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Biomedical subjects

A Leader

Publications and source records attributed to A Leader.

At least 37 records · Page 2Linked to original sources
PubMed1993

Natural cycle in vitro fertilization-embryo transfer at the University of Ottawa: an inefficient therapy for tubal infertility.

OBJECTIVE: To describe our experience with natural cycle IVF making clinical and endocrine comparisons with our standard stimulated cycle IVF program. DESIGN: We attempted 75 natural IVF-ET cycles with hCG given to preempt the LH surge and compared these with 450 attempts at standard superovulation IVF-ET done in our unit during the same time period. PATIENTS: Natural cycle patients are normally ovulating women < age 38. Superovulation IVF-ET patients are all < 41 years old. Patients in both groups had partners with normal semen parameters and tubal factor infertility. MAIN OUTCOME MEASURES: Cancellation rates, pregnancy rates per egg retrieval, per ET procedure, and luteal phase E2:P ratios of the treatment cycles are compared. RESULTS: There were 35 of 75 (47%) natural cycle and 112 of 450 (25%) superovulation cycle cancellations. An egg was retrieved in only 24 of 40 (60%) natural cycles and 336 of 338 (99%) superovulation egg retrieval procedures. Pregnancy rates per ovum pick-up procedure were significantly higher: 65 of 338 (19%) in the superovulation versus 2 of 40 (5%) in the natural cycle groups. Pregnancy rates per ET were not significantly different between natural IVF-ET, 2 of 18 (11%) and superovulation IVF-ET, 65 of 298 (22%). The E2:P ratios 5 days after ET were similar in both groups at 18 +/- 4 after natural IVF-ET and 21 +/- 18 after superovulation IVF-ET. CONCLUSIONS: [1] Cancellation rates for natural cycle IVF are very high. [2] Midluteal E2:P ratios are the same in both groups. [3] Pregnancy rates per egg retrieval are significantly lower for natural versus superovulation IVF-ET. [4] In our experience, natural cycle IVF-ET is an inefficient therapy for tubal infertility compared with superovulation IVF-ET.

Adult↗
PubMed1992

Luteal phase support in in-vitro fertilization using gonadotrophin releasing hormone analogue before ovarian stimulation: a prospective randomized study of human chorionic gonadotrophin versus intramuscular progesterone.

This study was conducted to compare the endocrine milieu and pregnancy rates in an in-vitro fertilization and embryo transfer (IVF-ET) programme employing a gonadotrophin-releasing hormone agonist (GnRHa) and human menopausal gonadotrophin (HMG) when either human chorionic gonadotrophin (HCG) or progesterone were used for luteal phase support. A total of 121 IVF-ET treatment cycles were prospectively studied. All patients started leuprolide acetate in the midluteal phase and it was continued for at least 10 days. When oestradiol levels were less than 150 pmol/l, HMG was started. When at least three follicles were greater than or equal to 17 mm in diameter, HCG 5000 IU i.m. was given. Oocytes were retrieved using transvaginal ultrasound and embryos were transferred 48 h later. The patients' cycles were prospectively randomized to receive HCG (72 cycles) or progesterone (49 cycles) luteal support. The HCG group received 1500 IU i.m. on days 3, 6 and 9 after the initial trigger. The progesterone group received 12.5 mg i.m. q.d. starting from the day after the HCG trigger. The dose of progesterone was increased to 25 mg i.m. q.d. starting on the day of embryo transfer and continued for 17-21 days. If the patient became pregnant, this dose of progesterone was continued until fetal heart activity was visualized by ultrasound. Mean ages, number of eggs retrieved, embryos transferred, oestradiol levels on the day of the HCG trigger, oestradiol and progesterone at the time of embryo transfer were the same in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Seminal plasma gamma-aminobutyric acid (GABA) levels in normospermic men.

Serum and seminal gamma aminobutyric (GABA) concentrations were documented in 10 healthy volunteers. Mean (+/- S.E.M.) GABA concentrations were 0.39 +/- 0.03 microM in serum and 103.3 +/- 28.2 microM in seminal fluid. These differences are in keeping with data reported for the rat and rabbit. A regulatory role for GABA in the reproductive tract is postulated.

Adult↗
PubMed1991

Levels of cholesterol and phospholipids in freshly ejaculated sperm and Percoll-gradient-pelletted sperm from fertile and unexplained infertile men.

Cholesterol and phospholipid levels were determined in individual sperm samples obtained from 20 fertile and 20 unexplained infertile men. The determination was performed on both washed freshly ejaculated sperm and Percoll-gradient-pelletted sperm. Although sperm cholesterol levels in unexplained infertile patients were significantly lower, i.e., 10.6 +/- 1.3 (mean +/- SD) nmol/10(7) freshly ejaculated sperm and 5.4 +/- 0.7 nmol/10(7) Percoll-gradient-pelletted sperm as compared with 19.9 +/- 1.9 nmol/10(7) and 12.6 +/- 1.5 nmol/10(7) for corresponding sperm populations in fertile donors. Motility parameters measured in 10 sperm samples of the two groups of fertile and unexplained infertile men revealed increases in the amplitude of lateral head displacement and decreases in percent of straightness in sperm tracks from unexplained infertile men.

