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Biomedical subjects

I Bar-Hava

Publications and source records attributed to I Bar-Hava.

At least 55 records · Page 3Linked to original sources
PubMed1999

Standard in vitro fertilization or intracytoplasmic sperm injection in advanced female age--what may be expected?

This study was conducted to evaluate the current results of standard in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) in the elderly (> or = 40 years of age) female population. Oocyte recovery, fertilization, embryo transfer, pregnancy and cumulative pregnancy rates were assessed. The results were analyzed for: the entire elderly population; the standard IVF group (group 1); all those in the ICSI group (group 2); and ICSI for severe male-factor category (group 3). A total of 330 IVF and 158 ICSI treatment cycles were carried out in 249 women. Forty-five (9.2%) clinical pregnancies were achieved. This rate was not statistically different from those achieved for groups 1, 2 and 3 (9.1%, 9.5% and 6.8%, respectively). The cumulative pregnancy rate for a total of five cycles was 19.2% and 26.4% for groups 1 and 2, respectively. For those who started their treatments at > or = 40 years, the cumulative pregnancy rate for three cycles was 26.5% and 36.5% in groups 1 and 2, respectively. These results clearly demonstrate that female age is a major success determinant, with similar influence on both standard IVF and ICSI therapy modalities.

Adult↗
PubMed1999

Does female age affect embryo morphology?

Deteriorating oocyte quality is commonly believed to be the primary determinant of the decreased implantation potential in older women. We assessed the influence of age on embryo morphology in standard in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) modalities. All 6350 consecutive embryos (2990 IVF, 3360 ICSI) obtained in our Assisted Reproductive Technology Unit from January 1996 through June 1997 were included. High quality embryos were defined as those with equal-sized blastomeres and < 10% fragmentations and a cleavage rate of four cells on day 2 or eight cells on day 3 transfers. The results were analyzed for the standard IVF group, the ICSI group, and the ICSI subgroup with severe male factor infertility (< or = 1 x 10(6) total motile spermatozoa in the ejaculate). For standard IVF, a positive association was observed between female age and increased proportion of good quality embryos. No such association was detected for the ICSI cycles (whole group or subgroup). We conclude that in standard IVF, embryo quality, as reflected by embryo morphology, does not deteriorate with increased maternal age.

Adult↗
PubMed1999

The role of intravenous albumin in the prevention of severe ovarian hyperstimulation syndrome. A pilot experimental study.

OBJECTIVE: To evaluate the role of intravenous albumin in the prevention of severe ovarian hyperstimulation syndrome (OHSS). DESIGN: A pilot experimental study. MATERIAL AND METHODS: Ovarian hyperstimulation was induced in 5 rabbits using human menopausal gonadotropin/human chorionic gonadotropin, after pretreatment without (control group) or with bovine serum albumin (BSA group). RESULTS: Despite an increase in serum protein levels, the BSA group showed comparable delta increase in body weight and degree of ascites formation. CONCLUSIONS: Intravenous albumin did not prevent severe OHSS in a rabbit model despite the observed increase in serum oncotic pressure.

Animals↗
PubMed1999

The effect of betamethasone on fetal biophysical activities and Doppler velocimetry of umbilical and middle cerebral arteries.

OBJECTIVE: Preliminary reports suggest that antenatal steroid administration may confound the assessment of fetal well-being by suppressing biophysical activities, consequently drug-induced effects could prompt unwarranted delivery of premature fetuses. The purpose of this study was to examine the effect of antenatal betamethasone administration on fetal biophysical activities and Doppler flow indices of the umbilical and middle cerebral circulation. METHODS: Forty women at risk of premature delivery between 27-32 weeks gestation (mean 30.2 weeks) received two consecutive doses of intramuscular betamethasone, 24 hours apart. Ultrasonographic observations of fetal behavior for 30 minute periods and Doppler examination of the umbilical and cerebral arteries were performed prior to (0 hours), 48 hours after, and 96 hours after administration of the first dose. To account for fetal circadian rhythms and maternal prandial status, all examinations were carefully timed and performed between 1-4 pm. Analysis of Variance, chi-square test and Fisher's Exact test were used for statistical analysis, as appropriate. RESULTS: Nine patients were excluded from analysis due to delivery prior to completion of all examinations. Number of breathing episodes as well as total breathing time at 48 hours decreased by 83.0% (p<0.01) and 90.4% (p<0.01), respectively, at 48 hours in comparison to baseline. Fetal limb and trunk movements decreased by 53.2% (p<0.01) and 48.6% (p<0.01), respectively. Amniotic fluid volume and fetal tone were normal in all patients. At 48 hours, 14 of 31 fetuses and 4 of 31 fetuses had a biophysical profile score of 6/8 and 4/8, respectively, in comparison to 0 of 31 and 0 of 31 at 0 hours (p<0.05 and p<0.001, respectively). All parameters returned to baseline values at 96 h. Pulsatility indices of umbilical and middle cerebral arteries remained unchanged at 48 hours and 96 hours (p=NS). CONCLUSIONS: Betamethasone induces a profound, albeit transient, suppression of fetal breathing, limb and trunk movements, resulting in decreased biophysical profile scores. Awareness of this drug-induced effect might prevent unnecessary iatrogenic delivery of preterm fetuses.

