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Papers by Simon Phillips

Fertility and Sterility, 2011

The use of modified natural-cycle in vitro fertilization (IVF) is a valuable alternative to contr... more The use of modified natural-cycle in vitro fertilization (IVF) is a valuable alternative to controlled ovarian hyperstimulation in young poor responders and should be considered in patients who require IVF and demonstrate endocrinologic evidence of ovarian aging and in those who have had one or two canceled controlled ovarian hyperstimulation cycles.

The Journal of Urology, 2018

Fertility and Sterility, 2009

Objective: To examine the relationship between sperm strict morphology and sperm chromatin integr... more Objective: To examine the relationship between sperm strict morphology and sperm chromatin integrity. Design: Prospective study. Setting: Infertility clinic. Patient(s): Eighty-seven consecutive semen samples from non-azoospermic men presenting for infertility evaluation and 6 samples from fertile donors. Intervention(s): Assessment of standard semen parameters and sperm chromatin structure assay (SCSA) parameters (%DFI [DNA fragmentation index] and %HDS [high DNA stainability]). Evaluation of %HDS and %DFI after treatment with dithiothreitol (a thiol-reducing agent used to decondense sperm nuclei) was also undertaken. Main Outcome Measure(s): Relationship between sperm strict morphology defects and SCSA parameters (%DFI and %HDS). Result(s): We observed significant relationships between the percentage of normal sperm forms and both %HDS (r ¼ À0.40) and sperm motility (r ¼ 0.32). We also found significant relationships between sperm head defects and both %HDS (r ¼ 0.40) and sperm concentration (r ¼ À0.39). Sperm tail, midpiece, and neck defects were not significantly related to the SCSA parameters. Treatment of spermatozoa with dithiothreitol (to induce decondensation) resulted in a substantial increase in %HDS but no measurable change in %DFI. Conclusion(s): The observed relationship between sperm head defects and %HDS suggests that sperm head abnormalities may, in part, be due to incomplete sperm chromatin condensation. (Fertil Steril Ò 2009;91:2495-500. Ó2009 by American Society for Reproductive Medicine.

Journal of Assisted Reproduction and Genetics, 2003

To investigate whether the consecutive embryo transfer of day 3 embryos and of blastocyst protect... more To investigate whether the consecutive embryo transfer of day 3 embryos and of blastocyst protects against failure to reach embryo transfer and provides additional pregnancies. Methods : An embryo transfer was performed on day 3 following which all remaining embryos were cultured to the blastocyst stage for a possible second transfer. Results : One hundred and forty-two patients were selected for extended culture. Thirty-two of these patients did not develop blastocysts in culture, however, there were 12 pregnancies achieved in this group. Conclusions : The consecutive transfer of day 3 embryos and blastocysts can prevent the total loss of a cycle when embryos fail to develop to the blastocyst stage in culture and thereby provide additional pregnancies.

Middle East Fertility Society Journal, 2021

Obstetrical outcomes in assisted reproduction techniques (ART) were compared with naturally conce... more Obstetrical outcomes in assisted reproduction techniques (ART) were compared with naturally conceived pregnancies and among each other in multiple reports. However, many important changes in the practice of in vitro fertilization (IVF) over the years, including single embryo transfers (sET) and the introduction of modified natural IVF (mnIVF), and the advances in the frozen embryo transfer (FET) might have impacted the outcomes. Our study is the first to our knowledge to assess four different groups, including spontaneous pregnancies, mnIVF, stimulated IVF (sIVF), and FET altogether in a head-to-head comparison. This is a retrospective study on perinatal outcomes of singleton babies conceived naturally or using three different ART protocols between 2011 and 2014. The primary objective was the comparison of gestational age and birth weight between spontaneously conceived pregnancies (NAT, n= 15,770), mnIVF (n=235), sIVF (n=389), and FET (n=222). Our results show a significant differe...

A total of 134 controlled natural IVF (nIVF) cycles were reviewed retrospectively and compared wi... more A total of 134 controlled natural IVF (nIVF) cycles were reviewed retrospectively and compared with 370 stimulated IVF (sIVF) cycles. The clinical pregnancy rate per embryo transfer following nIVF was 27% and 47% in sIVF cycles for patients aged less than 35. However, natural cycle patients could attempt consecutive cycles with much less impact on their lives, both medically and fi nancially. In patients under 35 years of age, the choice of controlled nIVF reduces the cost and risk to the patient, permitting her to have multiple, consecutive attempts, and cumulatively offers a clinical pregnancy rate which approaches that of sIVF. The multiple pregnancy rate in nIVF is signifi cantly reduced compared with sIVF treatment cycles. In patients over 35 years of age the benefi ts of nIVF were much less evident (clinical pregnancy rate: 8% per embryo transfer) and the opportunity to transfer multiple embryos in these patients seems to be advantageous.

