Biomedical subjects

Alberto Kably Ambe

Publications and source records attributed to Alberto Kably Ambe.

15 recordsLinked to original sources

PubMed2006

[Severe ovarian hyperstimulation syndrome treatment by decompressive paracentesis and self-transfusion of ascitis fluid].

BACKGROUND: The ovarian hyperstimulation syndrome is a serious complication in patients who undergo controlled ovarian stimulation and for that reason all clinicians who prescribe ovulation inducing agents must be prepared to recognize and manage ovarian hyperstimulation syndrome, to prevent severe and ocasionally mortal complications. OBJECTIVE: To communicate the experience in the treatment of ovarian hyperstimulation syndrome as a complication in patients who undergo controlled ovarian stimulation. PATIENTS AND METHODS: In the present study seven patients who developed severe ovarian hyperstimulation syndrome were included, and were treated by ultrasound guided paracentesis and self-transfusion of the ascitic fluid. RESULTS: In all patients we observed a clinical improvement immediately after the drainage of ascitic fluid no hematological or infectious disease were observed after the self-transfusion. We observed a reduction in hemoglobin of 20.9% and 22.2% in the hematocrit after paracentesis and self-transfusion, meanwhile we observed an increase of 55.5% in the albumin level. Any patient developed hemodynamic disturbance after paracentesis after drainage of great volume in the paracentesis (mean of 4453.4 mL per patient). CONCLUSIONS: The drainage of ascitis by paracentesis and self-transfusion of the fluid is a good therapeutic option in patients with severe ovarian hyperstimulation syndrome in combination with intravenous fluids and administration of human albumin 25%.

Adult↗

PubMed2006

[Uterine and jejunum perforation due to intrauterine device. A report of a case and literature review].

The application of a copper IUD can perforate completely the uterus and involve adjacent organs such as the bladder, small bowel, colon, rectum or appendix. Once the diagnosis is established, complete extraction must follow. We present a case report of a 33 year-old patient in which a copper IUD was placed in a medical office, three months after a third cesarean, without history of sepsis. Ninety days after placement, the patient complained of menstrual irregularities (opsomenhorrea) without any other symptoms. On physical examination with speculum, the IUD's guide strings were not visible; a transvaginal USG was performed without visualization of the IUD in the uterine cavity. An abdominal CAT scan showed the presence of the IUD outside the uterus. Hysteroscopy-laparoscopy was performed with transoperatory fluoroscopy, which revealed the copper IUD inside the yeyunum, a complete extraction followed with entero-entero anastomosis. This case will show that IUD placement is not innocuous and that adjacent organ damage must always be considered and resolved immediately.

Adult↗

PubMed2005

[Intrafollicular levels of sexual steroids and their relation with the antioxidant enzymes on the oocyte quality in an in vitro fertilization program].

OBJECTIVE: To establish a correlation between intrafollicular superoxide dismutase enzyme concentrations, activity with oestradiol levels, and the effects on oocyte quality and maturity. STUDY: Prospective, descriptive and observational. MATERIAL AND METHODS: Forty-one patients underwent IVF-ET program. The ovarian stimulation protocol was made with recombinant FSH and GnRH antagonists. All follicles were aspirated one by one, and the follicular fluid was stored at a -20 degrees C room temperature. We retrieved 120 follicular fluids and performed the measurement of oestradiol and superoxide dismutase enzyme on each follicular fluid and its correlation with fertilization and cleavage rates. Statistical analysis was carried out with ANOVA, t Student, chi2 and P Pearson tests. RESULTS: Patients' mean age was of 33.74 +/- 5.04 years, the mean of enzyme activity was of 76.89%, and the mean concentration of superoxide dismutase enzyme was of 68.71 UI/L. According to oocyte quality or maturity, no statistical differences were observed when comparing oestradiol levels with superoxide dismutase enzyme concentrations. But when we analized both variables, we observed a positive correlation in metaphase 2 oocytes (p = 0.236). When we correlated the superoxide dismutase enzyme activity with oestradiol concentrations in relation to oocyte quality, a positive correlation in good quality oocytes was observed too (p = 0.218). We perceived a strong correlation between SOD concentrations and oestradiol intrafollicular measurements in good quality oocytes. COMMENTS: Oocyte maturity and development are conditionated by a close relationship between SOD and intrafollicular oestradiol.

