Biomedical subjects

A Wisanto

Publications and source records attributed to A Wisanto.

At least 37 records · Page 2Linked to original sources

PubMed1990

Incidence of severe ovarian hyperstimulation syndrome after GnRH agonist/HMG superovulation for in-vitro fertilization.

In 1673 treatment cycles stimulated with buserelin and HMG, for IVF, GIFT or ZIFT, the severe ovarian hyperstimulation syndrome (OHSS) occurred in 10 cycles (0.6%). Eight patients were hyperandrogenic and showed an increased ovarian response to HMG. After replacement of a maximum of three embryos or zygotes, seven women became pregnant. Three women had a multiple gestation. All patients recovered uneventfully with conservative treatment. Support with progesterone or continuation of the agonist during the luteal phase did not prevent OHSS, confirming that the ovulatory HCG dose is the most important factor in inducing this severe complication. Luteal supplementation with HCG and/or HCG production during implantation could exacerbate OHSS.

Adult↗

PubMed1989

An 18-month survey of infertility treatment by in vitro fertilization, gamete and zygote intrafallopian transfer, and replacement of frozen-thawed embryos.

An 18-month survey of infertility treatment by in vitro fertilization (IVF) and related procedures at the Centre for Reproductive Medicine of the Vrije Universiteit Brussel is described. During this period, 1326 treatment cycles were started in patients with long-standing infertility and 1135 oocyte retrievals were performed in 771 different patients. IVF and embryo transfer (ET) after laparoscopic (N = 793) or ultrasonically guided (N = 342) ovum pickup, gamete intrafallopian transfer (GIFT; N = 284), or zygote intrafallopian transfer (ZIFT; N = 15) combined with IVF as well as the replacement of cryopreserved embryos yielded an overall pregnancy rate of 21.8% per started cycle. Echographic and laparoscopic oocyte retrieval gave similar results except for a higher fertilization rate after echographic-guided retrieval. For in vitro fertilization and embryo transfer an overall pregnancy rate of 26% per transfer was obtained. For GIFT and ZIFT the pregnancy rates were, respectively, 27.8 and 46.7% per replacement. For each procedure one-third of the pregnancies aborted. After the replacement of frozen and thawed embryos, during a natural cycle, a significantly lower fetal loss was observed.

Adult↗

PubMed1989

Human embryo viability after freezing with dimethylsulfoxide as a cryoprotectant.

This study concerns the effects of a slow freezing and thawing protocol using dimethylsulfoxide (DMSO) as a cryoprotectant on the survival and viability of 319 supernumerary human embryos produced after in vitro fertilization. One hundred twenty-one transfers were performed in a natural cycle and 18 pregnancies were achieved (15%), from which 14 were ongoing (12%). Overall, 52% of the thawed embryos retained at least 50% of their initial blastomeres intact after thawing, and were replaced. Survival was strongly correlated to prefreezing embryonic quality, as 78% of type I embryos, 55% of type II, 40% of type III, and none of type IV could be transferred. Implantations were obtained from type I embryos (21% per embryo replaced) and from type II (14.5%), whereas none of the type III embryos resulted in a pregnancy. In the authors' experience, using the DMSO protocol, the best pregnancy rates were achieved when replacing 8-cell embryos of high morphologic prefreezing quality. No statistically significant difference could be demonstrated, however, in implantation rates between 8-cell and 4-cell embryos, or between synchronously and asynchronously dividing concepti.

Blastomeres↗

PubMed1989

Performance of different embryo transfer catheters in a human in vitro fertilization program.

In a prospective and randomized study on 400 consecutive embryo transfers (ETs), the performance of three different transfer catheters was evaluated. In cases of difficult ET, the TDT catheter (Prodimed, Neuilly-en-Thelle, France) performed the best. However, the pregnancy rate with this catheter was the lowest (9.2%/ET). A better pregnancy rate (19.4%/ET) can be achieved when TDT catheter was used under ultrasound guidance. The Frydman catheter (Prodimed, Neuilly-en-Thelle, France) yielded the highest pregnancy rate (32.3%/ET) but also the highest frequency of difficult transfer procedures. The Wallace catheter (H.G. Wallace Limited, Colchester, England) showed similar performance, but the pregnancy rate was lower (19.2%/ET) compared with the Frydman catheter. Therefore, the Frydman catheter is used as the first choice, and for difficult transfers the TDT catheter under ultrasound guidance can be recommended.

Animals↗

PubMed1989

Zygote intrafallopian transfer as a successful treatment for unexplained infertility.

