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Biomedical subjects

J Ashkenazi

Publications and source records attributed to J Ashkenazi.

At least 19 recordsLinked to original sources
PubMed2000

Follicle-stimulating hormone treatment for men with idiopathic oligoteratoasthenozoospermia before in vitro fertilization: the impact on sperm microstructure and fertilization potential.

OBJECTIVE: To assess the effect of FSH on sperm fertilization potential and sperm intracellular structure in men with oligoteratoasthenozoospermia and a proven low fertilization rate in IVF. DESIGN: Prospective, randomized, partial crossover study. SETTING: IVF Unit, Golda Campus, Rabin Medical Center, Petah Tikva, Israel. PATIENT(S): Forty normogonadotropic, normogonadal men with oligoteratoasthenozoospermia and at least one previous IVF attempt in which fertilization failed or the fertilization rate was <30%. INTERVENTION(S): The men were randomly assigned to treatment with daily injections of 75 IU of FSH or 150 IU of FSH for at least 60 days before IVF treatment. A control group of men underwent an IVF cycle without treatment and then were randomly assigned tojoin group 1A or 1B for an additional IVF cycle with treatment. MAIN OUTCOME MEASURE(S): LH, FSH, and testosterone levels during FSH treatment, evaluation of ultramorphologic changes in sperm by electron microscopy, and comparison of fertilization rates in the control and study groups. RESULT(S): After treatment with 75 IU or 150 IU of FSH, the mean fertilization rates were 19.7% and 20.5%, respectively, compared with a 5.8% fertilization rate in the study control cycles. CONCLUSION(S): Prolonged treatment with FSH results in a significant increase in fertilization rates. This effect may be related to improvements in subcellular components of the sperm.

Acrosome↗
PubMed1999

Fibrin glue improves pregnancy rates in women of advanced reproductive age and in patients in whom in vitro fertilization attempts repeatedly fail.

OBJECTIVE: To evaluate the possible contribution of fibrin sealant to the ET stage of IVF. DESIGN: Case-control study. SETTING: An assisted reproductive technology unit that performed 2,535 treatment cycles from 1996-1997. PATIENT(S): All consecutively seen patients who underwent ET from January 1996 to September 1997. INTERVENTION(S): All women who underwent ET with the aid of fibrin sealant during the study period were compared with those who underwent standard ET (controls). Thereafter, a case-control study was conducted on the first consecutively seen 174 women who underwent ET with fibrin sealant and a control group that was matched for age and number of previous unsuccessful cycles. MAIN OUTCOME MEASURE(S): Patient age, number of previous unsuccessful IVF attempts, number of embryos transferred, and pregnancy rates. RESULT(S): During the study period, ET was performed with fibrin sealant in 265 women and by the standard procedure in 1,402 women. Women in the fibrin sealant group were significantly older. The pregnancy rate was not significantly different between the groups in the whole-cohort study (20.4% versus 23.1%), but it was significantly higher in the fibrin sealant group in the case-control study (25.3% versus 14.9%). This also was true when the older women (>35 years) and the women with > or =4 previous failed IVF attempts were analyzed separately (23.2% versus 9.8% and 26.1% versus 13.4%, respectively). CONCLUSION(S): The use of fibrin sealant in ET appears to be beneficial in women of advanced reproductive age and in patients in whom IVF attempts repeatedly fail.

Adult↗
PubMed1999

The role of purified follicle stimulating hormone therapy in the male partner before intracytoplasmic sperm injection.