Adult↗

PubMed2005

[Usefulness of luteinizant hormone levels to determine the oocyte quality].

OBJECTIVE: To evaluate the luteinizing hormone serum preovulatory levels and correlate them with the embryo number and quality, and with the fertilization and clavage rates. STUDY: Prospective, descriptive and observational. MATERIAL AND METHODS: We included 286 patients that underwent to IVF-ET program, we excluded patients with no mesurement of LH preovulatory levels, or patients that in the oocyte retrieval we do not found oocytes. The protocols for pituitary inhibition were: stop Lupron, long luteal phase and GnRH antagonist, the ovarian stimulation was realized with recombinant FSH. The studied variables were: LH preovulatory levels, number and quality of oocytes, fertilization and clevage rates and embryo quality. Statistical analysis was done with p Pearson and ANOVA tests. RESULTS: The mean age for patients was 34 +/- 3.96 years, the principal factor of infertility was tubal and pelvis pathology. The mean LH preovulatory levels were 2.19 +/- 1.83 UI/L by patient, we observed a negative correlation between LH levels and number of oocytes retrieved (p = -0.157, IC 99%), and the correlation between LH levels and number of metaphase 2 oocyte was negative too (p = 0.113, IC 95%). We observed greater levels of LH (3.15 UI/L) in the degenerated oocytes during oocyte retrieval. We did not found a statistical correlation between fertilization and cleavage rates with LH levels. LH preovulatory levels of 0.85 UI/L could predict good quality oocytes with a sensitivity of 72% and specificity of 25%. CONCLUSIONS: Normogonadotrophic patients without deep suppression of gonadotrophins by the use of GnRH analogues, high LH preovulatory levels correlates with a less number of oocytes, and with degenerated oocytes. Preovulatory LH levels of 0.85 UI/L could predict good quality oocytes.

Adult↗

PubMed2004

[Correlation between follicle levels of superoxide dismutase and oocyte quality, fertilization rates and embryo development].

BACKGROUND: The intraovarian oxidative balance is important during oocyte development, and fertilization. It has been proposed that one of the most important enzymes in the follicle is the superoxide dismutase (SOD). OBJECTIVE: To correlate levels and percentage of SOD activity in follicular liquid with quality, fertilization and embryo development in a group of patients submitted to in vitro fertilization. MATERIAL AND METHODS: We obtained 120 follicular liquids from oocytes aspirated in 41 patients during an IVF program and then we followed the development of each oocyte separately. We measured the activity and concentration of SOD in the follicular liquid, and we evaluated the following variables: quality and maturity in the oocytes, as well as fertilization rate, segmentation rate and pregnancy. The statistical analysis was made with ANOVA test and Pearson test. RESULTS: In the analysis of the results, we observed a higher percentage of activity in the SOD in oocytes with good quality (3 and 4) in comparison with poor quality oocyte (1 and 2) (89 and 82% vs 75 and 61% p<0.05). We observed higher concentrations and activity of SOD in oocytes with a good fertilization rate and segmentation (p<0.05). When we analyzed the variables in function of pregnancy, we observed that the embryos that were transferred and developed pregnancy had higher concentrations and activity of SOD than embryos that did not develop pregnancy. CONCLUSIONS: Elevated levels and high percentage in the activity of SOD are associated with a better quality in the oocyte, and a good embryo development, influenced by the oxidative balance.

Embryonic and Fetal Development↗

PubMed2004

[Value of the morphological characteristics of polar body as a predictive factor of embryo development].

