardly recognizable: current molecular methods permit high-density screening of the entire human genome for copy number variants, structural rearrangements, microdeletions, and polyploids to a resolution of 35 kilobases in less than 48 hours. Indeed, with the advent of real-time quantitative analyses of ploidy status that allow same-day trophectoderm biopsy with fresh transfer of a euploid blastocyst, the future is bright for PGS. Questions remain about how best to safely offer this technology to patients, and which patients, if any, will benefit from routine biopsy. Herein, we will review the limited available evidence for application of PGS in the general infertility population as an adjunct method to optimize live birth rates.
    Seminars in Reproductive Medicine 03/2014; 32(2):100-6. DOI:10.1055/s-0033-1363551 · 3.00 Impact Factor
  • Fertility and Sterility 09/2013; 100(3):S487. DOI:10.1016/j.fertnstert.2013.07.330 · 4.59 Impact Factor
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    ABSTRACT: To determine embryo and cycle-specific parameters associated with twin live birth in day 3 cryopreserved double embryo transfer (DET) cycles, and to propose a new prediction model for external validation. All cycles with autologous or donor cryopreserved DET of day 3 embryos from 2002 to 2011 at a single academic institution with a singleton or twin live birth were included (n = 207). Patient characteristics, post-thaw embryo morphology and freeze-thaw parameters were compared between patients with a single and twin live birth. Demographic characteristics were similar, except that patients delivering twins were younger at age of cryopreserved embryo transfer (CET), fewer were parous and more were anovulatory. Duration of embryo storage, time in culture post-thaw, endometrial thickness and use of assisted hatching were comparable. Six predictors of twin delivery were identified: patient age <35 year at CET, intact survival of the lead embryo, resumption of mitosis, 7-8 viable cells in the non-lead embryo, transfer of a lead embryo with ≥7 cells and a sum of ≥14 viable cells in the two transferred embryos. Regression modeling predicted a step-wise increase in the probability of twins with addition of each predictor; with all six present, the risk of twins was predicted to be 53 % and with none present, the risk decreased to 6 %. The six identified variables associated with twin live birth following day 3 cryopreserved DET have been applied to derive a prediction model for estimating the risk of twin delivery. External validation of the model is required prior to clinical application.
    Journal of Assisted Reproduction and Genetics 07/2013; 30(8). DOI:10.1007/s10815-013-0039-5 · 1.77 Impact Factor
  • Daniel J. Kaser · Maria Assens · Catherine Racowsky
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    ABSTRACT: Controlled ovarian hyperstimulation (COH) affects the transcriptional program of the mid-secretory endometrium, rendering it less receptive to embryo implantation. It is postulated that the supraphysiologic hormonal milieu at the time of fresh embryo transfer (ET) may impair trophoblast invasion and placental angiogenesis. One approach that circumvents this problem is to uncouple COH from ET by cryopreserving all embryos with subsequent replacement in a natural or programmed cycle. There is emerging evidence that pregnancy rates and obstetric and neonatal outcomes are all improved following delayed cryopreserved embryo transfer (CET). Before such an elective cryopreservation program is adopted, though, the existing observational evidence must be validated by adequately powered randomized controlled trials.
    Biennial Review of Infertility, 01/2013: pages 203-214; , ISBN: 978-1-4614-7186-8
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    ABSTRACT: OBJECTIVE: To compare outcomes after intramuscular progesterone (IMP) or 8% Crinone vaginal gel for luteal support for day 3 cryopreserved embryo transfer (CET). DESIGN: Retrospective cohort study with multivariable analysis. SETTING: Academic medical center. PATIENT(S): All autologous and donor egg in vitro fertilization and intracytoplasmic sperm injection patients who had a day 3 CET from January 1, 2008, to April 30, 2011, with luteal support using 25-50 mg/d IMP or 8% Crinone twice daily, initiated 3 days before the CET. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Implantation rate, clinical pregnancy, and live birth rates per CET. RESULT(S): IMP (n = 440) and Crinone (n = 298) recipients were similar for all demographic characteristics and cycle parameters assessed. Although implantation rates did not differ significantly between the two groups (Crinone vs. IMP: 19.6% vs. 30.4%), women supplemented with Crinone had significantly lower rates of clinical pregnancy (36.9% vs. 51.1%) and live birth (24.4% vs. 39.1%) compared with those on IMP. CONCLUSION(S): We observed that day 3 CET cycles with 8% Crinone luteal support had a 44% and 49% lower odds of clinical pregnancy and live birth, respectively, compared with those with IMP support. Further studies are required to identify the optimal timing and dose of 8% Crinone vaginal gel for use in CET cycles.
    Fertility and sterility 09/2012; 98(6). DOI:10.1016/j.fertnstert.2012.08.007 · 4.59 Impact Factor