This study describes the zygote intrafallopian transfer treatment in patients with unexplained infertility. After retrieval, the oocytes were inseminated with 80,000 progressive motile sperm cells per milliliter. If fertilization occurred, a maximum of three zygotes were replaced by laparoscopy in the fimbrial end of one healthy fallopian tube. A pregnancy rate of 48.1% per zygote intrafallopian transfer replacement was obtained. Seventeen pregnancies are actually ongoing, two patients delivered, and seven patients miscarried. Even after replacing a maximum of three zygotes, there were 6 twin and 2 triplet pregnancies.

Adult↗

PubMed1989

Assisted procreation in the presence of a positive direct mixed antiglobulin reaction test.

Twenty-five infertile couples in which the male had antisperm antibodies were treated by in vitro fertilization (IVF), zygote intrafallopian transfer, or gamete intrafallopian transfer in 38 cycles. In 10 females a tubal pathology was present, and in the normal female patients repeated intrauterine insemination with husband sperm had failed. The presence of an andrological factor in 17 male patients did not influence the fertilization and the cleavage of the retrieved oocytes. Although the fertilization rate of 45.8% was significantly lower than in patients with tubal pathology, the pregnancy rate was 34.2% per started cycle and 44.8% per replacement. Furthermore, the embryos were of lesser quality than in couples with tubal and idiopathic infertility. This study suggests that IVF could be considered as a useful therapeutic approach for couples with a positive direct mixed antiglobulin reaction test before advising them the use of heterologous sperm.

Adult↗

PubMed1989

Synchronization of donor's and recipient's cycles with GnRH analogues in an oocyte donation programme.

In this oocyte donation programme nine female donors were stimulated using a combination of GnRH analogues and human menopausal gonadotrophins. A total of 149 oocytes were retrieved. Thirty fresh embryos were transferred in 14 uterine replacements, resulting in four pregnancies and 15 fertilized oocytes were placed in the Fallopian tube of six recipients, yielding two pregnancies. A mean number of 2.2 embryos was replaced. The implantation rate per embryo was 13%. Furthermore 36 embryos were cryopreserved for later use. Following 20 replacements, six pregnancies were established (30% per transfer); since two patients aborted, the ongoing pregnancy rate was 20%.

Adult↗

PubMed1989

The effect of pneumoperitoneum gases on fertilization, cleavage and pregnancy in human in-vitro fertilization and gamete intra-fallopian transfer.

A prospective, randomized study was carried out, creating a pneumoperitoneum with 100% CO2 or with 5% CO2 in air and evaluating the effect(s) of these gas phases on fertilization, cleavage and pregnancy outcome in this in-vitro fertilization and embryo transfer programme. There was no significant difference in the fertilization rate when either 100% CO2 or 5% CO2 in air was used for insufflation during laparoscopy. Further, embryonic development and pregnancy rates also indicated no significant differences between the two groups. Similarly, the oocytes which were retrieved and replaced with spermatozoa in the gamete intra-Fallopian transfer programme using either 100% or 5% CO2, gave similar pregnancy rates. Furthermore, the fertilization and cleavage rates of the supernumerary oocytes were not significantly different in both groups.

Carbon Dioxide↗

PubMed1989

Zygote intra-fallopian transfer as an alternative treatment for male infertility.

The results of 42 zygote intra-Fallopian transfer cycles in 37 couples with persistent male infertility are reported. Of 396 retrieved oocytes, 39.1% fertilized normally and 63 zygotes were replaced in 25 cycles. Twelve patients became pregnant, including two twin pregnancies. The pregnancy rate was 28.6% per started cycle and 48.0% per replacement. The implantation rate per replaced zygote was 22.2% (14 of 63 replaced zygotes implanted). Sixty-two supernumerary zygotes or embryos were cryopreserved for later use.

Embryo Transfer↗

PubMed1989

Effect of transuterine puncture during transvaginal oocyte retrieval on the results of human in-vitro fertilization.

In many in-vitro fertilization (IVF) programmes, the transvaginal approach is now the most widely used method for ultrasound-guided oocyte retrieval. Sometimes, however, the position of the ovaries is such that it might not be possible to aspirate the follicle transvaginally without puncturing the uterine wall. Between May and November 1988, we performed 518 transvaginal, ultrasound-guided oocyte retrievals for IVF or zygote intra-Fallopian transfer (ZIFT). During this period, 22 transuterine punctures (4.2%) were necessary to reach one of the ovaries. To investigate the effect of uterine laceration on the results of IVF/ZIFT treatment, the outcome of treatment was compared between patients who had a transuterine puncture and a control group of patients treated by IVF or ZIFT during the same period without transuterine puncture. Seven of 16 patients who had a transuterine puncture became pregnant after IVF, compared to 84 pregnancies out of 347 cases (24.2%) in the control group. After ZIFT, two pregnancies (2/6) were achieved in patients with uterine laceration, compared to 46 pregnancies out of 149 procedures (30.8%) in the control group. These differences were not statistically significant. Transuterine puncture during transvaginal oocyte retrieval does not seem to have an adverse effect on the results of human IVF and ZIFT treatment.

