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A Hazout

Publications and source records attributed to A Hazout.

At least 73 records · Page 4Linked to original sources

Evidence for an adverse effect of elevated serum estradiol concentrations on embryo implantation.

Multiple follicular stimulation for IVF may be associated with greatly elevated serum E2 concentrations that are presumed to be antinidatory. This factor was analyzed in 825 consecutive embryo transfer cycles. The pregnancy rate decreased significantly after the transfer of one and two embryos in association with preovulatory E2 levels greater than the 90th percentile for the group (2320 pg/ml). The pregnancy rate did not vary with preovulatory E2 concentration following the transfer of three embryos. Highly significant correlations were noted between preovulatory E2 and early luteal phase concentrations of E2 and P. In a subgroup of 245 cycles, there were no significant relationships between implantation and early luteal phase levels of P or the ratio of E2/P. There was a small but nonsignificant tendency for the pregnancy rate to decrease in association with raised luteal E2. It is concluded that excessive E2 levels at the time of ovulation induction with hCG had an adverse effect on implantation when one or two embryos are transferred, but this may be overcome by the transfer of three embryos. The consequences for embryo transfer are discussed.

Embryo Implantation↗

An assessment of alternative policies for embryo transfer in an in vitro fertilization-embryo transfer program.

Conventionally, in in vitro fertilization (IVF) programs, all embryos obtained up to three are freshly transferred in the IVF cycle and supernumerary embryos frozen if cryopreservation facilities exist. This study was concerned with assessing alternative policies for embryo transfer (ET). When three or fewer embryos were obtained in the IVF cycle, fresh embryo transfer was either excluded (group I, n = 69) or only one embryo was immediately transferred (group II, n = 46), the remainder being transferred after freezing and thawing. The pregnancy rate in these two policies was compared to that in a control group of patients (group III, n = 115) in whom all the embryos were transferred in the IVF cycle. The ongoing pregnancy rate was similar in all three groups. No multiple pregnancies occurred in groups I and II compared with one in the controls. The consequences of these policies for pregnancy rates and the incidence of multiple gestation are discussed. It is concluded that the deliberate limitation of fresh ET to a maximum of one embryo followed by one or more cycles of thawed frozen ET is not detrimental to the pregnancy rate and is less likely to be associated with multiple gestations. Conversely, this policy increases the workload of the laboratory staff and raises certain ethical questions.

Chorionic Gonadotropin↗

Comparison between flare up and down regulation effects of luteinizing hormone-releasing hormone agonists in an in vitro fertilization program.

Luteinizing hormone-releasing hormone (LH-RH) agonists are being increasingly used in ovulation stimulation protocols in IVF programs. The results of two methods of utilization of LH-RH agonists are compared. In the long protocol, gonadotropin stimulation was commenced only after a preliminary period of pituitary desensitization with LH-RH agonist. In the short protocol, exogenous gonadotropins were administered shortly after the start of LH-RH agonist therapy, benefiting from the gonadotropin flare up effect. One hundred eighty-six patients were equally divided between the two treatments. There was no difference in the ovarian response on the day of human chorionic gonadotropin (hCG) or the number of mature oocytes recovered. The cleavage rate of mature oocytes was higher in the short protocol (70% versus 56% P less than 0.01). The ongoing pregnancy rate per treatment cycle was similar in both groups (18% in the long protocol and 16% in the short protocol). Analysis of the luteal phases revealed a trend for higher progesterone values in the long protocol although this was only significant on the 2nd day following oocyte retrieval. As the clinical results were similar, other factors should be taken into account when deciding therapy. These include patient convenience, cost, and side effects. Other schedules of ovulation stimulation with LH-RH agonists are discussed.

Adult↗

Selective oocyte retrieval: a new approach to ovarian hyperstimulation.