Adult↗
PubMed1999

Endometrial polyps during menopause: characterization and significance.

BACKGROUND: To characterize postmenopausal women with endometrial polyps and to evaluate their significance. METHODS: The study population included all consecutive postmenopausal patients with a diagnosis of endometrial polyp, treated at our center over a two-year period. Demographic, medical and gynecological data were assessed with regard to the endometrial histologic findings. RESULTS: Of the 146 eligible patients, 15 had endometrial hyperplasia (four with atypia); there were no cases of endometrial carcinoma. The 20 patients (13.7%) using hormone replacement therapy had a significantly higher rate of endometrial hyperplasia than non-hormone users (p<0.006). No differences were observed among the endometrial histological categories for any of the presenting symptoms and signs, ultrasonographic findings, or medical histories. CONCLUSIONS: Postmenopausal endometrial polyp is a common, mostly benign entity. However, the relatively high rate of concomitant endometrial hyperplasia, especially in patients receiving hormone replacement therapy, dictates a thorough histological evaluation in all cases.

Aged↗
PubMed1998

Endometrial carcinoma in a post-menopausal woman with atrophic endometrium and intra-cavitary fluid: a case report.

Measurement of endometrial thickness by vaginal ultrasonography is used to detect post-menopausal women at risk for endometrial pathology. The efficacy of this procedure is doubtful in cases of intrauterine fluid accumulation, which is a common finding in this population. We present a case of endometrial carcinoma in an asymptomatic, post-menopausal woman with ultrasonographic imaging of an atrophic endometrium and intra-cavitary fluid. It may be suggested that, in a case of intrauterine fluid accumulation (IFA), endometrial biopsy should be performed regardless of the sonographic endometrial thickness, since the fluid may increase the intracavity pressure and can mask endometrial pathology.

Aged↗
PubMed1998

Twin gestation: is there a correlation between the location of the gestational sacs at the beginning of pregnancy, and the order of delivery.

OBJECTIVES: To determine whether there is a dynamic in the location of amniotic sacs in a twin gestation, during pregnancy. STUDY DESIGN: The study group comprised 63 twin pairs discordant for sex, who by vaginal sonography performed between 14 and 16 weeks' gestation, were characterized as first twin (opposite the internal os), and second twin. The order of delivery was recorded in the pregnancies that ended with vaginal birth. RESULTS: Thirty seven of 41 (90.2%) twins who were delivered vaginally (between 32 and 41 weeks' gestation), were born in the same order as that predicted by transvaginal sonography early in pregnancy. It was found that in this small series there was a dynamic in the amniotic sac location in twin gestations during pregnancy in only about 10% of the cases. CONCLUSIONS: In roughly 90% of twins, there is no dynamic in the location of the amniotic sacs during pregnancy, and the first twin at the beginning of pregnancy intrinsically remains.

Adult↗
PubMed1998

Pre-operative ultrasonographic evaluation of nongravid, enlarged uteri--correlation with bimanual examination.

OBJECTIVE: To correlate the size of the nongravid uterus measured by ultrasound and bimanual examination before hysterectomy, with the actual size of the specimens. PATIENTS AND METHODS: Uterine size of 49 consecutive patients, who underwent elective hysterectomy, was assessed by bimanual pelvic examination, preoperative ultrasonographic evaluation and actual postoperative size. RESULTS: All preoperative ultrasonographic uterine dimensions significantly correlated with the corresponding actual dimensions of the uterine specimens. Furthermore, ultrasonographic uterine length had the best correlation with uterine size estimation by bimanual examination. A formula was established in an attempt to calculate clinical uterine size by gestational week, using preoperative ultrasonographic dimensions. CONCLUSIONS: By using the aforementioned formula, ultrasonographic uterine dimensions can be extrapolated to uterine size in terms of gestational week, and therefore, be applicable to traditional clinical practice.

Female↗
PubMed1998

Single intrauterine fetal death (fetus papyraceus) due to uterine trauma in a twin pregnancy.

