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Biomedical subjects

A Wisanto

Publications and source records attributed to A Wisanto.

53 records · Page 3Linked to original sources
PubMed1988

Embryo donation in patients with primary ovarian failure.

Thirty-six infertile patients with primary ovarian failure, who were referred for oocyte (embryo) donation are reported. After substitution therapy with oestradiol valerate (per os) and progesterone (i.m. or per os), endometrial tissue was made receptive for embryonic implantation, although the endometrial biopsies on day 21 demonstrated a certain delay in development (of 1.6-2.4 days). Six patients became pregnant, three of them delivered four healthy babies, one pregnancy is progressing normally and two ended in an early clinical abortion.

Chromosome Aberrations↗
PubMed1988

In-vitro fertilization with husband and donor sperm in patients with previous fertilization failures using husband sperm.

When previous attempts at in-vitro fertilization using semen from the husband failed, a subsequent IVF attempt was performed using husband and donor sperm in order to compare fertilization and embryo formation after insemination with husband and donor sperm of the same oocyte population. Significantly more eggs were fertilized in patients suffering from andrological and idiopathic infertility when donor sperm were used. No differences were seen in patients with tubal infertility. In the andrological group, the embryos fertilized by the husband showed significantly more fragmentation. No pregnancies were established when husband-fertilized oocytes (embryos) were replaced in the andrological and idiopathic infertility group. This study suggested that an IVF trial using husband and donor sperm might be indicated in couples suffering from andrological or idiopathic infertility in whom no fertilization occurred in a previous cycle using sperm from the husband.

Adult↗
PubMed1988

The luteal phase after in-vitro fertilization and related procedures.

To evaluate any beneficial effect of progesterone supplementation during the luteal phase of GIFT or IVF cycles stimulated by clomiphene citrate and HMG, two random prospective studies were performed. In the first study, a group of patients received a luteal phase supplement of 50 mg natural progesterone i.m. daily from the day of oocyte retrieval onwards. Initial results on 168 patients indicated that the pregnancy rate was similar in patients with or without progesterone supplements. No differences were found between the two groups in an analysis of pregnant and failed cycles. In a second study two different protocols of luteal phase supplementation after Buserelin-HMG stimulation were compared: natural progesterone in combination with oestradiol valerate (50 patients) or HCG supplements (41 patients). A 32% pregnancy rate per cycle was encountered in both groups. Endometrial biopsies, taken during the luteal phase from patients who did not undergo embryo replacement, revealed retarded endometrial development in most of the biopsies.

Buserelin↗
PubMed1988

The luteal phase and early pregnancy after combined GnRH-agonist/HMG treatment for superovulation in IVF or GIFT.

Endometrial biopsies showing inadequate development were observed after ovarian stimulation with the GnRH agonist Buserelin and HMG for IVF or GIFT when luteal supplementation was omitted. Ninety-one patients were randomly allocated to two luteal supplementation regimens: in 41 women HCG and in 50 women progesterone and oestradiol valerate. The pregnancy patients treated with a combination of the GnRH agonist and HMG a delay of implantation of 1.3 days was observed compared to pregnancies after clomiphene citrate-HMG stimulation. This delay was not due to slower preimplantation embryo development after GnRH agonist-HMG treatment. Temporarily defective function of the corpus luteum was evidenced by measuring serum progesterone, 17 beta-oestradiol and 17-hydroxyprogesterone in the patients receiving progesterone and oestradiol valerate. This inadequate corpus luteum function could be related to the prolonged blockage of pituitary gonadotrophic function after arrest of the GnRH agonist.

Buserelin↗
PubMed1988

Oocyte donation in patients without ovarian function.

The clinical, hormonal and cytogenetic findings in 36 women with primary ovarian failure, referred for oocyte or embryo donations are reported. Fifteen women were suffering from ovarian dysgenesis and 11 from premature menopause. Six of these 26 patients showed X-chromosome abnormalities. One patient had a Noonan syndrome. The remaining 10 had surgical menopause. The mean duration of their infertility was 6.5 +/- 3.2 years (+/- SD). All patients had elevated serum gonadotrophins within the menopausal range. Hypothalamic, pituitary and thyroid function were found to be intact. In one of the 15 ovarian biopsies on the patients with chromosomal competent ovarian failure, primordial follicles were found. Hysterosalpingograms revealed a normal uterine cavity in all patients. In view of oocyte donation, careful evaluation of the obstetric risk was mandatory in the six patients with X-chromosome aberrations and in the patient with the Noonan syndrome, because of their short stature and possible concomitant cardiovascular and renal disease. After substitution therapy with oestradiol valerate and natural progesterone, 13 pregnancies were established, seven patients delivered (one set of twins), eight healthy children were born, three pregnancies aborted and three pregnancies are progressing normally.