Case Reports in Clinical Medicine, 2017

A 19 years old patient with primary amenorrhea was referred to our center. Based on discrepancy b... more A 19 years old patient with primary amenorrhea was referred to our center. Based on discrepancy between high follicle stimulating hormone (FSH) level and normal ovarian reserve parameters, follicle stimulating hormone receptor (FSHR) mutation was screened. The patient was homozygous in exon 6 of the FSHR gene for the new variant c.479T > C and predicted to result in an aminoacid substitution p.Ile160Thr. One year later, her anti-müllerian hormone (AMH) level inexplicably decreased. Oocyte vitrification was thus offered for fertility preservation. After 17 days of recombinant follicle stimulating hormone (recFSH) (900 IU daily), no follicular growth was seen and estradiol levels remained low. In vitro maturation (IVM) was then suggested. Ten oocytes were successfully vitrified.

Fertility and Sterility, 2018

Reproductive Biomedicine & Society Online, 2019

An analysis of national registry data for 5 years of in-vitro fertilization (IVF) funding in Queb... more An analysis of national registry data for 5 years of in-vitro fertilization (IVF) funding in Quebec, Canada was compared with the previous complete year of non-funded IVF cycles, as well as the first complete year following the end of funding. The number of cycles, livebirth rates, age group of patients treated, use of donor gametes, multiple pregnancy rates and cycle cancellation rates were assessed. The total number of IVF cycles performed increased dramatically during the funded period, averaging over 10,000 cycles per year. There was no change in the age group distribution of patients treated, but less egg donation was performed. Interestingly, funding was also associated with an increase in the IVF cycle cancellation rate (17.0% versus 34.4%, P b 0.001), a dramatic decline in the multiple pregnancy rate (25.6% versus 4.9%, P b 0.001), and a decline in the livebirth rate per fresh embryo transfer in stimulated IVF cycles (32.3% versus 25.5%, P b 0.001). Although the livebirth rate for stimulated IVF declined, over 9000 babies were born as a result of the coverage. Lessons learned from this experience could help develop a more fiscally responsible programme that still facilitates access to IVF care.

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018

Background: Most studies conclude that the cumulative pregnancy rate depends on embryo quality an... more Background: Most studies conclude that the cumulative pregnancy rate depends on embryo quality and quantity, which is directly related to patient’s age. In the best-case scenario, the cumulative pregnancy rate reaches 79% when the number of embryos reaches 15. Other studies reported 75% probability of live birth after 6 cycles of controlled ovarian stimulation and IVF.Methods: Retrospective cohort study comparing IVF cycles between January 2008 to December 2009 (before governmental coverage), and between January 2012 to December 2013. University-affiliated private IVF clinic. 298 good prognosis IVF patients from 2008-2009 and 610 patients from 2012-2013 were included. The cumulative LBR per IVF cycle was the main outcome measure; the secondary outcome measures were the type of protocol used, percentage of ICSI cycles, fertilization rate, proportion of day 3 versus (vs) day 5 embryo transfers, average number of embryos transferred, average number of frozen embryos, the clinical pregn...

Fertility and Sterility, 2017

OBJECTIVE: To examine recent trends and associations in intracytoplasmic sperm injection (ICSI) u... more OBJECTIVE: To examine recent trends and associations in intracytoplasmic sperm injection (ICSI) use among states with and without an insurance mandate for coverage of in vitro fertilization (IVF) services. DESIGN: Population-based cross-sectional study. MATERIALS AND METHODS: Data from the 2000-2014 National Assisted Reproductive Technology Surveillance System were analyzed. We used linear regression to assess trends in ICSI use among fresh IVF cycles performed in 8 states with insurance mandates for IVF, and 43 states without mandates (including the District of Columbia), stratified by male factor infertility. For the most recent 5-year period (2010-2014), we compared ICSI use by mandate status, and used log-binomial regression to calculate adjusted rate ratios (aRR) for associations between ICSI use and insurance mandates, accounting for clustered clinic outcomes with generalized estimating equations. We also compared ICSI use in non-male factor infertility cycles by mandate status for selected characteristics (unexplained infertility, low oocyte yield, maternal age greater than or equal to 38 years, greater than or equal to 2 prior cycles and no live births, and use of preimplantation genetic diagnosis (PGD)). P-values less than 0.05 were considered statistically significant. RESULTS: ICSI use increased overall during 2000-2014, but for nonmale factor infertility cycles, the increase was greater among nonmandate states (34.6% vs 71.4%, a 36.8% change, P<.0001) versus mandate states (39.5% vs 62.3%, a 22.8% change, P<.0001). From 2010-2014, ICSI use was higher in non-mandate vs. mandate states, for cycles with (94.5% vs. 90.9%, aRR 0.97; 95% CI, 0.94-0.996, P¼.03), and without (68.4% vs. 59.6%, aRR 0.86; 95% CI, 0.74-0.99, P¼.04) male factor infertility. ICSI use was statistically significantly higher in non-mandate states than in mandate states for the selected characteristics assessed except for PGD; this difference was the greatest among cycles with unexplained infertility (66.7% vs. 53.5%) and low oocyte yield (71.8% vs. 61.1%). CONCLUSIONS: Mandates were associated with decreased ICSI use for non-male factor infertility cycles, especially for cycles with unexplained infertility and low oocyte yield.