Female↗

PubMed1989

Time of insemination and its effect on in-vitro fertilization, cleavage and pregnancy rates in GnRH agonist/HMG-stimulated cycles.

In this prospective study, we compared the effect of delayed inseminations on fertilization, cleavage and pregnancy rates in two groups of patients. In one group, the ovarian stimulation was performed with a clomiphene citrate/human menopausal gonadotrophin/human chorionic gonadotrophin (CC/HMG/HCG) protocol. The other group was pre-treated with gonadotrophin-releasing hormone agonist (GnRHa) and ovarian stimulation was carried out with an HMG/HCG protocol. Under both protocols, a delay of 2, 4 or 6 h in insemination showed no significant differences in the fertilization, cleavage or pregnancy rates. To find out which type of oocyte has the potential for better fertilization, cleavage and implantation, a simple oocyte classification scheme is proposed. In the GnRHa/HMG group, 9% post-mature, 90% mature and only 1% immature oocytes were retrieved. The post-mature oocytes showed a tendency towards reduced fertilization when insemination was delayed. The mature and slightly immature oocytes fertilized equally well when spermatozoa were added 2, 4 or 6 h after retrieval. Similarly, no significant difference was observed in the cleavage (80%) or fragmentation (20%) rates of these oocytes. The pregnancy rates after inseminations delayed for 2, 4 and 6 h were 14, 27 and 26%, respectively. Though these figures were not statistically significant, the 4- and 6-h groups in both the IVF and zygote intra-Fallopian transfer treatments showed a slightly improved pregnancy rate compared to the 2-h group. An insemination delay of 4 h is advocated on a routine basis.

Adult↗

PubMed1989

Establishment of 22 pregnancies after oocyte and embryo donation.

Donated oocytes inseminated with partner's semen or donated embryos were transferred on 95 occasions in 28 women without ovarian function and in 21 with functional ovaries. Overall, 22 pregnancies were established, 13 after the transfer of fresh embryos and nine after the transfer of frozen-thawed embryos. Eleven of the pregnancies were established in women without ovarian function and 11 in women with functional ovaries. Nine of the pregnancies were established with donated oocytes inseminated with partner's semen and 13 with donated embryos. Fifteen healthy infants were born including one set of twins; three pregnancies are progressing normally and five miscarried.

Adult↗

PubMed1988

Perurethral ultrasound-guided ovum pickup.

Either a percutaneous-transvesical, a transvaginal, or a perurethral-transvesical approach can be used for oocyte recovery under ultrasound guidance in an in vitro fertilization and embryo transfer program. After having experienced these three different approaches in our program, we preferentially used the perurethral-transvesical approach as our routine technique for oocyte recovery under ultrasound guidance. We feel that this method is easier to perform and also carries less risk for contamination. From January to December 1986, 186 oocyte retrievals under ultrasound guidance were performed. In 7 cases no oocytes were found despite normal ovarian stimulation. A total of 767 oocytes was collected; the fertilization rate was 71.8%. Forty pregnancies were achieved (21.5% per attempt or 27.7% per embryo replacement). Except for transient hematuria, no complications were observed.

Chorionic Gonadotropin↗

PubMed1988

Inhibition of gonadotropic and ovarian function by intranasal administration of D-Ser (TBU)6-EA10-LHRH in normo-ovulatory women and patients with polycystic ovary disease.

We investigated the effectiveness of D-Ser (TBU)6-EA10-LHRH (Buserelin) intranasally 600 micrograms/day given 6 times daily in desensitizing normal ovulatory women and patients with polycystic ovarian disease (PCOD) before initiation of ovarian stimulation for in vitro fertilization. We found that this regimen was sufficient to suppress the gonadotrophs in the normal women and in 8 out of 10 PCOD patients. In PCOD ovarian hormones became normal after Buserelin administration. Adrenal steroidogenesis was not affected by the GnRH agonist. We suggested that the frequency of administration of Buserelin was important to achieve a constant receptor binding and consequently a rapid desensitization. The choice of a monoclonal immunoradiometric assay for luteinizing hormone (LH) and follicle stimulating hormone (FSH) in association with the estradiol-benzoate provocation test were essential in evaluating desensitization.