OBJECTIVE: To determine the relation between polar body quality and perivitelline space with fertilization and segmentation rates and embryo quality. STUDY: Prospective and descriptive. MATERIAL AND METHODS: Sixty-one patients underwent the in vitro fertilization and embryo transfer program (IVF-ET). The intracytoplasmatic sperm-injection (ICSI) was applied for insemination. Controlled ovarian hyperstimulation was made with recombinant FSH. Oocytes were evaluated 4-6 hours after retrieval and polar body, perivitelline space, and pellucid zone were assessed too. Fertilization was evaluated 17 hours after ICSI, and segmentation rates were analyzed at 48 and 72 hours. The number of blastomeres and quality of each embryo was assessed prior transference. Statistical analysis was done with chi2 test. RESULTS: We evaluated 883 oocytes, of which 43.8% had a normal polar body, 54.9% had a normal perivitelline space, and 69% a normal pellucid zone; 57% of retrieved oocytes with normal polar body developed an adequate fertilization rate, and oocytes with abnormal polar body had fertilization in less than 20%. Embryo cleavage was adequate in oocytes with normal polar body, in the abnormal oocytes was less than 20%, and 79% of the oocytes with fragmented polar body did not developed in embryo. There were not significant differences in fertilization rates and segmentation when compared with the pellucid zone and perivitelline space. CONCLUSIONS: Oocyte quality has a great influence on fertilization and embryo development. One of the most important variables is the polar body quality, which correlates adequately with fertilization and embryo cleavage.

Embryonic Development↗

PubMed2003

[Fertilization rate analysis as a predictive variable for an in-vitro fertilization program success].

OBJECTIVE: Determining if fertilization rates can be used as a predictive factor for pregnancy induction in ETIVF-ICSI programs. TYPE OF STUDY: Retrospective, observational and descriptive. MATERIALS AND METHODS: Six hundred and seventy nine cycles of the in vitro fertilization program, using long protocol hypophyseal suppression, stop, or antagonsits, were included. Ovarian stimulation was carried out with menotropines or recombinant FSH. Those patients whose cycle was stopped due to the lack of follicular development were excluded. Variables under study were: age, fertilization percentage, pregnancy rate, pre-ovulatory estradiol levels, number and quality of captured oocytes, transferred embrios and endometrial thickness on the day of transference and the presence of pregnancy. The Pearson P Test with a 95% confidence interval and the Student T Test used to establish differences with a 95% confidence interval statistical analyses were applied. RESULTS: Six hundred and seventy nine cycles were studied, 487 of which used the conventional fertilization method, and 192 used the ICSI method. Mean age among patients was 34 +/- 1.1 years old, with pre-ovulatory estradiol levels of 4,023 +/- 1,134 pg/mL, the average quantity of captured oocytes was 11.7 +/- 3.2 with a capture rate of 69.6%. Mean fertilization rates averaged 54% with a 20.7% pregnancy rates using the transference method. After analyzing the fertilization rate in each group, a statistically significant linear correlation was observed (P = 0.547, CI 95%) with the pregnancy rate. After assigning patients to two different groups: conventional IVF and ICSI, a higher positive correlation was observed (P = 0.827, CI 99%) in the first group. No significant differences were observed in the remaining parameters between both groups, excepting oocyte maturity, where greater prophase I and metaphase II percentages were observed in the ICSI group. When 50% fertilization was taken as the cutting point, a 78.19% negative predictive value was determined, with a 25% positive predictive value, 77.5% sensitivity, and 25.6% specificity. CONCLUSIONS: A fertilization percentage greater than 50% can be used as a pregnancy predicting factor in in vitro fertilization programs.

Adult↗

PubMed2003

[Statistical correlation between a transference test and embryonic transference in an assisted reproduction program].