Case Reports in Clinical Medicine, 2013

Reproductive Medicine and Biology, 2003

This case report describes a successful full-term pregnancy and birth after the transfer of rescu... more This case report describes a successful full-term pregnancy and birth after the transfer of rescue intracytoplasmic sperm injection (ICSI) embryos derived from 1-day-old oocytes. A total of eight oocytes were retrieved and inseminated 3 h after collection. No oocytes were fertilized 16-18 h after insemination. A rescue ICSI was performed on the four metaphase II stage oocytes. At the regular time (16 h after ICSI) of examination for fertilization, there were no distinct two pronuclei (2PN) in the cytoplasm of any oocytes, but the culture of these oocytes led to the development of four two-cell stage embryos 26 h after ICSI. Further culture of these four embryos showed development to a four-cell stage the following day. The transfer of three embryos resulted in a full-term pregnancy with the delivery of a pair of healthy twins. This result suggests that the observation of 2PN at the normal time of fertilization assessment may not appear to be an absolute indicator of fertilization in the case of rescue ICSI. (Reprod Med Biol 2003; 2: 83-85)

Obstetrics & Gynecology, 2002

To establish the relative success of treatment by unstimulated in vitro maturation (IVM) of oocyt... more To establish the relative success of treatment by unstimulated in vitro maturation (IVM) of oocytes or stimulated in vitro fertilization (IVF) in women with polycystic ovaries undergoing assisted conception treatment. METHODS: The case-control study included 107 IVM and 107 IVF cycles matched for age and cause of infertility. In vitro maturation patients underwent transvaginal recovery of immature oocytes during an unstimulated cycle, in vitro oocyte maturation, and fertilization. Those in the IVF group underwent ovarian stimulation after pituitary suppression. Embryos were transferred in the same cycle in both groups. Main outcome measures included numbers of mature oocytes and embryos produced, and rates of implantation, pregnancy, live birth, and complications. RESULTS: In the IVM group after in vitro culture, 7.8 mature oocytes and 6.1 embryos were obtained per retrieval. With IVF, 12.0 mature oocytes (P < .01) and 9.3 embryos (P < .01) were obtained. The IVM pregnancy and live birth rates per retrieval were 26.2% and 15.9% compared with 38.3% and 26.2% for IVF (nonsignificant). The implantation rate of IVF-derived embryos was higher (17.1% versus 9.5%) than that for IVM (P < .01). There were 12 cases (11.2%) of moderate or severe ovarian hyperstimulation syndrome in IVF patients, compared with none in the IVM group (P < .01). CONCLUSION: Our results suggest that for women with polycystic ovaries who require assisted conception, IVM is a promising alternative to conventional IVF treatment.

Journal of Assisted Reproduction and Genetics, 2014

Purpose To evaluate the impact of serum AMH levels on stimulated IVF implantation and clinical pr... more Purpose To evaluate the impact of serum AMH levels on stimulated IVF implantation and clinical pregnancy rates. Methods • Design: Retrospective study with multivariate analysis. • Setting: Clinique ovo (Montreal University affiliated Center). • Patient(s): Six hundred and thirty seven patients undergoing a stimulated IVF protocol were included. Only nonpolycystic ovary patients at their first IVF attempt were considered for the analysis. • Intervention(s): None. • Main outcome measures(s): Implantation and ongoing pregnancy rates. Result(s) Cycle outcomes were analysed according to AMH percentiles based on the AMH normogram per patient's age of our infertile population. Multivariate analyses were done to adjust for potential confounding factors such as age, total exogenous FSH dosage and number of eggs retrieved. Compared to the reference population, a significant lower mean implantation rate (0.26 vs 0.45) was observed in patients under 35 years of age with AMH<1 ng/ml. Women with AMH<25th percentile had less chances of having an embryo transferred, lower chances of having an ongoing pregnancy per started IVF cycle and a lower embryo freezing rate compared to the reference population. Conclusion(s) Patients with AMH<0.47 ng/ml should be advised before starting a stimulated IVF cycle of the poorer prognosis compared to our reference population independently of their age, total exogenous FSH dosage and number of eggs retrieved. Therefore, AMH could enable a more individualized number of embryo transfer policy based on oocyte quality.

