3601 4Th St
Lubbock TX 79430
Medical School: Other - Unknown
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: A98758
Request Appointment Information
Awards & Recognitions
Medical Malpractice Cases
Medical Board Sanctions
High Peak Estradiol Predicts Higher Miscarriage and Lower Live Birth Rates in High Responders Triggered with a GnRH Agonist in IVF/ICSI Cycles. - The Journal of reproductive medicine
To investigate parameters predictive of pregnancy outcomes in high responders undergoing fresh, autologous, GnRH antagonist IVF/ICSI cycles using a GnRH agonist trigger.Retrospective cohort study of all patients deemed high-risk for ovarian hyperstimulation syndrome who underwent fresh, autologous IVF/ICSI using a GnRH agonist trigger at an academic fertility center from 2010-2012.A total of 71 first cycles were analyzed. Rates of clinical pregnancy, live birth (LB), and total (clinical plus biochemical) miscarriage (MC) were 52%, 38%, and 25%, respectively. Mean peak estradiol (E2) and the number of oocytes retrieved were 3,701 pg/mL and 15.2, respectively. Peak E2 was significantly higher in those cycles resulting in clinical MC (p = 0.003). After adjusting for age, basal follicle stimulating hormone, and the number of oocytes retrieved, elevated peak E2 remained associated with increased clinical MC (p = 0.029) and trended towards a relationship with higher total MC (p = 0.062). When peak E2 was treated as a binary variable based on the threshold value of > 5,000 pg/mL, peak E2 above this value was associated with a higher rate of clinical MC (OR = 16.14 with 95% CI 1.25-209.35, p = 0.033) and total MC (OR = 6.81 with 95% CI 1.12-41.54, p = 0.037), as well as a lower LB rate (OR = 0.095 with 95% CI 0.01-0.90, p = 0.041).Clinicians should recognize most IVF/ICSI patients triggered with a GnRH agonist as inherently in danger of excessively high serum E2 and avoid peak levels > 5,000 pg/mL in order to avoid higher MC and lower LB rates.
Pregnancy outcomes decline with increasing body mass index: analysis of 239,127 fresh autologous inÂ vitro fertilization cycles from the 2008-2010 Society for Assisted Reproductive Technology registry. - Fertility and sterility
To examine the effect of body mass index (BMI) on IVF outcomes in fresh autologous cycles.Retrospective cohort study.Not applicable.A total of 239,127 fresh IVF cycles from the 2008-2010 Society for Assisted Reproductive Technology registry were stratified into cohorts based on World Health Organization BMI guidelines. Cycles reporting normal BMI (18.5-24.9Â kg/m(2)) were used as the reference group (REF). Subanalyses were performed on cycles reporting purely polycystic ovary syndrome (PCOS)-related infertility and those with purely male-factor infertility (34,137 and 89,354 cycles, respectively).None.Implantation rate, clinical pregnancy rate, pregnancy loss rate, and live birth rate.Success rates and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for all pregnancy outcomes were most favorable in cohorts with low and normal BMIs and progressively worsened as BMI increased. Obesity also had a negative impact on IVF outcomes in cycles performed for PCOS and male-factor infertility, although it did not always reach statistical significance.Success rates in fresh autologous cycles, including those done for specifically PCOS or male-factor infertility, are highest in those with low and normal BMIs. Furthermore, there is a progressive and statistically significant worsening of outcomes in groups with higher BMIs. More research is needed to determine the causes and extent of the influence of BMI on IVF success rates in other patient populations.Copyright Â© 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Pregnancy outcomes decline with increasing recipient body mass index: an analysis of 22,317 fresh donor/recipient cycles from the 2008-2010 Society for Assisted Reproductive Technology Clinic Outcome Reporting System registry. - Fertility and sterility
To examine the effect of recipient body mass index (BMI) on IVF outcomes in fresh donor oocyte cycles.Retrospective cohort study.Not applicable.A total of 22,317 donor oocyte cycles from the 2008-2010 Society for Assisted Reproductive Technology Clinic Outcome Reporting System registry were stratified into cohorts based on World Health Organization BMI guidelines. Cycles reporting normal recipient BMI (18.5-24.9) were used as the reference group.None.Implantation rate, clinical pregnancy rate (PR), pregnancy loss rate, live birth rate.Success rates and adjusted odds ratios with 95% confidence intervals for all pregnancy outcomes were most favorable in cohorts of recipients with low and normal BMI, but progressively worsened as BMI increased.Success rates in recipient cycles are highest in those with low and normal BMI. Furthermore, there is a progressive and statistically significant worsening of outcomes in groups with higher BMI with respect to clinical pregnancy and live birth rate.Copyright Â© 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Ectopic pregnancy rate increases with the number of retrieved oocytes in autologous in vitro fertilization with non-tubal infertility but not donor/recipient cycles: an analysis of 109,140 clinical pregnancies from the Society for Assisted Reproductive Te - Fertility and sterility