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    ABSTRACT: The optimal surgery for combined apical and posterior vaginal prolapse is not well defined. Our objective was to examine the anatomic and functional outcomes following sacrocolpopexy (SCP) with or without posterior colporrhaphy (PC). We retrospectively evaluated 258 women who underwent abdominal (n = 62) or laparoscopic (n = 196) SCP with or without PC. Preoperative anatomic support and standardized bowel symptoms were compared to 6-week and 1-year postoperative values, using Student's t test and Wilcoxon rank sum test, respectively. Six-week follow-up data were available for 235 of 258 (91.1 %) women, while 125 of 258 (48.4 %) women had 1-year anatomic and functional outcomes recorded. While the SCP + PC group had worse posterior descent and bowel function preoperatively, there were no significant differences in postoperative anatomic support or symptoms. Long-term pelvic floor function was similar, as measured by three validated instruments. Reduction in the proportion of women with splinting was greater in the SCP + PC group. SCP with or without PC is associated with improved posterior support and decreased obstructive and irritative bowel symptoms at 1 year in women with apical and posterior prolapse.
    International Urogynecology Journal 03/2012; 23(9):1215-20. DOI:10.1007/s00192-012-1695-1 · 2.16 Impact Factor
  • D J Kaser · S.A. Missmer · K F Berry · M R Laufer
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    ABSTRACT: To evaluate the efficacy and tolerability of norethindrone acetate (NA) as single-agent hormonal therapy for suppression of endometriosis symptoms in adolescents and young adults. Retrospective study. Two academic medical centers. A keyword search using the query 'NA' was applied to the electronic medical records of all women treated by one gynecologist (M.R.L.) from 1992 to 2010. IRB-approved chart review was then conducted on the index records. Continuous treatment with NA (5-15 mg daily). Postoperative bleeding and pain scores; adverse effects. One hundred and ninety-four patients with surgically diagnosed endometriosis initiated NA postoperatively during the study period. Median patient age was 18.9 years. 92.2% of patients had stage 1 or 2 disease, and distribution was similar among those excluded. Median pain scores decreased from 5 at NA initiation to 0 at follow-up (P = .0001) and bleeding scores from 2 to 0, respectively (P = .001) for all stages of endometriosis. Post-NA bleeding scores were improved regardless of prior hormonal regimen, and post-NA pain scores improved in all patients except for those previously prescribed GnRH-agonist plus add-back. Most patients (55.2%) did not report any side effects. The most common adverse effect was weight gain (16.1%), with a mean increase in BMI of 1.2 ± 1.6 kg/m(2) at 12 months. NA alone is a well-tolerated, effective option to manage pain and bleeding for all stages of endometriosis. Among those on prior hormonal therapy, symptoms improved after NA initiation.
    Journal of pediatric and adolescent gynecology 12/2011; 25(2):105-8. DOI:10.1016/j.jpag.2011.09.013 · 1.81 Impact Factor
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    ABSTRACT: To determine the incidence of fragmented oocytes in intracytoplasmic sperm injection (ICSI) cycles, describe the developmental potential of their sibling oocytes, and define clinical outcomes from affected cycles. Case-control study. Academic medical center. All ICSI cycles from January 2006 to December 2010 (n = 2,844) were reviewed for the presence of fragmented oocytes at cumulus stripping or fertilization check (n = 93). Sibling oocytes and corresponding embryos from index cycles were compared with matched control cycles without fragmented oocytes. None. Cycle characteristics, embryo quality, and pregnancy rates per retrieval. The incidence of ICSI cycles containing at least one fragmented oocyte was 3.3% (93/2,844). Twelve patients were represented more than once in these 93 index cycles. Only the first cycles (n = 81) were included, of which 28 contained fragmented oocytes at cumulus stripping, 48 at fertilization check, and five at both. Compared with matched controls, index cycles had fewer good-quality embryos available for transfer (18.8% vs. 32.1%) and significantly lower rates of implantation (20.3% vs. 32.7%), clinical pregnancy (33.3% vs. 58.0%), and ongoing delivery (29.6% vs. 49.4%). The cumulative ongoing delivered rate was also significantly lower for index cycles (32.1% vs. 55.6%), with no difference in the percentage of cycles with cryopreserved embryos remaining at study conclusion (13.5% vs. 23.5%). Cohorts containing fragmented oocytes have decreased developmental potential. The biologic mechanisms underlying this occurrence merit further investigation, and patient counseling should reflect the possible decreased success rates associated with this aberrant developmental pattern.
    Fertility and sterility 12/2011; 97(2):338-43. DOI:10.1016/j.fertnstert.2011.11.013 · 4.59 Impact Factor
  • Fertility and Sterility 09/2011; 96(3). DOI:10.1016/j.fertnstert.2011.07.911 · 4.59 Impact Factor
  • Daniel J. Kaser · Marc R. Laufer
    Journal of Pediatric and Adolescent Gynecology 04/2011; 24(2):e49–e50. DOI:10.1016/j.jpag.2011.01.013 · 1.81 Impact Factor
  • Source
    Daniel J Kaser · David E Reichman · Marc R Laufer
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    ABSTRACT: Vulvovaginal sequelae of Stevens-Johnson syndrome and toxic epidermal necrolysis are well documented in the literature, although little consensus exists about effective prevention strategies. This review summarizes the available literature and offers expert opinion about how to minimize long-term vaginal impairment from these rare but often devastating illnesses.
    Reviews in obstetrics and gynecology 01/2011; 4(2):81-5.

Publication Stats

40 Citations
53.12 Total Impact Points

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Institutions

  • 2011–2015
    • Harvard Medical School
      • Department of Obstetrics, Gynecology, and Reproductive Biology
      Boston, Massachusetts, United States
    • Boston Children's Hospital
      • Division of Gynecology
      Boston, Massachusetts, United States
  • 2011–2014
    • Harvard University
      Cambridge, Massachusetts, United States