OBJECTIVE: Determining if a statistical correlation can be established between those variables observed during the transference test performed before ovarian stimulation and those obtained during the real embryo transference. TYPE OF STUDY: Clinical retrospective. MATERIALS AND METHODS: Ninety four female patients included in the IVF-ET were studied and a transference test previous to ovarian stimulation was performed. The following parameters were considered in this test: hysterometry, type of catheter, degree of difficulty, and person performing it. A total of 117 embryonic transferences were carried out, and the same parameters observed during the test were measured. The chi square test was used for the statistical analysis. RESULTS: The most commonly used kind of catheter was the Cook Soft Pass (n = 92), and a statistically significant correlation was observed with the one used during the real transference (n = 94). Concerning the degree of difficulty, the transference test resulted complicated in 4.2% of the cases, difficult in 31.6% of them, and easy in 64.2% of them, presenting a statistical correlation with the real transference, where the procedure resulted complicated in 1.7% of the patients, difficult in 32.4% of them, and easy in 65.8%. In addition, and with the intention of ruling out the medical factor, we tried to have the same person performing the transference test and the real procedure, and a statistically significant correlation was also observed. Pregnancy rate per transference was 27.4%. When an association between the difficulty of a real transference and pregnancy rates was tried, no statistical association between an easy or a difficult transference was observed. CONCLUSIONS: Embrionic transference is a fundamental phase for IVF-ET programs. However, a variety of factors can influence this procedure, some are medical and others are mechanical. Our results allow us to conclude that there is a statistical correlation between those variables observed during the real embryonic transference and the test, so the latter can be considered as a very useful element in the integral in vitro fertilization process, which prevents the real transference from becoming a blind procedure.

Adult↗

PubMed2003

[Azoospermia : In vitro fertilization results, using testicular biopsy and cryopreserved spermatozoa].

Testicular sperm extraction (TESE) by open testicular biopsy, has become, since the introduction of the ICSI in 1992, the corner stone in treatment for azoospermia. This study reports the outcome of patients with open testicular biopsy for ICSI procedure indicated by azoospermia. 16 patients with azoospermia (12 obstructive and 4 non obstructive). The open testicular biopsy was performed prior the controlled ovarian hyperstimulation (COH) protocols of their couples, in two of the 16 patients no sperm were found in the biopsy, and the other 14 patients were admitted to 18 ICSI cycles, and the testicular samples were cryopreserved until oocyte capture. The controlled ovarian hyperstimulation (COH) was individualized in each case in accordance to the characteristics of each patient: 12 patients were used the long luteal phase GnRH agonist protocol, ultrashort protocol (Flare up) in one patient, GnRH antagonist in four, and the last one with endometrial preparation for cryopreserved embryo transfer. The mean of oocytes recovered was 11.71 +/- 7.24 oocytes per patient with a recovery rate of 72.64%. The fertilization rate was 49.35 +/- 29.24 and were transfered an average of 3 embryos per patient with a range between 1 and 5 embryos. In 18 cycles, 7 pregnancies occurred, four singles, one twin, one triple and one biochemical pregnancy. In conclusion the testicular sperm extraction (TESE) by open testicular biopsy is a good option for patients with azoospermia usually it achieves an adequate sample of testicular tissue with high possibilities of sperms recovery, in our study we obtained appropriate sperms in fourteen of sixteen patients for the ICSI procedure with good fertilization and pregnancy rates.

Adult↗

PubMed2003

[Initial values of human chorionic gonadotropin as a prognostic variable of pregnancy evolution in assisted reproduction].

INTRODUCTION: In assisted reproduction programs, once a pregnancy has been achieved, the power of predicting its evolution is important for the medical team as well as for the patient. The determination of pregnanediol or of placental protein 14 levels has been postulated as a predictive factor, however, the determination of hCG is, seemingly, the most adequate parameter for the detection of early developmental alterations during pregnancy. OBJECTIVE: To determine those predictive values of hCG which establish a prognosis concerning the evolution of pregnancy through the analysis of the values of this hormone on post-transference days 14 and 16, as well as to determine hCG values for multiple pregnancies. MATERIAL AND METHODS: Data from 88 patients participating in the in vitro fertilization program, in whom pregnancy was achieved, were retrospectively analyzed, and hCG levels were determined on post-transference days 14 and 16. Results were analyzed by the ANOVA test in order to compare mean values, & ROC were used to determine sensitivity and specificity. RESULTS: The patients were divided in three groups: 1) pregnant for more than 26 weeks; 2) pregnant for less than 26 weeks; and 3) chemical pregnancy. Significant differences in hCG levels on post-transference days were observed among these groups of patients. The levels of hCG, on post-transference day 14, 113 IU/L, and on day 16, 403 IU/L, presented, respectively, an 80% and 79% specificity, while the greater than 200.33 IU/L hCG increase offers a sensitivity and specificity of 80% and 83%, respectively, for a pregnancy of more than 26 weeks. In order to consider hCG levels as predictive for a high fetal order pregnancy, it was observed that hCC levels of 270.42 UI/L on day 14 present a sensitivity of 91% with a specificity of 64%, and levels higher than 837.14 IU/L on day 16 offer a sensitivity and specificity of 91% and 62%, respectively. CONCLUSIONS: The determination of hCG levels greater than 113 IU/L on day 14 and greater than 403 IU/L on day 16 offer adequate sensitivity and specificity as predictive factors for pregnancy evolution beyond the 26 GW, while hCG levels of 270.42 and 837.14, respectively, on days 14 and 16 offer a very high sensitivity (91%) for multiple pregnancy.

