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Biomedical subjects

C M Herbert

Publications and source records attributed to C M Herbert.

At least 37 records · Page 2Linked to original sources
PubMed1989

Diagnosis and management of out-of-phase endometrial biopsies among patients receiving clomiphene citrate for ovulation induction.

Eighty-seven patients who underwent a late secretory phase endometrial biopsy while taking clomiphene citrate (CC) for ovulation induction were studied. Of the endometrial biopsies, 21 (24%) showed an endometrium greater than 2 days out of phase (OOP) with respect to the subsequent menstrual cycle. All 87 patients were categorized by age, weight, CC dosage, and underlying disease entity. The patients then were evaluated by these categories in relation to the incidence of an OOP biopsy while taking CC. Patients with a diagnosis of hypothalamic amenorrhea were statistically more likely to have an OOP endometrium. No other subgroup showed an increased or decreased incidence of OOP biopsies. Conception and spontaneous abortion rates were similar among patients with in-phase biopsies and those with out-of-phase biopsies, which subsequently were corrected with further medical therapy. An aggressive approach to the diagnosis and treatment of luteal phase insufficiency in patients who receive CC for ovulation induction is recommended.

Abortion, Spontaneous↗
PubMed1989

The influence of oocyte maturity and embryo quality on pregnancy rate in a program for in vitro fertilization-embryo transfer.

An important factor influencing the pregnancy rate after in vitro fertilization-embryo transfer (IVF-ET) appears to be the number of embryos transferred to the uterus. In this study, the influence of oocyte maturity and embryo quality on pregnancy rate was assessed in patients undergoing IVF-ET. Ovarian hyperstimulation was performed by human menopausal gonadotropin (hMG [n = 29]), clomiphene citrate (CC)/hMG (n = 81), and hMG/follicle-stimulating hormone (FSH [n = 13]) protocols. Oocyte maturity was graded on a scale from 1 to 5 based on the morphology of the ooplasm, cumulus mass, corona radiata, and membrana granulosa cells. Embryos were graded according to the symmetry of the blastomeres and the presence or absence of fragmentation. Mature preovulatory oocytes yielded the highest fertilization rates. No differences were found among the protocols in terms of fertilization rate, embryo quality, or pregnancy rate. When all protocols were combined, patients who conceived had a significantly higher number of embryos transferred than those who did not conceive (3.6 +/- 0.1 [mean = SEM] versus 2.7 +/- 0.1). When embryo quality was compared, there was no difference in the number of "B" embryos transferred between patients who conceived and those who did not (1.2 +/- 0.2 versus 1.2 +/- 0.1), but the patients who conceived had significantly more "A" embryos transferred (1.6 +/- 0.3 versus 0.8 +/- 0.1). These data suggest that the treatment protocol did not determine embryo quality. Furthermore, the increase in pregnancy rates seen with an increase in embryos transferred is the result of the transfer of more "A" embryos.

Blastomeres↗
PubMed1989

Results of in-vitro fertilization in normal ovulatory women treated with pure follicle stimulating hormone. Analysis of the oestradiol response.

The relationship between various measures of oestradiol (E2) secretion and the total number of oocytes retrieved (OR) and cleaved embryos (CE) was characterized in normal ovulatory women stimulated with pure follicle-stimulating hormone (FSH) in a programme for in-vitro fertilization and embryo transfer (IVF-ET). Patients in this study included women with tubal factor as their only cause for infertility. Cycles were monitored with serum E2 concentration and ultrasonography. Human chorionic gonadotrophin (HCG) was administered when two follicles had a maximum diameter greater than 15 mm. The variables used to characterize the E2 secretory response included: (i) the difference between the highest and lowest E2 concentration during stimulation; (ii) the ratio of terminal to initial E2 concentration; (iii) E2 concentration on the day of HCG administration; and (iv) the slope of the E2 curve. These measures of E2 secretion each correlated with both the number of OR and the number of CE. When all E2 variables were considered simultaneously in a stepwise multivariate regression procedure, variations in the number of OR (r2 = 0.84) or CE (r2 = 0.77) could be explained by variation in the E2 secretory profile. Equations derived from these E2 variables may help to identify and improve problem areas within IVF-ET programmes when actual results differ from expected.

Adolescent↗
PubMed1989

Comparison of late luteal phase endometrial biopsies using the Novak curette or PIPELLE endometrial suction curette.