Journal of Assisted Reproduction and Genetics, 2013

Background Sperm DNA damage is associated with male infertility, lower pregnancy rates and pregna... more Background Sperm DNA damage is associated with male infertility, lower pregnancy rates and pregnancy loss. Objective The primary aim of our study was to evaluate the prevalence of sperm DNA damage in younger and older men with normozoospermia. Design, Setting and Participants We obtained semen from 277 consecutive non-azoospermic men presenting for sperm DNA testing. Outcome Measurements and Statistical Analysis The main outcome measures included sperm % DNA fragmentation index (%DFI, using sperm chromatin structure assay), sperm concentration, motility and morphology, and, paternal age. Results and Limitations Sperm % DFI was positively correlated with paternal age (r=0.20, P<0.001) and inversely correlated % progressive motility (r=−0.16, P=0.01). Sperm %DFI was significantly higher in older (≥40 years) compared to younger (<40 years) normozoospermic men (17±13 vs. 12±8, respectively P=0.008), whereas, sperm concentration, progressive motility and morphology were not significantly different in these two groups. Moreover, the prevalence of high levels of sperm DNA damage (>30 % DFI) was significantly higher in older compared to younger normozoospermic men (17 % vs. 3 %, respectively, P<0.001). Conclusion The data indicate that a conventional semen analysis can often fail to detect a defect in spermatogenesis (high %DFI) in older men and suggest that infertile couples with advanced paternal age, including those with normal semen parameters, should consider sperm DNA testing as part of the couple evaluation.

Journal of Assisted Reproduction and Genetics, 2004

Purpose : To examine the reproductive performance of hepatitis B (HBV) and C (HCV) discordant cou... more Purpose : To examine the reproductive performance of hepatitis B (HBV) and C (HCV) discordant couples following IVF-ET. Methods : A retrospective cohort study of 25 IVF-ET cycles in HBV and HCV discordant couples was performed. Thirteen patients in the study cohort were discordant for HBV (10 males and 3 females), and 12 (9 males and 3 females) for HCV. Twenty-seven consecutive age matched patients comprised the control group. All patients underwent controlled ovarian hyperstimulation using the long downregulation protocol followed by IVF or ICSI. Results : Patients in the three groups (HBV, HCV, and controls) had similar ages, and day 3 FSH concentrations. Despite comparable response to COH, and similar fertilization, and cleavage rates in the three groups, couples discordant for HBV or HCV had significantly poorer implantation and pregnancy rates (7.7%, 0% respectively) compared with controls (41%). Conclusions : Despite comparable response to COH, HBV and HCV positive discordant couples, have significantly lower implantation and pregnancy rates compared with age-matched controls.

Fertility and Sterility, 2012

behaved with abnormal distribution, were therefore expressed by the median and range. Statistical... more behaved with abnormal distribution, were therefore expressed by the median and range. Statistical analysis was performed using the Kruskal Wallis test with Bonferroni correction method in case of independent comparisons. Significance was assumed at P<0.05. RESULTS: Group 1: 56,3% of patients (18/32) had a recovery rate of mature oocytes of 100% (median 100%, range 66-100%). Group 2: 27.6% (8/ 29) showed 100% MII rate (median 80%, range 0-100%). Group 3: 31.8% (12/38) showed 100% MII rate (median 90.5%, range 29-100%). Triptorelin was significantly greater than leuprolide (P¼0.003). There was not difference between groups 1 and 3, and group 2 and 3 (P¼0.075 and 0.370 respectively). The fertilization rate was similar between groups, Group 1: 98% (40-100%) vs. Group 2: 100% (44-100%) vs. Group 3: 86% (0-100%). CONCLUSION: The use of triptorelin for the final oocyte maturation, yielded similar mature oocytes percentages and fertilization rates to that achieved by r-hCG and better than leuprolide acetate. It was formerly demonstrated that triptorelin prevents the ovarian hyperstimulation syndrome. Therefore it could be used safely and efficiently as an agent of first choice in donor cycles to trigger the endogenous LH surge.