Adult↗
PubMed1987

Gamete intra-Fallopian transfer: evaluation of 100 consecutive attempts.

The results of 100 gamete intra-Fallopian transfer (GIFT) procedures to treat persistent infertility are reported. Twenty-four pregnancies were achieved, of these six aborted, two were extra-uterine, two stillbirths occurred and nine patients delivered 11 healthy children (two sets of twins) and five pregnancies are progressing well, including two sets of twins. Pregnancy rate in the different groups of patients was: 28% for idiopathic infertility (n = 39), 13% for male infertility (n = 16), 22% for endometriosis (n = 27), and 29% in the presence of antisperm antibodies (n = 7). In our GIFT procedure, we place three oocytes and 50,000 to 100,000 motile spermatozoa per patient into one healthy tube, the remaining oocytes being inseminated and cultured in vitro. Of 502 oocytes recovered, 252 fertilized normally and 178 early embryos were frozen. The replacement of 41 frozen-thawed embryos resulted in five additional, ongoing pregnancies. The combined treatment by gamete intra-Fallopian transfer, in-vitro fertilization and cryopreservation increases the chance of conception.

Adult↗
PubMed1987

Management of failed cycles in an IVF/GIFT programme with the combination of a GnRH analogue and HMG.

The addition of the gonadotropin releasing hormone (GnRH) agonist Buserelin to human menopausal gonadotrophin/human chorionic gonadotropin (HMG/HCG) during ovarian stimulation was evaluated in 23 cycles of 21 women who previously had unsuccessful IVF treatments when stimulated with clomiphene--HMG/HCG. No adverse effects of GnRH-agonist on folliculogenesis were seen. A mean number of 7.2 oocytes per retrieval was collected in 20 treatment cycles. Oocytes quality, fertilization and cleavage parameters were normal. Replacements by gamete intra-Fallopian transfer (GIFT) or IVF took place for 16 patients. Four patients became pregnant in their treatment cycle, one aborted. For 8 patients 18 embryos were cryopreserved, one transfer of a frozen--thawed embryo in a subsequent natural cycle led to a pregnancy. Inadequate luteal phases were constantly observed when supplementation was omitted. Further study is required to confirm that systematic luteal support improves the pregnancy rate.

Adult↗
PubMed1987

Cryopreservation of human embryos obtained after gamete intra-Fallopian transfer and/or in-vitro fertilization.

During a one-year period 636 excess embryos obtained after in-vitro fertilization and gamete intra-Fallopian transfer combined with in-vitro fertilization were cryopreserved using two different protocols. For early stage embryos including the pronucleate stage, 1,2-propanediol was used as cryoprotectant (procedure A, adapted from Renard) and for later stage embryos dimethylsulphoxide was used in protocol B, adapted from Trounson and Mohr. After thawing 288 embryos, half of them were of sufficient quality to be replaced. After cryopreservation, procedure A gave the best survival in embryos having less than or equal to 2 blastomeres; for later stage embryos best survival was obtained using the dimethylsulphoxide protocol. Survival after cryopreservation was also clearly related to the quality of the embryos prior to freezing. Embryos were replaced during endocrinologically monitored natural cycles and were transferred in synchrony between endometrial and embryonic age. After replacement of 126 embryos in 110 patients, 20 pregnancies occurred. So far six healthy children have been born, two patients aborted and 12 pregnancies are ongoing. In this series no statistical difference was observed between the implantation rate of embryos cryopreserved by procedure A or B. Six pregnancies occurred in patients from the oocyte and embryo donation programme. An adequate cryopreservation programme circumvents the difficult problem of synchronizing the ovarian cycles of donor and acceptor patients.

Embryo Transfer↗
PubMed1987

Ovarian stimulation, including in vitro fertilisation.