Adult↗

PubMed2002

[Changes in mitochondrial membrane potentials and its exponential relation with phosphatidylserine translocation in the plasma membrane as markers in the initial events of apoptosis: evaluation in different spermatic fractions].

OBJECTIVE: To determine the integrity of the plasmatic membrane through phosphatidylserine (PS) translocation in two spermatic fractions and their correlation with the spermatic mitochondrial membrane potential. MATERIAL AND METHODS: The analysis of both spermatic fractions was carried out through a discontinuous gradient separation with Percoli, in order to obtain two samples with high and low mobility (90-40%). Twelve patients were recruited for the initial evaluation of seminal parameters. Mitochondrial membrane integrity was determined using a second antibody (Mitosensor), and was analyzed by fluorescence microscopy, evaluating an average of 200 cells. A 450-490 nm excitation filter was used for this analysis. Cytoplasmatic assessment was carried out by anexine V bonding to PS, in order to determine the initial events of cellular death. Non parameter tests were used in order to determine the differences between mitochondrial potentials and plasmatic membrane processes. Linear correlation tests were used for the anexine V and Mitosensor ratios. RESULTS: Due to the study's design, some differences were observed regarding the displacement parameters and the presence of apoptosis, both, in the plasmatic membrane and in mitochondrial membrane potentials. A positive correlation between both, mitochondrial and cytoplasmic membrane functions was also found. CONCLUSIONS: This is the first study performing a comparative analysis between mitochondrial membrane function and cytoplasmatic PS expression as early cellular death markers. The male infertility population is probably associated with an increase in this kind of apoptosis processes.

Apoptosis↗

PubMed2002

[Ovum-embryo competitiveness determined by the quantification of perifollicular indices in Doppler vascular micro-architecture].

OBJECTIVE: To obtain the linear correlation between Doppler flowmetry rates and follicular development and the observed embryo growth in ovarian hyperstimulation cycles in the IVFTE/ICSI results. MATERIAL AND METHODS: A prospective and observational study including 29 patients was carried out. The ovarian reserve was determined--by the ovaries morphometric conditions--as well as basal FSH. These were correlated with pulsatility rates (PR), resistance rates (RR), and the systole/diastole ratio (S/D) and the maximum flow rate (TAmax), using a USG pulse-colour Doppler. All these were correlated to embryo development. Covariance, regression lines and confidence intervals analyses were performed for its statistical determination. RESULTS: A correlation between RR and the formation of mature follicles was observed (p = 0.05), and, at the same time, a negative relationship between FSH and ovarian volume was found. CONCLUSIONS: A series of markers of ovarian reserve have been described, however, none of these is a specific marker when ovum quality is expressed through the administration of ovulation inducers. Considering the data obtained in our study, we can say that Doppler flowmetry rates can indicate follicular expression and the resulting ovum and embryo development.

Adult↗

PubMed2002

[Pelvic surgery as a predictive marker of the follicular response to ovulation inducers].