To study the impact of controlled ovarian stimulation on ectopic pregnancy (EP) rate as a function of the number of oocytes retrieved, using donor IVF cycles as a control.Retrospective cohort study using a large national database.Not applicable.Data from 109,140 cycles from the 2008-2010 SART registry, including 91,504 autologous cycles and 17,636 donor cycles in patients with non-tubal infertility.Varying amounts of oocytes retrieved in autologous and donor IVF.Ectopic pregnancy rates.In autologous cycles, the EP rate significantly increased as oocyte yield increased. This association was not found in oocyte recipients.In autologous IVF cycles, increasing oocyte yield is correlated with a significantly increased EP rate. This association is not found in oocyte recipients, indicating that the increased EP rate may be due to the supraphysiologic hormone levels achieved with controlled ovarian hyperstimulation.Copyright Â© 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Pregnancy rates in donor oocyte cycles compared to similar autologous in vitro fertilization cycles: an analysis of 26,457 fresh cycles from the Society for Assisted Reproductive Technology. - Fertility and sterility
To use a large US IVF database and compare pregnancy outcomes in fresh donor oocyte versus autologous IVF cycles in women age 20-30 years.Retrospective cohort study.Not applicable.Women undergoing fresh autologous ovarian stimulation, and oocyte donors and recipients in the United States between 2008 andÂ 2010.None.Implantation, clinical pregnancy (CP), and live birth (LB) rates.Despite similar demographics, stimulation, and embryo parameters, donor oocyte recipients had significantly higher rates of implantation, CP, and LB compared to those undergoing fresh autologous cycles. Odds ratios for implantation, CP, and LB significantly favored the donor oocyte group in all comparisons, including those limited to intracytoplasmic sperm injection cycles, intracytoplasmic sperm injection with male factor, unexplained infertility, cleavage stage embryo transfer, blastocyst transfer, elective single blastocyst transfer, and autologous patients with prior tubal ligation.Recent US data suggest that the hormonal environment resulting from autologous ovarian stimulation lowers IVF success rates. Further research is needed to determine when to avoid fresh embryo transfer in autologous patients.Copyright Â© 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Pregnancy outcomes decline in recipients over age 44: an analysis of 27,959 fresh donor oocyte in vitro fertilization cycles from the Society for Assisted Reproductive Technology. - Fertility and sterility
To use a large and recent national registry to provide an updated report on the effect of recipient age on the outcome of donor oocyte in vitro fertilization (IVF) cycles.Retrospective cohort study.United States national registry for assisted reproductive technology.Recipients of donor oocyte treatment cycles between 2008 and 2010, with cycles segregated into five age cohorts: â‰¤34, 35 to 39, 40 to 44, 45 to 49, and â‰¥50 years.None.Implantation, clinical pregnancy, live-birth, and miscarriage rates.In donor oocyte IVF cycles, all age cohorts â‰¤39 years had similar rates of implantation, clinical pregnancy, and live birth when compared with the 40- to 44-year-old reference group. Patients in the two oldest age groups (45 to 49, â‰¥50 years) experienced statistically significantly lower rates of implantation, clinical pregnancy, and live birth compared with the reference group. Additionally, all outcomes in the â‰¥50-year-old group were statistically significantly worse than the 45- to 49-year-old group, demonstrating progressive decline with advancing age.Recent national registry data suggest that donor oocyte recipients have stable rates of pregnancy outcomes before age 45, after which there is a small but steady and significant decline.Copyright Â© 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Oocyte number as a predictor for ovarian hyperstimulation syndrome and live birth: an analysis of 256,381 in vitro fertilization cycles. - Fertility and sterility
To investigate the association between oocyte number and the rates of ovarian hyperstimulation syndrome (OHSS) and live birth (LB) in fresh autologous inÂ vitro fertilization (IVF) cycles.Retrospective cohort study.An academic reproductive medicine practice.We analyzed data from 256,381 IVF cycles using the 2008-2010 Society for Assisted Reproductive Technology national registry. Patients were divided into five groups based on retrieved oocyte number.Rates of OHSS and LB were calculated for each group. A generalized estimating equation (GEE) was used to assess differences in OHSS and LB between groups. Receiver operating characteristic (ROC) curves were used to evaluate oocyte number as a predictor of OHSS and LB.None.The LB rate increased up to 15 oocytes, then plateaued (0-5: 17%, 6-10: 31.7%; 11-15: 39.3%; 16-20: 42.7%; 21-25: 43.8%; and >25 oocytes: 41.8%). However, the rate of OHSS became much more clinically significant after 15 oocytes (0-5: 0.09%; 6-10: 0.37%; 11-15: 0.93%; 16-20: 1.67%; 21-25: 3.03%; and >25 oocytes: 6.34%). These trends remained after adjustment with the use of GEE. ROC curves revealed that although oocyte number is not useful in the prediction of LB, 15 retrieved oocytes is the number that best predicts OHSS risk.Retrieval of >15 oocytes significantly increases OHSS risk without improving LB rate in fresh autologous IVF cycles. In general, less aggressive stimulation protocols should be considered, especially in high-responders, to optimize outcomes.Copyright Â© 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Late ovarian hyperstimulation syndrome after controlled ovarian stimulation in a woman with systemic lupus erythematosus and lupus nephritis. - Fertility and sterility