OBJECTIVE: To evaluate the impact of long-term purified FSH (pFSH) therapy in male partners before intracytoplasmic sperm injection (ICSI). DESIGN: Prospective, randomized, controlled study. SETTING: Large university-based IVF unit. PATIENT(S): Seventy-eight patients made up the study and control groups (39 patients each). All patients had severe male factor infertility. INTERVENTION(S): Induction of ovulation, oocyte retrieval, ICSI, and ET were carried out in both groups. In the study group, male partners received pFSH (75 IU FSH, <1 IU LH) for > or = 50 days before oocyte retrieval. MAIN OUTCOME MEASURE(S): Fertilization rate, embryo quality, implantation and pregnancy rates. RESULT(S): Fertilization and pregnancy rates were higher in the study group (68% and 35.9%, respectively) were higher than in the control group (59% and 17.9%, respectively), although the differences did not reach statistical significance. The implantation rate was significantly higher in the study group (15.5% versus 6.5%). The study group showed a trend toward a higher number of better-quality embryos per transfer (mean +/- SD, 2.2 +/- 1.6 versus 1.6 +/- 1.6). CONCLUSION(S): Purified FSH therapy in male partners before ICSI improves implantation rate. Improved embryo quality may be a contributory factor.

Embryo Implantation↗
PubMed1999

Pharmacokinetics of natural progesterone administered in the form of a vaginal tablet.

Our study was conducted to assess the pharmacokinetics of natural progesterone administered in the novel formula of an effervescent vaginal tablet. Fifty post-menopausal women, with a median age of 43.5 years (range 28-55), volunteered to participate in the research. All women discontinued their hormonal replacement therapy 1 month prior to the study. The pharmacokinetics of 50 and 100 mg of progesterone administered as a vaginal tablet were evaluated. After the initial administration of 50 mg or 100 mg, a mean serum Cmax of 20.43 +/- 8.01 nmol/l and 31.61 +/- 12.62 nmol/l (P < 0.0004) was reached at a Tmax of 6.1 +/- 2.63 and 6.4 +/- 3.35 h respectively. The terminal half-life was 13.18 +/- 1.3 and 13.7 +/- 1.05 h respectively. Continuous use of the 100-mg tablet resulted in a mean serum progesterone concentration of 26.08 +/- 13.96 nmol/l and 21.42 +/- 16.32 nmol/l after 14 and 30 days respectively. Women >40 years were found to have a significantly lower Tmax compared to younger women (P = 0.02). The continuous use of vaginal progesterone did not influence the hormonal, liver or lipid profiles evaluated. Only three (6%) women suffered from mild vaginal irritation. Natural progesterone given as a vaginal tablet is well tolerated, safe and an easily administered treatment. Even in a non-oestrogenized vagina the absorption was efficient and the 100 mg dosage resulted in adequate serum progesterone concentrations.

Absorption↗
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↗
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↗
PubMed1996

The impact of woman's age and sperm parameters on fertilization rates in IVF cycles.

OBJECTIVE: To examine the predictive value of different sperm parameters and the age of a couple on fertilization rate. MATERIAL AND METHODS: One-hundred six consecutive sperm samples were analysed before insemination of oocytes in IVF cycles. Sperm count and motility were examined with the Makler Counter Chamber. Morphology was evaluated by the eosin nigrosin and giemsa stains. Membrane integrity was evaluated by the hypoosmotic swelling test (HOST). RESULTS: Using a step-wise logistic regression test the following parameters were all significantly correlated with the fertilization rates: sperm concentration after a 3-h layering (chi 2 = 15.85, P < 0.001), sperm motility index (chi 2 = 6.12, P < 0.0134), woman's age (chi 2 = 6.25, P < 0.012), and the hypoosmotic test (chi 2 = 6.63, P < 0.01). A fertilization capacity formula was established by using these four parameters to predict the fertilization capacity of a couple. Significantly lower fertilization rates were detected in elderly women with the partner sperm concentration of 7 x 10(6)/ml after 3-h layering, < 30% swollen spermatozoa in the HOST and motility index score of < 50. CONCLUSIONS: By the aforementioned formula, sperm fertilization capacity can be predicted by using simple sperm parameters and women's age. Elderly women with partners who have suboptimal sperm parameters reflected by low fertilization capacity scores may benefit from micro-manipulation procedures.

Adult↗
PubMed1996

The value of hysteroscopic evaluation in patients with preclinical in-vitro fertilization abortions.