Centrifugation↗
PubMed1990

Therapeutic donor insemination with frozen semen.

Although it is now accepted that cryopreserved semen must, on ethical and medicolegal grounds, be used for donor insemination many clinicians still believe that it has an unacceptably reduced fecundability rate as compared with fresh semen. We studied the outcome of 81 recipients who started therapeutic donor insemination (TDI) treatment during 1986 in a program that used exclusively cryopreserved semen; 55 had never undergone TDI and were receiving the first series (six cycles), 6 were receiving the second series (also six cycles), and 20 had achieved pregnancy through TDI previously and were starting the treatment again. Insemination with semen stored in 0.5-ml French straws was performed daily during the periovulatory period while the modified Insler score was 10 or greater out of 15. A total of 42 (52%) of the recipients became pregnant within six TDI cycles; 4 (10%) had a spontaneous abortion. An average of 4.8 straws were used per cycle among those who became pregnant and 5.1 per cycle among those who did not. On average 2.6 cycles were required to achieve pregnancy. The overall fecundability rate was 14.6%. We conclude that a TDI program involving exclusively frozen semen can be operated with a success rate comparable to rates achieved with fresh semen if a simple, established cryopreservation method and an uncomplicated clinical management protocol are used.

Adult↗
PubMed1990

Treatment of spermagglutination with proteolytic enzymes. I. Sperm motility, vitality, longevity and successful disagglutination.

The treatment of antibody-mediated spermagglutination by corticosteroid therapy has a high incidence of side-effects and sperm washing is often followed by re-agglutination. The possibility of enzymatic disagglutination was therefore investigated. In the first part of the study the effects of four proteases on sperm motility, vitality and longevity were evaluated. Subtilisin had prohibitively detrimental effects even at 10 U/ml. However, chymotrypsin (less than or equal to 500 U/ml), trypsin (less than or equal to 500 U/ml) and papain (less than or equal to 50 U/ml) had no adverse effects. In the second series of experiments one or more of these latter three enzymes was found to disagglutinate spermatozoa which had previously been incubated with sperm-agglutinating antibody-positive sera in 87% of cases. Although further investigation is required, enzymatic disagglutination may be beneficial for the treatment of immunologically mediated spermagglutination.

Cell Membrane↗
PubMed1987

Evidence for an absence of deleterious effects of ultrasound on human oocytes.

Animal and human data would suggest that ultrasound causes deleterious effects to oocytes during meiosis. We directly compared the fertilization rate and embryonic development following in vitro fertilization and embryo transfer of those oocytes exposed to ultrasound and those not exposed in the same patient. In 39 unscreened patients a combination of laparoscopy and ultrasound was used for oocyte recovery. Laparoscopy was performed first on the most accessible ovary (usually the right) and at least one oocyte was obtained. Ultrasound-guided oocyte recovery was successful in the other inaccessible ovary. To assess how oocytes obtained by ultrasound or laparoscopy related to the pregnancy rate, two groups of patients were evaluated in whom the embryos transferred either had been exposed to ultrasound or had not been. The fertilization and the embryo cleavage rates were not significantly different between the ultrasound-exposed and the unexposed groups. The pregnancy rate was also not significantly different [9 of 49 (18.4%) for ultrasound exposed versus 14 of 74 (18.9%) for unexposed]. There was one early spontaneous abortion in each group. Further analysis of a group of 40 patients, in whom the oocytes were exposed to ultrasound in situ, after the endogenous luteinizing hormone (LH) surge had begun 1-27 hr earlier, revealed that 6 became pregnant (15%). This preliminary study suggests that exposure of human oocytes to ultrasonic waves, either during the different phases of meiosis or after the completion of meiosis, did not significantly influence the developmental potential of the in vitro fertilized embryos.

Chorionic Gonadotropin↗
PubMed1987

A comparison of Dextran 70 with carbon dioxide as the distention medium for hysteroscopy in patients with infertility or requesting reversal of a prior tubal sterilization.

Our previous publications have demonstrated a high prevalence of hysteroscopic findings, particularly adhesions and polyps. It was the purpose of this study to compare the findings in 992 women in whom hysteroscopy was successfully performed by Dextran 70 with a similar group of 335 women in whom hysteroscopy was performed by CO2 as the distention medium. The incidence of uterine abnormalities in women with primary infertility, secondary infertility, and requesting reversal of sterilization when Dextran was used as the distention medium was 29%, 41%, and 33%, respectively, but only 7.2%, 11%, and 6%, respectively, when CO2 was used. It was concluded from these data that many of the findings of our preliminary studies were probably artifactual and a function of the technique of hysteroscopy and that our early reports must be read with caution.