The late luteal phase endometrial biopsy is an important part of the evaluation of patients with recurrent spontaneous abortion or infertility. The procedure can be painful and, if an adequate amount of tissue is not obtained, may have to be repeated. In this report, the results of endometrial biopsies performed in the late luteal phase with either the Novak curette or the PIPELLE Endometrial Suction Curette were analyzed retrospectively. The two techniques did not differ in the number of biopsy specimens found to have inadequate tissue for diagnosis; however, patients who underwent biopsy with the PIPELLE recalled significantly less pain associated with the procedure. When used in premenopausal patients undergoing endometrial biopsy during the late luteal phase, the PIPELE provided adequate tissue with preservation of glandular, stromal, and capsular architecture.

Biopsy↗
PubMed1988

Management of heart transplant recipients: guidelines for the obstetrician-gynecologist.

As the number and survival time of heart transplant recipients continue to increase, their quality of life, including sexuality and childbearing, have become important issues. Reproduction is possible for both male and female patients after the transplant. Counseling for contraception when sterilization is not desired must take into account the increased risk of infection and genital carcinoma associated with immunosuppressant drug therapy. Teratogenicity has not been reported either with traditional immunosuppressive agents (prednisone, azathioprine) or with cyclosporine. Osteoporosis prophylaxis is particularly important in the female heart transplant recipient, because the chronic use of prednisone increases this risk. Guidelines are provided to counsel patients in these areas.

Contraception↗
PubMed1988

Therapeutic donor insemination: the impact of insemination timing with the aid of a urinary luteinizing hormone immunoassay.

The records of 120 patients undergoing therapeutic donor insemination were reviewed to determine if the use of the enzyme immunoassay of urinary luteinizing hormone (LH) to plan inseminations decreased the number of cycles required to achieve conception. All inseminations were performed with fresh semen. Patients in group 1 (n = 26) utilized urinary LH testing in addition to basal body temperature (BBT) and cervical mucus examinations to time their inseminations, while inseminations in group 2 (n = 94) were timed with only BBT and cervical mucus examinations. The monthly fecundability of patients in group 1 was 0.13, whereas the monthly fecundability of patients in group 2 was 0.11. The mean number of inseminations was 1.4 and 1.6 per cycle for groups 1 and 2, respectively. There were no significant differences between groups 1 and 2 in regard to the number of cycles required to achieve conception. The use of a urinary LH immunoassay for insemination timing offers no benefit over conventional methods of timing (BBT, cervical mucus) when fresh donor semen is used.

Adult↗
PubMed1988

Efficacy of a modified oxidized cellulose fabric in the prevention of adhesion formation.

A new fabric of regenerated oxidized cellulose (TC-7) was evaluated for the prevention of postoperative adhesions. Standardized injuries were performed on the uterine fundal serosa, the unilateral uterine cornu, and the contralateral ovary in 24 New Zealand rabbits. TC-7 was applied to the injured surfaces in 12 rabbits utilizing a randomized study design. At second-look laparotomy 3 weeks later, adhesions were graded without knowledge of the treatment category in the 22 rabbits surviving the study. There were no statistically significant differences in adhesion formation between treated and control animals at any of the injury sites. No gross or histologic residua of the TC-7 were evident 3 weeks after intraperitoneal application. Further studies will be needed to clarify the clinical role of this new fabric.

Animals↗
PubMed1987

Combination clomiphene citrate/human menopausal gonadotropin stimulation protocols for in vitro fertilization-embryo transfer.

Various protocols have been utilized for stimulation of multiple ovarian follicles in patients undergoing in vitro fertilization-embryo transfer (IVF-ET). Previous studies have suggested that the combination of clomiphene citrate (CC) and human menopausal gonadotropins (hMG) is superior to either CC or hMG alone in terms of follicular development, oocyte recovery, and embryo transfer. However, no significant increase in viable pregnancy rates has been reported with any of the protocols. This report examines five different CC/hMG protocols. While differences were seen in terms of serum estradiol response and fertilization rates of mature oocytes among the various protocols, no significant differences were found in terms of follicular development, oocyte recovery, embryo transfer, or pregnancy. The pregnancy rate in IVF-ET appears unaffected by variations in the dose and timing of CC and hMG in a combination protocol.

Adult↗
PubMed1987

Use of individual human follicles to compare oocyte in vitro fertilization to granulosa cell in vitro luteinization.