Selective oocyte retrieval is a new approach to ovarian hyperstimulation (OHS) that prevents side effects of OHS and multiple pregnancies by puncturing most of the ovarian follicles 35 hours after hCG administration as in an IVF program. The remaining intact follicles can still result in a singleton or twin pregnancy. In three patients who presented a multiple follicular development, this technique resulted in two pregnancies; moreover, the retrieved oocytes were fertilized and the embryos frozen.

Female↗

LHRH agonists in IVF: different methods of utilization and comparison with previous ovulation stimulation treatments.

LHRH agonists are being increasingly used in ovulation stimulation protocols in IVF programmes. We have compared the results of two methods of utilization of LHRH agonists. In the long protocol, gonadotrophin stimulation was only commenced after a preliminary period of pituitary desensitization with LHRH agonist. In the short protocol, exogenous gonadotrophins were administered shortly after the start of LHRH agonist therapy, benefiting from the gonadotrophin flare-up effect. One-hundred-and-eighty-six patients were divided equally between the two treatments. There was no difference in the ovarian response on the day of HCG or the number of mature oocytes recovered. The cleavage rate of mature oocytes was higher in the short protocol (70, versus 56, P less than 0.01). The ongoing pregnancy rate per treatment cycle was similar in both groups (18, in the long protocol and 16, in the short protocol). Analysis of the luteal phases revealed a trend for higher progesterone values in the long protocol although this was only significant on the second day following oocyte retrieval. As the clinical results were similar other factors should be taken into account when deciding therapy. These include patient convenience, cost and side-effects. Other schedules of ovulation stimulation using LHRH agonists are discussed.

Female↗

Improvements in ovarian stimulation for in vitro fertilization.

What are the major improvements in stimulation over recent years? The stimulated cycle has completely superseded the natural cycle since this is the only method of obtaining several embryos. In conventional stimulation, despite an enormous body of literature, no single treatment modality has emerged as superior to other forms of therapy. Undoubtedly it is the experience and habits of individual IVF teams that determine the success of one or another method. Therefore programmed stimulation is an improvement in that it introduces the factors of convenience and simplicity while retaining the clinical efficacy of stimulation by conventional treatment. The analogues of LHRH are still in an early phase of development, but they appear to be associated with a low cancellation rate even in previous poor-responders. Furthermore, preliminary results seem to indicate that this is the first development since the widespread adoption of follicular stimulation, which is associated with an increased pregnancy rate. We are currently involved in trying to associate programmed stimulation and analogue treatment in a bid to combine the advantages of both therapies. Finally, embryo cryopreservation must be mentioned. There is no point in refining our stimulation protocols to obtain many embryos if those surplus to immediate requirement are disposed of. Cryopreservation offers the means of maximizing the pregnancy potential of a single IVF cycle while reducing the possibility of multiple pregnancy.

Embryo, Mammalian↗

Human embryo viability related to freezing and thawing procedures.

Freezing and thawing procedures did not affect the chances of successful transfer of human embryos. The postimplantation viability of frozen-thawed embryos was equivalent to that of fresh, immediately transferred embryos. Selection of the embryos that were more suitable for freezing did influence the pregnancy rate after transfer of the remaining fresh embryos. The therapeutic efficacy of in vitro fertilization and embryo transfer programs will be greatly increased if only one embryo is transferred in the in vitro fertilization cycle, the others being separately frozen for further embryo transfer in subsequent cycles.

Embryo Transfer↗

Factors influencing the success rate of human embryo freezing in an in vitro fertilization and embryo transfer program.

Certain factors influencing the success of embryo cryopreservation were analyzed from 124 cycles of in vitro fertilization and embryo transfer (IVF-ET) program in which 193 1- or 2-day embryos were frozen and had already been thawed. There were 100 transfers of one or two surviving embryos from which 26 pregnancies were initiated. Several factors significantly influenced embryo survival after thawing. They were: the developmental stage of frozen embryos; the appearance of the embryo at the time of freezing; and the mode of ovarian stimulation in the IVF cycle. The pregnancy rate after frozen-thawed embryo transfer was higher with 4-cell frozen embryos than with embryos at all other stages combined. There were also tendencies for the pregnancy rate to be higher if a spontaneous luteinizing hormone surge occurred in the transfer cycle or if the duration of embryo storage did not exceed 1 to 2 months. The results obtained support a new policy in IVF-ET programs: it should be advantageous for the sterile couple if the immediate fresh embryo transfer is only performed with the categories of embryos that demonstrate a poor aptitude for survival following cryopreservation procedures.