To report a case of late ovarian hyperstimulation syndrome (OHSS) in a woman with lupus nephritis undergoing controlled ovarian stimulation and in vitro fertilization (IVF) with subsequent transfer into a gestational surrogate.A case report.Academic reproductive medicine clinic.A 33-year-old woman who presented 10 days after recombinant human chorionic gonadotropin (hCG) injection with fatigue, abdominal pain, and bloating, diagnosed as OHSS.Patient admitted for intravenous fluid hydration, anticoagulation, and gonadotropin-releasing hormone (GnRH) antagonist therapy.Successful detection and management of severe OHSS in a patient with chronically impaired kidney function.The patient has returned to her baseline condition, and the gestational carrier was noted to have a twin gestation.In patients with impaired renal function, final oocyte maturation should be triggered with a GnRH agonist rather than hCG.Copyright Â© 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Clinical utility of routine proteinuria evaluation in treatment decisions of patients receiving bevacizumab for metastatic solid tumors. - The Annals of pharmacotherapy
Bevacizumab is an anti-vascular endothelial growth factor monoclonal antibody approved for use in treatment of patients with metastatic breast, colorectal, and non-small cell lung cancer. In the pivotal Phase 3 clinical trials, grades 3-4 proteinuria occurred in <5% of patients. The manufacturer recommends monitoring for the development of proteinuria but does not provide specific recommendations, except to discontinue treatment if the patient develops nephrotic syndrome.To determine the incidence and severity of elevated proteinuria and the frequency of changes in bevacizumab administration due to elevated proteinuria; secondary objectives included analysis of the cost of routine proteinuria monitoring and the relationship of proteinuria with other patient comorbidities such as diabetes, hypertension, chronic kidney disease, and viral hepatitis.A retrospective chart review was performed at the University of Washington Medical Center, a large academic teaching hospital, and its affiliated ambulatory clinics at the Seattle Cancer Care Alliance. Patients treated with bevacizumab and seen in the breast, lung, and gastrointestinal cancer clinics from June 1, 2005, to November 30, 2007, were included in the study.A total of 243 patients were included in the analysis. Only 1.6% of these patients developed grades 3-4 proteinuria. All 4 of these patients had a history of hypertension, 2 of these patients had prior chronic kidney disease, and 3 patients had prior viral hepatitis. Elevated proteinuria affected treatment decisions in 2% of patients. Over $130,000 was charged to patients for monitoring of proteinuria.These results demonstrate that the development of grades 3-4 proteinuria with bevacizumab is rare and affects treatment decisions in few patients with metastatic solid tumor. Furthermore, routine proteinuria monitoring is associated with high cost and may not be required before each administration.
Combined cataract extraction and trabeculotomy by the internal approach for coexisting cataract and open-angle glaucoma: initial results. - Journal of cataract and refractive surgery
To provide an update of the short-term results of combined phacoemulsification and trabeculotomy by the internal approach with a follow-up to 21 months.Universities and private practices in the United States.This prospective interventional case series comprised 304 consecutive eyes with open-angle glaucoma and cataract having combined phacoemulsification and trabeculotomy with a Trabectome (NeoMedix Inc.). The Trabectome is designed to open a direct pathway for aqueous to flow from the anterior chamber into Schlemm canal collector channels. Under gonioscopic control, bipolar cautery was applied by a purpose-designed footplate to ablate the trabecular meshwork and inner wall of Schlemm canal. The main outcome measures were intraocular pressure (IOP), glaucoma medication use, and complications.The mean IOP was 20.0 mm Hg+/-6.3 (SD) preoperatively, 14.8+/-3.5 mm Hg at 6 months, and 15.5+/-2.9 mm Hg at 1 year. There was a corresponding drop in glaucoma medications from 2.65+/-1.13 at baseline to 1.76+/-1.25 at 6 months and 1.44+/-1.29 at 1 year. Subsequent secondary glaucoma procedures were performed in 9 patients. The only frequent complication, blood reflux in 239 patients (78.4%), resolved within a few days.Combined phacoemulsification and trabeculotomy by the internal approach using the Trabectome lowered IOP and medication use in the majority of patients. Complications were minimal and comparable to those in an earlier series of Trabectome-only procedures.
Map & Directions
3601 4Th St Lubbock, TX 79430
3601 4Th St
Texas Tech University Health Sciences Ctr 3601 4Th Street Stop 8182