OBJECTIVE: Comparing the follicular response in a group of patients with previous pelvic surgery submitted to in vitro fertilization. MATERIAL AND METHODS: Patients who were going to be submitted to controlled ovarian stimulation and in vitro fertilization were included. Two groups were formed: one with those patients who had had a previous pelvic operation and the other with those patients who had not. The characteristics which were analyzed included: age, weight, body mass index, FSH, LH and estradiol levels, as well as total ova numbers, grade of embryonic maturity, and number of transferred embryos. RESULTS: Ninety nine patients were studied: 46 had been submitted to pelvic surgery and 53 had not. Due to the design of the study there were no differences regarding age, weight, size and body mass index; the evaluation of the ovarian reserve was similar in both groups. However, the group of patients previously submitted to pelvic surgery presented a lower quantity of total ova (p = 0.004), less mature ova (p = 0.008) with a significantly lower pregnancy rate. CONCLUSIONS: Surgical procedures, combined with adherence processes, probably have a direct incidence on the characteristics of the perifollicular environment which interfere with adequate development of the ovum. All these can be observed in a decrease of fertilization processes and embryonic development, regardless of the expression of the adequate biochemical markers of the ovarian reserve. Our research shows that the group under study presents a decrease in follicular response affecting the quality of the ovum-embryo expressed in the pregnancy rate.

Case-Control Studies↗

PubMed2002

[Unexpected failed fertilization in vitro: ICSI reinsemination or ICSI indication for subsequent cycles].

The objective was to determine if intracytoplasmatic sperm injection (ICSI) for "rescue" of unexpected failed conventional insemination should be carried out for therapeutic or diagnostic purposes, that is, as a predictor for performing ICSI as a standard treatment in subsequent cycles. A retrospective clinical study was carried in 26 patients who showed unexplained fertilization failure on a first conventional IVF attempt, and reinsemination by ICSI was performed. We compared these results with those of 13 of the 26 patients who underwent a second attempt in which ICSI was used as the only insemination technique. A fertilization rate of 46.27% was achieved with reinsemination by ICSI but none resulted in pregnancy (0%). Fertilization was achieved with ICSI in all patients with previous fertilization failure and a pregnancy rate of 38.46%. Patient characteristics, cycle characteristics, sperm parameters or oocyte quality did not differ significantly between two groups. In conclusion, the ICSI reinsemination technique can give good fertilization rates but the potential of the generated embryos to achieve pregnancy seems to be low. In addition, it can be demonstrated that these patients have good possibilities of obtaining a pregnancy in a following cycle using ICSI.

Adult↗

PubMed2002

[Use of GnRH antagonists (cetrorelix) in assisted reproduction: first report in Mexican literature].

The use of GnRH antagonists in assisted reproduction techniques (ARTs) has been shown to be effective in blocking the luteinizing hormone (LH), without a repercussion on ovaric response. The present study reports the use of a GnRH antagonist (cetrorelix) 0.25 mg/d s.c. in patients stimulated with recombinant FSH (rFSH) for IVF/ICSI. 44 patients with mean age of 33.3 years were included in this study, four patients were receptors for oocyte donation program and another patients was receptor for frozen embryos. Controlled ovarian stimulation was carried out with rFSH, starting on day 3 of menstrual cycle. The total mean dose used was 3.570 +/- 1.102 UI for each patient. The LH serum concentrations were monitored during ovaric stimulation, in two patients a premature LH surge (> 10 UI/L) was detected. The oocytes were collected 36 hours after hCG administration, the mean preovulatory oestradiol was 4.006 +/- 2.418 pg/mL. The mean total oocytes retrieved was 10.8 +/- 7.4 per patient, the fertilization rate was 58.3%, in only three patients fertilization was failed. No difference was observed in oocyte retrieval, fertilization rate, implantation rate between both groups (GnRH antagonists versus GnRH agonists). The embryo transfer was realized on day 3, and only two patients was on blastocyst stage. In 17 of 41 patients with successful transfer, pregnancy was achieved in the group with antagonists, and 8 of 20 patients in the group with agonists. In conclusion Cetrorelix prevents adequately premature LH surges and allows an effective ovaric response in controlled stimulation in IVF cycles, except in patients in oocyte donation programs who require higher cetrorelix doses.

Adult↗