The study was conducted on 144 women who experienced preclinical abortions, i.e. a transitory rise in beta-human chorionic gonadotrophin (HCG) without any clinical or sonographic evidence of pregnancy, to identify the relationship between preclinical abortions and intrauterine pathology. Hysteroscopy was performed 1-2 weeks after the decline of beta-HCG concentrations to negative values. Intrauterine adhesions were detected in three patients (2.1%), most of these being of the mild type. Concomitant intrauterine abnormalities, mainly uterine septa, were found in 14 (9.7%) cases. We believe that preclinical abortions do not predispose intrauterine adhesions and curettage is superfluous. An incomplete uterine septum seems to be the major factor predisposing this early pregnancy wastage. Hysteroscopy following this condition is an easy and efficient means for both identifying intrauterine pathology and excluding adhesions.

Abortion, Spontaneous↗
PubMed1995

Polycystic ovary syndrome patients as oocyte donors: the effect of ovarian stimulation protocol on the implantation rate of the recipient.

OBJECTIVE: To evaluate the outcome of oocytes donated by women with polycystic ovarian syndrome (PCOS) compared with oocytes donated by women with mechanical infertility. DESIGN: A retrospective study. PATIENTS: The outcome of 159 oocyte donation cycles with oocyte donated by PCOS patients were compared with 69 oocyte donation cycles with oocytes donated by patients with mechanical infertility. We compared the stimulation protocols in the donors to assess if the combination of GnRH analogue (GnRH-a), FSH, and hMG has an advantage over FSH and hMG alone with respect to their effect on fertilization and implantation rates in oocyte donation cycles. RESULTS: When treated with GnRH-a, pregnancy rates in PCOS and mechanical infertility donors were higher than those treated with FSH and hMG alone. The comparison between PCOS and mechanical factor oocyte recipients revealed no significant difference in the pregnancy and abortion rates, but the oocytes of patients with PCOS that were exposed to GnRH-a had a significantly higher implantation rate than those not exposed to GnRH-a. CONCLUSIONS: Oocytes obtained from PCOS patients had a fertilization potential equal to oocytes obtained from mechanical infertility donors. Furthermore, because the oocytes of patients with PCOS exposed to GnRH-a had a significantly higher implantation rate, a detrimental role of high LH on oocyte quality seems probable. However, because PCOS has a high familial prevalence, some reservations may arise due to a possible propagation of the problem in the next generation of oocyte donation programs.

Embryo Implantation↗
PubMed1995

Effect of uterine leiomyomata on the results of in-vitro fertilization treatment.

The effect of uterine leiomyoma on infertility is subject to controversy. Two main mechanisms associating leiomyomata and infertility have been suggested: the obstruction of gamete transport and impaired implantation. In-vitro fertilization (IVF) is a unique setting for examining the effect of leiomyomata on the implantation rate. This study was designed to determine the impact of uterine leiomyomata on the results of IVF. In a retrospective analysis of IVF cycles, 46 women with documented uterine leiomyoma were compared with a control group with mechanical infertility. The implantation rate and pregnancy outcome in relation to the leiomyoma were observed. Implantation (22.1%/transfer, 6.8%/embryo) and abortion rates (36%) in the study group were similar to the results in the control group with pure mechanical factor. An analysis of IVF results according to the hysteroscopic pretreatment findings revealed that impaired implantation is associated with leiomyoma only where uterine intracavitary abnormalities co-exist. We conclude that implantation rate and pregnancy outcome are impaired in women with uterine leiomyomata only when they cause deformation of the uterine cavity. In patients with leiomyomata associated with an abnormal uterine cavity, surgical treatment should be considered prior to IVF because of the reduced implantation rate.

Abortion, Spontaneous↗
PubMed1994

Acute pelvic inflammatory disease after oocyte retrieval: adverse effects on the results of implantation.