Carbon Dioxide↗
PubMed1987

The effect of the day of initiation of ovarian stimulation in the day of luteinizing hormone surge and outcome of in vitro fertilization.

It was hypothesized that the day of initiation of ovarian stimulation may influence the day of the luteinizing hormone (LH) surge onset and follicular development. Two groups of 52 patients were randomly selected to commence ovarian stimulation on either day 2 or day 4. The mean +/- standard deviation day of the LH surge was 11.0 +/- 0.9 for day 2 and 12.2 +/- 0.9 for day 4 (P less than 0.001), and the day of human chorionic gonadotropin (hCG) administration was 10.7 +/- 1.2 for day 2 and 11.4 +/- 0.9 for day 4 (P less than 0.02). The two groups also differed significantly in the mean number of days of human menopausal gonadotropin (hMG) administration (day 2, 7.4 +/- 2.7, versus day 4, 6.3 +/- 2.5), and the mean number of vials of hMG administered (day 2, 10.4 +/- 3.2, versus day 4, 8.1 +/- 2.9). However, the mean estradiol level on the day of the LH surge or hCG administration, the number of oocytes collected and fertilized, the number of embryos transferred, and the pregnancy rates were not significantly different. In conclusion, the day of the LH surge or hCG administration can be influenced by the day of initiation of ovarian stimulation, and the initiation of ovarian stimulation around day 4 of the menstrual cycle is clinically more efficient than initiation of follicular development early in the follicular phase.

Clinical Trials as Topic↗
PubMed1987

Laparoscopy: blood-gas values and minor sequelae associated with three techniques based on isoflurane.

Three anaesthetic techniques based on isoflurane were compared in outpatients undergoing laparoscopy. Sixty healthy patients were randomly allocated to receive isoflurane via mask (spontaneous respiration), via tracheal tube (spontaneous respiration) or via tracheal tube with controlled ventilation. Moderate hypercarbia occurred in the group breathing from a mask, although there was no further increase during carbon dioxide insufflation and laparoscopy. No arrhythmias were seen during insufflation and surgical conditions in all groups were good. Spontaneous respiration via a face mask did not lead to significant hypercarbia, acidosis or cardiac arrhythmia. A high incidence of minor morbidity was found in all groups. Sore throat was much less frequent in the mask group, whereas the incidence of other after-effects, including muscle pains, did not differ significantly among the groups.

Adult↗
PubMed1986

"Ultrasound rescue": a successful alternative form of oocyte recovery in patients with periovarian adhesions.

Oocyte recoveries for in vitro fertilization/embryo transfer were performed in 82 cycles in 73 women. The status of the ovaries was unknown. Laparoscopy was performed and oocytes from accessible follicles aspirated. The remaining follicles were aspirated ultrasonographically. The recovery rates for laparoscopy of accessible follicles and for ultrasonographic recovery from laparoscopically inaccessible follicles were identical. In 26 patients laparoscopy only was performed. One or more oocytes was obtained in 92% of patients. In 56 cycles when laparoscopy was followed by ultrasound, one or more oocytes were recovered in 95% of patients; in 12 of these patients, three of whom achieved pregnancy, the only oocytes were recovered by the ultrasonographic means after laparoscopy had failed. This method provided an alternative to screening laparoscopy and indicated that cycles of controlled hyperstimulation could be performed with a satisfactory expectation of oocyte recovery in women in whom the state of the pelvis was unknown.

Clomiphene↗
PubMed1985

Effects of low-dose human chorionic gonadotropin on corpus luteum function after embryo transfer.

This paper reports the effect of low-dose human chorionic gonadotropin (hCG) on the levels of serum hCG, progesterone, and estradiol, luteal-phase length, and conception in 20 patients undergoing in vitro fertilization and embryo transfer (IVF-ET). Alternate patients in a group of 20 received 1000 IU hCG on the day of embryo transfer and 3 days after. Six and 9 days from embryo transfer 2000 IU hCG was given. The remaining patients served as controls. No patients in the treated group and four in the control group became pregnant. The endocrine profiles with respect to hCG, progesterone, and estradiol levels were similar in the treated patients compared with pregnant patients in the control group. Treated patients had significantly longer (18.0 +/- 1.1 days) luteal phases compared with nonpregnant patients in the control group (12.5 +/- 1.2 days), indicating that low-dose hCG prolonged the life of the corpus luteum. It was concluded that while the administration of low-dose hCG prolonged the life of the corpus luteum, it did not apparently improve the conception rate.

Chorionic Gonadotropin↗