Embryo Transfer↗

One year's experience with programmed oocyte retrieval for IVF.

We have previously described a simplified form of ovulation stimulation for IVF in which the day of presumed oocyte retrieval is determined several weeks in advance. This paper retrospectively analyses this technique in 296 unselected patients over a one year period to assess if the method is suitable for routine use in an IVF programme. Oocyte retrieval was performed on the predetermined day in 70% of patients commencing stimulation. In the remainder, the presumptive day of oocyte retrieval was modified, or the cycle was cancelled. Compared with 356 patients undergoing a comparable classically monitored IVF stimulation during the same period, there was no significant difference in the cancellation rate of cycles prior to oocyte recovery, in the numbers of oocytes or embryos obtained or in the pregnancy rate between the two populations. It is concluded that programmed oocyte retrieval does not have a deleterious effect on the success rate of IVF compared with classical clomiphene citrate/HMG stimulation and it considerably facilitates the administration of an IVF programme.

Clomiphene↗

An obstetric assessment of the first 100 births from the in vitro fertilization program at Clamart, France.

From April, 1981, to July, 1984, 142 pregnancies have been attained after in vitro fertilization and embryo transfer. They are divided into 22 biochemical pregnancies (human chorionic gonadotropin greater than or equal to 20 mU/ml but remaining below 1000 mU/ml), 27 spontaneous abortions, three ectopic pregnancies, and 90 ongoing pregnancies, of which 11 were twin pregnancies. The 90 women in whom the pregnancies progressed were compared with the 52 women having nonprogressive pregnancies. The two populations did not differ either in age, in the indication for in vitro fertilization and embryo transfer, or in the quality of ovulation or results of semen analysis. The 90 ongoing pregnancies were compared with those pregnancies occurring in the same obstetrics department during this period. We found that the in vitro fertilization group had a higher proportion of arterial hypertension (16.5% versus 8.5%, p less than 0.05), breech presentations (13.9% versus 4.3%, p less than 0.001), and caesarean sections (46.8% versus 15.5%, p less than 0.001) but the sex ratio did not differ.

Abortion, Spontaneous↗

High pregnancy rate after early human embryo freezing.

Human embryos produced by in vitro fertilization (IVF) were frozen with 1,2-propanediol as a cryoprotectant. Embryo survival after thawing was related to the presence of a nucleus in frozen cells and decreased with the increasing number of cells in the frozen embryo. None of five embryos frozen 3 or 4 days after IVF survived when thawed. Of 48 early embryos (35 patients) frozen 1 or 2 days after IVF, 42 (87.5%) were transferred in 32 patients. Ten pregnancies were initiated after frozen embryo transfer (ET). If we exclude the three infertile patients who had sexual intercourse in the fertile period, the pregnancy rate for each patient who had 1- or 2-day frozen embryo(s) was 22% (7 of 32). One of the pregnancies was obtained after ET of a 1-cell pronucleated frozen and thawed embryo. The rate of ongoing pregnancies after triple fresh ET was 23%. In patients having four embryos obtained in a single IVF cycle, the expected overall liveborn rate in an IVF-ET program including embryo cryopreservation could theoretically equal that of natural human fertility.

Cell Survival↗

A new approach to follicular stimulation for in vitro fertilization: programed oocyte retrieval.