OBJECTIVE: To determine the impact of pelvic inflammation on the results of IVF after oocyte retrieval. DESIGN: Retrospective analysis of IVF cycles. SETTING: IVF Unit, Golda Medical Center, Petah Tikva, Israel. PATIENTS: Twenty-eight women with a diagnosis of pelvic inflammatory disease (PID) during IVF therapy. MAIN OUTCOME MEASURE: The pregnancy rate (PR) of IVF cycles complicated by PID after oocyte retrieval was compared with our ongoing IVF results. RESULTS: All 28 women with PID during IVF treatment did not conceive, despite the high number of oocytes retrieved, fertilized, and transferred. The PR over the same period was 23% to 31%. CONCLUSIONS: Pelvic infection after IVF treatment might have a detrimental effect on the results of treatment. In an effort to maximize the chances for normal implantation, postponement of ET should be considered when pelvic infection or inflammation is diagnosed.

Acute Disease↗
PubMed1994

Minidose gonadotropin-releasing hormone agonist is the treatment of choice in poor responders with high follicle-stimulating hormone levels.

OBJECTIVE: To investigate the effectiveness of minidose GnRH agonist (GnRH-a) + hMG in poor responders with elevated basal level FSH. DESIGN: Retrospective analysis of IVF cycles. SETTING: IVF Unit, Golda Medical Center, Petah Tikva, Israel. PATIENTS: One hundred six patients who were defined as poor responders on two previous IVF attempts. Three treatment protocols of midluteal Decapeptyl (D-Trp6) were compared: [1] a single-dose of 3.75 mg; [2] 0.5 mg daily until menstruation, followed by 0.1 mg daily; and [3] 0.1 mg daily until menstruation, followed by 0.05 mg daily. MAIN OUTCOME MEASURES: Comparisons were made among the three protocols regarding basal FSH levels, number of oocytes retrieved and fertilized, number of days of stimulation, follicular phase, P levels, and pregnancy and miscarriage rates. RESULTS: Treatment with minidose GnRH-a resulted in higher E2 levels and lower P levels on the day of hCG and lower cancellation rates. Furthermore, a higher number of oocytes recovered and fertilized and embryos transferred were recorded. The trend indicated improved pregnancy and implantation rates with a lower miscarriage rate. CONCLUSION: Minidose GnRH-a is a better choice than regular GnRH-a strategies in poor-responder patients undergoing IVF treatment.

Dose-Response Relationship, Drug↗
PubMed1994

Early diagnosis and successful nonsurgical treatment of viable combined intrauterine and cervical pregnancy.

Cervical pregnancy is a rare form of EP often resulting in an obstetric catastrophe. We report a case of a combined viable IUP and cervical pregnancy resulting from IVF-ET treatment and which was diagnosed during the 7th week of gestation. Nonsurgical treatment consisting of selective intra-arterial catheterization and administration of MTX directly into the uterine arteries was carried out successfully. Complications were avoided, and the patient's reproductive capability was preserved.

Adult↗
PubMed1994

A prospective randomized comparison of two gonadotrophin-releasing hormone agonists, nafarelin acetate and buserelin acetate, in in-vitro fertilization-embryo transfer.

We tested the efficacy of a new gonadotrophin-releasing hormone agonist (GnRHa), nafarelin acetate, in in-vitro fertilization (IVF), and compared the results with those of another widely used GnRHa, buserelin acetate; both were in the form of nasal spray. Therapy was used in a long protocol in the luteal phase in two groups of women with similar aetiology of infertility. There was no significant difference in patient response, measured by cycle cancellation, number of oocytes retrieved, fertilization rate and cleavage rate. Pregnancy rates were similar in nafarelin acetate and buserelin acetate treated women, namely 22% and 24% pregnancies per cycle, and 28.8% and 32.1% pregnancies per transfer, respectively. Side-effects were few and comparable in both groups. The only difference noted was that women receiving nafarelin acetate required significantly fewer ampoules of human menopausal gonadotrophin, making a significant difference in the expense involved. We conclude that on the basis of our experience, nafarelin acetate is an efficient and safe gonadotrophin-releasing hormone agonist, effective in IVF therapy.

Administration, Intranasal↗