Granulosa-lutein (G-L) cells from individual follicles aspirated during cycles of in vitro fertilization-embryo transfer were examined after 3 and 6 days in culture. G-L cells from follicles that contained an oocyte that fertilized in vitro were compared with G-L cells from follicles that contained an oocyte that did not fertilize in vitro. Spent culture media was assayed for progesterone at days 3 and 6 of culture and luteinizing hormone/human chorionic gonadotropin (LH/hCG) receptor content of G-L cells was determined at day 6. G-L cell cultures from follicles that contained an oocyte that fertilized in vitro produced significantly more progesterone over 3 and 6 days of culture than those obtained from follicles in which the oocyte did not fertilize. Furthermore, LH/hCG receptor content after 6 days was significantly higher in G-L cells obtained from follicles with fertilized oocytes compared with follicles with unfertilized oocytes. Increased progesterone output and LH/hCG receptor acquisition demonstrate more maturation or "luteinization" by G-L cells aspirated from individual follicles that contain oocytes that fertilized in vitro.

Cells, Cultured↗
PubMed1986

Comparison of two brands of clomiphene citrate for stimulation of follicular development in a program for in vitro fertilization.

Although clomiphene citrate (CC) is used frequently to stimulate multiple follicular development in in vitro fertilization programs, comparison of the two commercially available types has been limited. Therefore, a comparison was made of Serophene (Serono Laboratories, Inc., Randolph, MA) and Clomid (Merrell Dow Pharmaceuticals, Inc., Cincinnati, OH), using the same dosage regimen of CC (150 mg/day for days 3 to 7 of the cycle). Weights and ages of the two groups were not different. Serum estradiol (E2) levels were significantly elevated in Clomid cycles, but the number of developing follicles was not different between the two brands. The percentages of patients in each group who underwent laparoscopy, oocyte recovery, oocyte fertilization, and embryo transfer were also equivalent. Among patients undergoing laparoscopy, no differences in oocyte recovery, oocyte fertilization, and embryo development were noted. Thus, despite greater elevation of serum E2 levels with Clomid, no difference in stimulation regimen outcome was observed.

Adult↗
PubMed1986

Cycle of conception endometrial biopsy.

Although controversial, the diagnosis of luteal phase inadequacy and its therapy may improve reproductive outcome, but an endometrial biopsy in the cycle of conception (COC) might theoretically interrupt an intrauterine pregnancy. Fifty-four biopsies obtained in the COC were identified, and patient outcome was documented. Eleven (20%) of the 54 women who underwent COC biopsy did not deliver viable infants. Two patients had ectopic pregnancies, and nine had early abortions, including one whose biopsy specimen contained an early implantation site and another with a trisomy 16 fetus. Although COC endometrial biopsy did not appear to increase the incidence of fetal wastage, biopsy information provided no predictive information suggestive of ultimate pregnancy outcome. Because no useful information is gained from a COC biopsy, we recommend either that pregnancy be avoided or a sensitive pregnancy test be employed for detection in a cycle in which a biopsy is to be performed.

Abortion, Spontaneous↗
PubMed1986

Sonography of the endometrium during conception and nonconception cycles of in vitro fertilization and embryo transfer.

The thickness of the endometrium was compared in 15 patients who conceived and 15 who did not with an in vitro fertilization and embryo transfer (IVF-ET) protocol after ovulation induction with human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG). There was no statistically significant difference (P = 1.0) in the endometrial thickness in the conception versus the nonconception group. Average estradiol (E2) values and number of mature follicles were also not statistically different in the two groups (P = 0.78, P = 0.81). There was a slightly significant difference in the number of embryos transferred in the conception versus nonconception groups (2.5 versus 1.9, P = 0.005). However, the most significant difference between the conception and nonconception groups was the total number of oocytes retrieved (4.4 versus 2.8, P = 0.005). These findings indicate that there are no sonographically detectable differences in the endometrial thickness in patients who achieve pregnancy versus those that do not when given a similar ovulation induction regimen of hMG/hCG for IVF-ET.

Chorionic Gonadotropin↗
PubMed1986

Comparison of human menopausal gonadotropin, clomiphene citrate, and combined human menopausal gonadotropin-clomiphene citrate stimulation protocols for in vitro fertilization.