Fetus papyraceus is a rare condition. We describe the intrauterine fetal death with subsequent fetus papyraceus of one twin due to blunt maternal trauma in the second trimester of pregnancy. Blunt maternal trauma should raise the clinical suspicion of fetal death and dictate further observation; in a twin pregnancy, the possibility of a single fetal death should be investigated.

Abdominal Injuries↗
PubMed1998

Simplifying ovulation induction for surrogacy in women with Mayer-Rokitansky-Kuster-Hauser syndrome.

A simple approach for ovulation induction in women with Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKH-S) during in-vitro fertilization (IVF)/freezing/surrogacy cycles was evaluated. Weekly progesterone plasma concentrations were measured in order to accurately establish the luteal phase in MRKH-S women. When a rising titre was detected, a gonadotrophin-releasing hormone analogue (GnRHa) was administered as part of a long protocol. Two weeks later human menopausal gonadotrophin (HMG) therapy was started. Ten treatment cycles in four women with MRKH-S were carried out. In all cases, three or less progesterone estimations were needed. Three of the four women are now, through surrogacy, genetic mothers; one of them has two children. We concluded that weekly determination of progesterone plasma concentration is a convenient, efficient and inexpensive simple approach to identify the luteal phase, and therefore suitable to the start of a GnRHa/HMG protocol in MRKH-S women enrolled in an assisted reproduction technology programme.

Amenorrhea↗
PubMed1998

Ovarian abscess after ovum retrieval for in-vitro fertilization.

An ovarian abscess is an uncommon surgical emergency that could be lethal. The causes of an ovarian abscess vary, and treatment thereof may unfortunately lead to an oophorectomy. In order to draw the attention of physicians to this rare entity, we present a case of ovarian abscess resulting from follicle aspiration for in-vitro fertilization. Furthermore, with correct preoperative diagnosis and prompt surgical intervention at an early stage, the affected ovary may be salvageable.

Abscess↗
PubMed1998

The impact of intrauterine contraceptive devices on cytological findings from routine Pap smear testing.

OBJECTIVE: To evaluate the impact of intrauterine contraceptive device (IUCD) use on the interpretation of routine Pap smears. STUDY DESIGN: A retrospective case-control study. PATIENTS AND METHODS: During a 2-year period, we evaluated the Papanicolaou (Pap) tests of 452 consecutive asymptomatic women of childbearing age who used a copper IUCD (study group), and 452 matched controls who practiced no contraceptive methods (control group). RESULTS: Inflammatory exudate, inflammatory epithelial changes or extensive metaplastic cells were more commonly encountered among the IUCD user as compared with non-users (p < 0.05). No difference was noted in the detection rates of cervical squamous intraepithelial lesions in the two study groups. CONCLUSIONS: It can therefore be concluded that the use of an IUCD does not increase the incidence of squamous intraepithelial lesions. Any abnormal Pap smear in an IUCD user should first be repeated after local vaginal treatment, if only to temporarily palliate the inflammatory cellular reaction which impedes unequivocal interpretation of the routine Pap smear.

Adult↗
PubMed1998

Flexible starting schedule for oral contraception: effect on the incidence of breakthrough bleeding and compliance.

OBJECTIVE: To compare the effect of starting oral contraceptives on the first day of menses with the effect of starting on the day of menses' cessation (but no later than the 5th day following its onset), on the incidence of early breakthrough bleeding. METHOD: Oral contraceptives containing 30 micrograms ethinylestradiol and 75 micrograms gestodene were prescribed to 200 consecutive healthy women in whom oral contraceptives were found to be the most suitable method of contraception. In the first 100 women, treatment was started on the 1st day after the onset of menses (Day 1 group), and in the remainder, treatment was started on the day of menses' cessation, but no later than the 5th day following its onset (Flexible group). RESULTS: The Flexible group had better compliance and a reduced incidence of breakthrough bleeding. No differences were observed between the two groups for age, parity and gravity, or contraceptive failure. CONCLUSIONS: Oral contraceptives may be initiated on the day of menses' cessation, but no later than the 5th day following its onset. This regimen might increase patient compliance and lower the incidence of breakthrough bleeding, probably without adversely affecting contraceptive efficacy.

Adolescent↗
PubMed1998

Asymptomatic postmenopausal intrauterine fluid accumulation: characterization and significance.