The stimulation regimens and the results of ovulation induction in anovulatory patients and in patients suffering from a Luteinized Unruptured Follicle (LUF) syndrome are discussed as well as the findings concerning superovulation in IVF cycles. The percentage of multiple pregnancies (less than or equal to 20 p. cent) is acceptable, due to the accurate daily performance of hormonal determinations. The pregnancy rate is lower in a LUF population, than in anovulatory patients. This is likely due to the unknown pathophysiology of the LUF syndrome. Compared to natural cycles, the maximum serum LH concentration is reduced in stimulated cycles although multiple oocytes have to mature in superovulated patients. A possible explanation for these reduced LH surges could be an increase in inhibin -like substances. There is still a need for more research to find out the real interaction between the follicle and the hypothalamic-hypophysial axis.

Anovulation↗
PubMed1987

Pregnancies without corpus luteum rescue.

Four beginning pregnancies after cycles with ovarian stimulation are described. Due to a delay of implantation no rescue of the corpus luteum occurred. At first the cycles ended with menstruation, negative serum hCG and normal low serum steroid hormone concentrations. A new stimulation was started and subsequently terminated as soon as the pregnancies were detected. There was no progesterone production in all these four cases during the first 9-13 days of pregnancy. Induced by the renewed stimulation new follicular development was noticed in three patients, followed by ovulation during pregnancy. Two clinical pregnancies were the result, one with good further evolution and delivery, and one aborted at 10 weeks after the first menstrual period. The other two pregnancies ended with preclinical abortions.

Abortion, Incomplete↗
PubMed1986

Endocrine profiles in early pregnancies with delayed implantation.

Delayed implantation in cycles with ovarian stimulation and ovulation induction was observed in eight patients. Endocrinological evidence for ovulation during pregnancy is presented in three cases; in one of them the implantation was evidently rescued by a new active corpus luteum. All pregnancies had the following factors in common: (1) A delay in the detection of the first positive serum human chorionic gonadotrophin (HCG) by 4-5 days. (2) The corpus luteum was not rescued initially and menstruation started at low serum concentrations of 17 beta-oestradiol and progesterone between 12 to 18 days (13.8 +/- 1.9 days) after induction of ovulation. (3) Because of the negative HCG, menstrual bloodloss and low steroid hormone concentrations, a new ovarian stimulation was started and continued for some days until pregnancy was detected. On the basis of the endocrine findings, three different forms of delayed implantation could be distinguished. Two of the eight pregnancies had a normal progression until full-term delivery, two developed into echographically-confirmed clinical pregnancies, but aborted at 9 and 11 weeks after the first menstrual period had started. The remaining four ended with a preclinical abortion between 7 and 8 weeks.

Adult↗
PubMedDate not supplied

Follicular rupture changes the endocrine profile of peritoneal fluid.

We determined the concentration of progesterone (P) and 17 beta-estradiol (E2) in peritoneal fluid 32 hours after endogenous luteinizing hormone surge (LH) or 34 hours after injection of human chorionic gonadotropin (hCG) in 4 groups of patients: group A: 5 natural cycles, unruptured follicles, mean concentrations of P (1.48 micrograms/l) and E2 (169 ng/l); group B: 28 stimulated cycles, unruptured follicles after an endogenous LH surge, mean concentrations of P (5.33 micrograms/l) and E2 (1 344 ng/l); group C: 13 stimulated cycles, ruptured follicles after endogenous LH surge, mean concentrations of P (446 micrograms/l) and E2 (59 500 ng/l); group D: 8 stimulated cycles, unruptured follicles after injection of hCG, mean concentrations of P (8.21 micrograms/l) and E2 (551 ng/l). The variations of the hormonal concentrations in peritoneal fluid are discussed.

Ascitic Fluid↗
PubMedDate not supplied

Success of in vitro fertilization and embryo transfer in relation to the causes of infertility.

In 1984 163 patients were treated in our in vitro fertilization program, including 4 patients accepting embryos from the oocyte and embryo donation program. Twenty pregnancies were achieved with an average chance per transfer of 16,6%. The final success of IVF strongly depends on the cause of infertility. The best results were obtained for patients with tubal infertility, with a pregnancy rate of 15% per laparoscopy and 19% per transfer. There is a significant decrease in oocyte cleavage rate from tubal (61%) to male infertility (13%). Once the barrier of embryo formation is taken, there is no marked difference in the mean number of embryos transferred on the pregnancy rate after transfer, among the different patient groups. In patients with tubal infertility the pregnancy rate per cycle remains constant, resulting in a cumulative pregnancy rate of 40% after 3 cycles.

Antibodies↗