Human menopausal gonadotropins (hMG) and clomiphene citrate (CC), either alone or in combination, are frequently used for in vitro fertilization (IVF) in an attempt to maximize the number of oocytes recovered and the number of embryos transferred. However, direct comparison of the relative efficacy of these protocols in the same institution has been limited. To evaluate this question, the authors examined the outcome of 304 consecutive women attempting IVF. One hundred eighty-one women received hMG, 42 received CC, and 81 received combination hMG/CC. The percentages of women undergoing laparoscopy were not different among the groups (69%, 71%, and 74%, respectively), nor were the rates of oocyte recovery (94%, 100%, and 100%). However, the percentage of women achieving oocyte fertilization (77%, 83%, and 93%) and embryo transfer (73%, 83%, and 90%) were significantly greater among those who had received hMG/CC stimulation. A comparison of hMG/CC with hMG and CC cycles revealed a statistically significant increase in the total number of developing follicles (4.5 +/- 0.3, 3.3 +/- 0.2, and 3.1 +/- 0.3, respectively; P = 0.0137), total oocytes recovered (4.1 +/- 0.3, 3.2 +/- 0.2, and 2.5 +/- 0.2; P = 0.0011), and embryos transferred (2.2 +/- 0.2, 1.4 +/- 0.2, and 1.4 +/- 0.2; P = 0.0013). However, there was no significant difference in the occurrence of ongoing pregnancies. Thus, in terms of the per-patient number of follicles, oocytes, and embryo transfers, combined hMG/CC stimulation appears to be superior to either hMG or CC alone. However, to date the combined regimen has not improved pregnancy rates.

Clomiphene↗
PubMed1986

Ureteral abnormalities in women with endometriosis.

High-volume intravenous urography was performed in 63 women with surgically proven endometriosis. Subtle abnormalities were found in 15.9% of these women. No patient had urologic symptoms, and there was no evidence of hydroureter or ureteral obstruction on the IVP. Long-term follow-up study will be required to determine whether or not these lesions will progress and cause ureteral obstruction.

Adult↗
PubMed1986

Operative laparoscopy for the management of tubal pregnancy.

Laparoscopic management of selected cases of tubal pregnancy may be an alternative to the conventional approach, laparotomy. Twenty-seven patients were managed with this technique; each had a readily accessible unruptured ampullary pregnancy less than 4 cm in diameter. All but one went home by the second hospital day. One suffered an immediate postoperative hemorrhage that required laparotomy to control. Six of eight patients tested from three to ten months after the operation had tubal patency. Five of eight patients attempting conception have become pregnant, with one repeat ipsilateral tubal pregnancy. In five patients, serum beta-human chorionic gonadotropin remained elevated for more than 30 days after laparoscopy with no untoward effect. Although insufficient data exist to compare reproductive outcome after this technique with that after laparotomy, in properly selected cases operative laparoscopy seems to be safe and effective conservative therapy, decreasing the need for laparotomy and the duration of hospitalization.

Chorionic Gonadotropin↗
PubMed1985

Selection of superior stimulation protocols for follicular development in a program for in vitro fertilization.

Classification of stimulated controlled follicular development cycles in programs for in vitro fertilization by the likelihood of culminating in a pregnancy would allow for increased efficacy in patient management and the distribution of care provider services. Analysis of human menopausal gonadotropin stimulations by the estradiol (E2) patterns identified trends suggesting superiority of one pattern, but no statistically significant difference was identified. Similarly, trends were identified in the Norfolk data for the height and pattern of E2 response, but no statistical significance was identified. While these observations may become significant with larger numbers, until that time, criteria for altering patient management based on the rise of follicular phase E2 levels should be reconsidered.

Chorionic Gonadotropin↗
PubMed1985

Outcome of successive cycles of ovulation induction in the same individual.

Because of the failure to conceive after the first cycle of in vitro fertilization (IVF), many couples often undergo repeated attempts. However, choosing the best stimulation protocol in successive cycles of IVF in the same individual is hindered by the lack of information regarding outcome in successive cycles following utilization of the same or different stimulation protocols. Examination of repeated cycles of the same stimulation protocol in 33 women demonstrated that comparing women with an initial "A" estradiol (E2) pattern (daily E2 levels that continued to rise throughout the stimulation) and those with non-A E2 patterns (failure to have continually rising E2 levels throughout the stimulation), the former were significantly less likely to have a subsequent passed cycle (P = 0.007) and tended to be more likely to have a subsequent A cycle (P = 0.079). Changing the stimulation protocol resulted in a different E2 pattern in 15 of 20 subsequent cycles. Thus, it is suggested that after a cycle with an acceptable E2 pattern, successive cycles be performed with the same stimulation protocol. However, after an initial unacceptable E2 pattern, it may be more efficacious to utilize an alternate stimulation protocol.

Chorionic Gonadotropin↗