Programed oocyte retrieval was performed in a group of 35 patients undergoing in vitro fertilization (IVF) treatment. The date of follicular aspiration was decided several months in advance and the cycle prior to oocyte recovery was modified with a progestagen or an estrogen-progestagen contraceptive pill. This was followed by a fixed-schedule ovulation stimulation and induction regimen. Follicular growth was not monitored. Thirty-four of the 35 patients had follicular aspiration, and at least one embryo was obtained in 30 of them. The clinical pregnancy rate (excluding cryopreserved embryos) was 20% per IVF cycle, 21% per attempted oocyte retrieval procedure, and 23% per embryo transfer cycle. Programmed oocyte retrieval is a realistic option for follicular stimulation for IVF treatment and is associated with significant practical and economic benefits.

Contraceptives, Oral, Combined↗

Various techniques for oocyte recovery in an in vitro fertilization and embryo transfer program.

Oocyte recovery in an in vitro fertilization and embryo transfer (IVF-ET) program can be performed by laparoscopy or by sonography. Most IVF teams use either one or the other of these methods. In Clamart, we undertook 407 IVF attempts from September 1983 to March 1984, 225 by laparoscopy under general anesthesia, 97 by laparoscopy under local anesthesia, and 85 by sonography. Excluding the recovery techniques, all aspects of the program (ovulation monitoring, culture, and transfer) were identical in order to study the effects of the anesthesia and the ultrasound. We did not find any significant difference in pregnancy rates, inclusive of biochemical pregnancies, among these three recovery methods, although ultrasonically guided puncture gave fewer follicles, oocytes, and embryos than laparoscopy.

Adult↗

In vitro fertilization in tuberculous infertility.

Twenty women, suffering from infertility due to histologically proved genital tuberculosis, were managed by in vitro fertilization (IVF) in 49 attempts. The main histopathological lesions were tuberculous salpingitis in 12 women, tuberculous endometritis in 5, and pelvic peritoneal tuberculosis in 3. A preliminary evaluation including, particularly, a laparoscopy and a hysteroscopy was performed. Five deliveries and one ongoing pregnancy were obtained. The results suggest that IVF nowadays represents the only treatment for tuberculous infertility.

Adult↗

[Amniofetography].

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Amniocentesis↗

[Assisted reproductive technologies after conservative management of borderline or invasive ovarian tumours].

OBJECTIVE: Ovulation induction, the usual resort of Assisted Reproductive Technologies (ART), has been suspected of carrying a responsibility in the genesis of ovarian tumours. For patients with a borderline or invasive ovarian tumour, treated by conservative surgery and desiring to become pregnant, the problem is thus of a possible resort to the Assisted Reproductive Technologies. PATIENTS AND METHODS: This is a multicenter, national and retrospective study. 40 operated patients between January 1971 and January 2001 have been included. 27 patients (67.5%) had a borderline tumour, 10 (25%) a non-epithelial tumour (germinal or stromal) and 3 (7.5%) an epithelial invasive carcinoma. All these patients have benefited from a conservative surgical management of fertility. The Assisted Reproductive Technologies were simple stimulation for 5 women and IVF for the 35 others. The effectiveness and the risks of Assisted Reproductive Technologies have been estimated respectively by the number of pregnancies obtained and the recurrence rates. RESULTS: With a global follow-up of 372 months (January 1971: date of the primary surgical procedure--June 2002: closing of the study), 17 patients have obtained 17 pregnancies with the Assisted Reproductive Technologies, rate of 42.5% (17/40): 1 spontaneous abortion, 16 delivery with 23 children (triple pregnancies and 3 twin pregnancies). 3 patients treated for a borderline tumour have had a recurrence after induction of ovulation. Among the 40 patients, no one presented an evolved disease at the last news. The patients who had a recurrence had a delay to begin the Assisted Reproductive Technologies significantly lower than the patients who had no recurrence. DISCUSSION AND CONCLUSION: The assisted reproductive technologies for patients who had been treated for a borderline or invasive ovarian tumour, and who were infertile in spite of conservative management, have allowed 42.5% of these women to obtain a pregnancy and does not seem to increase significantly the risk of recurrence.

Adult↗