OBJECTIVES: The aims of the study were to characterize those postmenopausal women who develop intrauterine fluid accumulation and to evaluate its significance. METHODS: All asymptomatic postmenopausal women who were referred for routine transvaginal ultrasonographic examination between 1 January 1995 and 31 March 1996 were included in the study. Demographic and ultrasonographic parameters were recorded on a prospectively created computerized database. When intrauterine fluid accumulation was identified, the women was referred for endometrial sampling. RESULTS: A total of 1175 consecutive, asymptomatic postmenopausal women were evaluated; intrauterine fluid accumulation was identified sonographically in 166 (14.1%). Women with intrauterine fluid accumulation were older, had experienced more years since the menopause, and had smaller uterine volume indices, thinner endometria and smaller indices of ovarian area, compared to those without intrauterine fluid accumulation (all at a significant level of p < 0.0005). The prevalences of hormone replacement therapy use were 6.6% in the 'accumulating fluid' women and 43% in the 'non-accumulating fluid' group (p < 0.0005). Of the 166 women with intrauterine fluid accumulation, 91 had an endometrial biopsy, of which 70% were insufficient for evaluation and 30% were normal on histology. CONCLUSION: Postmenopausal intrauterine fluid accumulation is a common, mostly benign phenomenon that typically occurs in the late postmenopausal age subgroups. It may be postulated that it represents part of the atrophic mechanism that takes place at this stage of life. Hormone replacement therapy appears to be a 'protection' against this phenomenon.

Aged↗
PubMed1998

Ultrasonographic evaluation of hysterectomized patients with and without concomitant adnexectomy?

OBJECTIVE: To present our experience with the use of ultrasonography in the evaluation of hysterectomized patients. METHODS: The study group was comprised of 100 consecutive women referred to our ambulatory unit for pelvic sonographic evaluation between April 1, 1996 and March 31, 1997. Inclusion criteria were previous hysterectomy for a benign condition with or without concomitant bilateral salpingo-oophorectomy and available medical and gynecological histories. RESULTS: No significant difference was observed in the rate of abnormal ultrasonographic findings among the patients who had had bilateral salpingo-oophorectomy 5/50 and those who had not (8/50). There was also no significant difference in pelvic mass rate between the patients who were receiving hormone replacement therapy and those who were not. The sensitivity of sonography in our study was 100% and the positive predictive value, 84.5%. CONCLUSIONS: Sonography is a useful diagnostic tool in the follow-up and management of post-hysterectomy patients.

Aged↗
PubMed1997

Morphology and clinical outcomes of embryos after in vitro fertilization are superior to those after intracytoplasmic sperm injection.

OBJECTIVE: To compare embryos obtained after IVF and intracytoplasmic sperm injection (ICSI) regarding morphology and the likelihood of achieving clinical pregnancy. DESIGN: Case-control study. SETTING: An IVF unit controlling 1,310 cycles in 1996. PATIENT(S): Women having a total of 477 IVF and 475 ICSI consecutive cycles. INTERVENTION(S): Ovarian stimulation, IVF-ET, or ICSI-ET for all couples. MAIN OUTCOME MEASURE(S): Number of grade-A embryos transferred, preclinical pregnancy losses, and clinical pregnancy rates in IVF and ICSI cycles. RESULT(S): In comparison with the ICSI group, the IVF group showed significantly more grade-A embryos available for transfer (mean, 2 +/- 1.6 versus 1.8 +/- 1.5), significantly fewer preclinical pregnancy losses (1.6% versus 4%), and significantly higher clinical pregnancy rates (25% versus 19.1%). CONCLUSION(S): Embryos obtained after IVF are superior to those obtained after ICSI in relation to embryo morphology and the likelihood of achieving clinical pregnancy.

Adult↗
PubMed1997

Gestational diabetes and preterm labour: is glycaemic control a contributing factor?.

OBJECTIVES: (1) to evaluate the incidence of preterm delivery in patients with gestational diabetes mellitus; (2) to determine the association between glycaemic control and preterm delivery in these patients. STUDY DESIGN: (1) The incidence of spontaneous preterm singleton deliveries was determined in 550 intensively-treated patients with gestational diabetes mellitus. A total of 14 552 consecutive patients without gestational diabetes mellitus who delivered during the same interval served as a control population; (2) Glycaemic profiles (i.e., mean blood glucose, percent of hypoglycaemic [ < 60 mg/dl] and hyperglycaemic [ > 120 mg/dl] episodes) were compared in 34 patients with gestational diabetes mellitus who delivered preterm, and 68 matched controls with gestational diabetes mellitus who delivered at term. RESULTS: (1) The incidence of preterm delivery in gestational diabetics was similar to that found in the non-diabetic population (6.2% vs. 6.5%, respectively, P = 0.82; confidence limits: 0.65, 1.36); (2) women with gestational diabetes mellitus who delivered at term, or preterm had similar glycaemic profiles for both the entire treatment period and the week preceding delivery. CONCLUSIONS: (1) There is no increased risk for preterm delivery in intensively-treated gestational diabetes mellitus patients; (2) In a population such as this women with gestational diabetes mellitus who deliver preterm cannot be characterised by their glycaemic profile.

Adult↗