Biomedical subjects
Publications and source records attributed to Avner Hershlag.
Should surgical treatment of presumed endometriosis be advocated for all patients who fail to conceive after multiple IVF cycles? Without appropriately designed clinical studies, there is currently little evidence to support this approach.
Embryos that underwent assisted hatching before freezing had a statistically significant higher survival rate and blastocyst formation rate compared with controls. Therefore, breaching the integrity of the zona pellucida and directly exposing the embryos to cryoprotectants not only does not result in damaging the embryos but might also afford them an advantage as they go through the freeze-thaw cycle.
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OBJECTIVE: To determine whether the performance of intracytoplasmic sperm injection (ICSI) in cases of unexplained infertility and of borderline semen parameters can prevent fertilization failure. DESIGN: Prospective cohort study. SETTING: Hospital-based assisted reproductive technology program. PATIENT(S): Sixty couples with unexplained infertility (group 1) and 50 couples with borderline semen (group 2). INTERVENTION(S): Conventional IVF and ICSI were performed on sibling oocyte cumulus complexes. MAIN OUTCOME MEASURE(S): Rate of fertilization according to patient diagnosis. RESULT(S): The fertilization rate per oocyte cumulus complex in couples with unexplained infertility (group 1) was significantly higher with ICSI (65.3%) compared with IVF insemination (48.1%). Fertilization rates per OCC in couples with borderline semen (group 2) were not significantly different between ICSI (58.1%) and IVF (56.7%). In group 1, failure of fertilization after IVF insemination occurred in 10 of the 60 couples (16.7%) and in none with ICSI. In group 2, 2 of 50 couples (4.0%) failed fertilization by IVF, and 1 (2.0%) failed with ICSI. No couple in group 2 failed both IVF insemination and ICSI. CONCLUSION(S): In couples with unexplained infertility, a higher fertilization rate was achieved through ICSI compared with conventional IVF. No such benefit could be demonstrated for couples with borderline semen parameters. The use of ICSI rescued 12 of 110 cycles (10.9%) where IVF failed. Adoption of the ICSI-IVF insemination split in cases of unexplained infertility may help eliminate fertilization failures.
OBJECTIVE: To study cases where bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT)-induced menopause was entirely reversed. DESIGN: Retrospective analysis. SETTING: An inpatient BMT unit and an ambulatory fertility center in a university hospital. PATIENT(S): Two patients with Hodgkin's disease and two with advanced breast carcinoma requiring stem cell transplantation. INTERVENTION(S): Estrogen treatment, monitoring of follicle-stimulating hormone (FSH) and estradiol (E(2)) levels, and, ultimately, monitoring of pregnancy. MAIN OUTCOME MEASURE(S): Pregnancy. RESULT(S): All four patients established pregnancies, but two of them elected to terminate due to the use of tamoxifen early in pregnancy. CONCLUSION(S): Menopausal changes resulting from BMT may spontaneously reverse, with reestablishment of normal hormonal function and viable pregnancies.