Administration, Intranasal↗

PubMed1988

Success rate in gamete intrafallopian transfer using low and high concentrations of washed spermatozoa.

The effect of a reduced number of spermatozoa on pregnancies and miscarriages was studied retrospectively in 307 consecutive gamete intrafallopian transfer (GIFT) cycles. The number of spermatozoa introduced per GIFT in each group was as follows: 100,000 (group I), 50,000 (group II), 10,000 (group III), 5,000 (group IV), and 2,500 (group V), which gave a pregnancy rate of 20%, 38%, 37%, 30%, and 24%, respectively (differences were not significant). With respect to the pregnancies, no correlation was found between the number of spermatozoa transferred and the cause of infertility. In the male factor group also no significant difference was observed in the pregnancy rate when the sperms were reduced from 100,000 to 2,500. Lowering the number of sperms in GIFT did not reduce the abortion rate, which remained around 33%. It was the patients with unexplained infertility who benefited most from the GIFT procedure. Their pregnancy rate was significantly higher than the pregnancy rate of those who had endometriosis, or andrologic or immunologic disorders.

Adult↗

PubMed1988

Hormonal monitoring for in-vitro fertilization and related procedures.

Details of the endocrine monitoring of patients during in-vitro fertilization are analysed. Hormones usually measured are 17 beta-oestradiol, FSH, LH, progesterone and HCG. The assays must be rapid, robust, and have satisfactory precision and reproducibility. Radioimmunoassays have become standardized but immunoradiometric assays are being introduced, where the antibodies can be more easily labelled than antigens, but need care with very high concentrations of antigen. Enzyme immunoassays also have advantages: they are less hazardous than radioimmunoassays and the labelled materials have longer shelf-lives. Chemiluminescence has also been introduced, together with time-resolved fluoroimmunoassays, representing simpler, perhaps cheaper and improved methods. Immunoassays by latex particle counting offer the advantage of being completely automated. Practical examples of these methods are given with details of the treatment of individual patients.

Chorionic Gonadotropin↗

PubMed1988

Addition of Buserelin to human menopausal gonadotrophins in patients with failed stimulations for IVF or GIFT.

The combined therapy of a gonadotrophin-releasing hormone agonist (GnRHa) D-Ser(TBU)6-EA10-LHRH (Buserelin) and human menopausal gonadotrophins (HMG) for ovarian stimulation for in-vitro fertilization and gamete intra-Fallopian transfer was evaluated during 84 cycles. All women selected for this therapy had previously failed stimulations with clomiphene citrate/HMG. The GnRHa prevented spontaneous luteinizing hormone surges and premature luteinization in all patients. After addition of the agonist to HMG, the cancellation rate dropped from 17 to 7% and improved the results in 72.6% of the cycles. Twenty-six per cent of the started cycles resulted in a pregnancy. Eighteen healthy children were born at term.

Buserelin↗

PubMed1988

Hyperstimulation: the need for cryopreservation of embryos.

Successful application of in-vitro fertilization (IVF), zygote intra-Fallopian transfer (ZIFT) and gamete intra-Fallopian transfer (GIFT) requires ovarian hyperstimulation for the maturation of multiple follicles. To control the risk of multiple pregnancies, the number of gametes (GIFT) or embryos (IVF, ZIFT) replaced is limited to three. For the supernumerary embryos resulting from IVF, ZIFT or GIFT, the strategy is cryopreservation for a later transfer. Cryopreservation was performed using either dimethylsulphoxide or 1,2-propanediol as a cryoprotective agent. Embryos were frozen either in the pronucleate stage with 1,2-propanediol or in the multicellular stage with dimethylsulphoxide or 1,2-propanediol. Survival after thawing was scored for both cryoprotective agents as a function of the developmental stage of the embryo and the embryonic quality. Evaluation of survival after thawing was performed on the basis of morphological intactness of the 1-cell pronucleate embryo or of the blastomeres of multicellular embryos. For pronucleate stage embryos, the use of 1,2-propanediol resulted in a 60% survival after thawing. For 2-cell stage embryos the survival was similar for dimethylsulphoxide and 1,2-propanediol. Later stage embryos survived better when dimethylsulphoxide was the cryoprotectant. For all stages, embryo quality before freezing was a crucial factor in survival after thawing. The pregnancy rate (12.2%) was similar for the two cryopreservation protocols. In conclusion, the choice of an appropriate cryoprotective agent can increase the survival after thawing when embryos are of good quality before freezing.

Cryoprotective Agents↗