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Biomedical subjects

J B Lessing

Publications and source records attributed to J B Lessing.

At least 91 records · Page 5Linked to original sources
PubMed1998

Oocyte donation in Israel: a study of 1001 initiated treatment cycles.

There are numerous studies concerning pregnancy rates in oocyte donation, yet only a handful report the obstetric outcome in such pregnancies. The purpose of this study was to assess factors that influence pregnancy rates, to determine the incidence of complications, and to evaluate obstetric outcome in pregnancies resulting from oocyte donation. This study included 423 oocyte recipients who underwent 1001 oocyte donation cycles at the Oocyte Donation Programme, In-Vitro Fertilization (IVF)-Embryo Transfer Unit, Herzlia Medical Center, Israel. Donors were all healthy women < 34 years old who underwent IVF themselves. In 873 cycles, fertilization occurred and embryo transfer was performed, resulting in 194 clinical pregnancies. Pregnancy rates (PR) significantly declined with the increase in number of previous attempts, and with increasing age of recipient (36.8%/embryo transfer in patients < or = 30 compared to 17.8% in patients > 40 years old). A significant increment in PR was noted with the increasing number of embryos transferred. The overall PR was 22.2%/embryo transfer. However, in young amenorrhoeic patients with normal karyotypes undergoing their first cycle, PR was 52.2%; the 'take home baby' rate was 38.3% per patient undergoing embryo transfer and 17.8% per embryo transfer cycle. A significant increase in the incidence of pregnancy-induced hypertension and a higher proportion of abortions were noted in older patients. A significantly higher incidence of prematurity and low birthweight was observed in multiple pregnancies.

Adult↗
PubMed1998

A 3 year, prospectively-designed study of late selective multifetal pregnancy reduction.

The aim of our study was to evaluate the pregnancy outcomes of late selective multifetal reduction (MFPR). We performed a 3 year, prospectively-designed study in which 28 patients underwent MFPR at a mean gestational age of 20.2 +/- 3.9 weeks (range 14-29 weeks). The indications for MFPR included: multiple gestation (> or = 3) (57%), structural anomaly (29%), and chromosomal abnormality (14%). The procedure was performed using ultrasonographically-guided intracardiac injection of potassium chloride. The mean gestational age at delivery was 36.6 +/- 2.2 weeks (range 31-40 weeks). Nine patients (32%) delivered before 36 weeks of gestation. The mean birth weight was 2370 +/- 614 g (range 1510-3250 g). Discordancy was evident in four twins (14%), and intrauterine growth retardation in four pregnancies. One case (3.5%) presented with oligohydramnios, and one with pregnancy-induced hypertension. One case of late abortion due to passive cervical dilatation 4 weeks after the MFPR was observed. Procedure-related amnionitis followed by late abortion occurred in one case. A total of 57% of the patients delivered vaginally and 43% delivered by Caesarean section. We concluded that late selective MFPR is associated with favourable perinatal outcome. Late MFPR may facilitate the detection of structural and chromosomal anomalies prior to the procedure, and the accomplishment of selective reduction of the affected fetus.

Abortion, Spontaneous↗
PubMed1998

Double-blind, placebo-controlled study of magnesium hydroxide for treatment of sensory urgency and detrusor instability: preliminary results.

In a prospective, randomised, double-blind, placebo-controlled study 40 women with sensory urgency or detrusor instability randomly received either magnesium hydroxide (group A) or placebo (group B). Pre- and post-treatment symptoms, frequency-volume charts and cystometry results were compared. Eleven of 20 patients receiving magnesium (55%) reported a subjective improvement of their urinary symptoms, compared with five patients taking placebo (20%). In both study groups there was no statistically significant difference in pre- and post-treatment urodynamic parameters in those reporting symptomatic improvement. Magnesium was well tolerated by patients in group A, and no side effects were reported. These results suggest that magnesium hydroxide may be beneficial for detrusor instability or sensory urgency in women.

Dose-Response Relationship, Drug↗
PubMed1998

High levels of anticardiolipin antibodies in patients with abnormal embryo morphology who attended an in vitro fertilization program.

PROBLEM: Recently, it has been suggested that anticardiolipin antibodies (ACAs) may serve as possible markers for reproductive failure. The association between ACAs and embryo morphology in patients undergoing in vitro fertilization (IVF) was investigated. METHOD OF STUDY: This prospective study comprised 117 patients with either tubal factor or unexplained infertility. Embryo morphology was blindly scored from I to IV according to blastomere regularity and the presence of fragments. Anticardiolipin antibodies (immunoglobulin [Ig] G and IgM) were detected. RESULTS: Anticardiolipin antibodies were found in 26 (50%) of the 52 patients with abnormal morphology, compared with 13 (20%) of the 65 patients with normal embryo morphology (P = 0.001). No statistically significant differences were found between the prevalence of ACAs among patients with tubal factor and those with unexplained infertility (29.6% and 36.5%, respectively). CONCLUSIONS: Our study shows an association between embryo morphology and the presence of ACAs. This association may explain the low implantation rate and early pregnancy loss in patients with ACAs.

Antibodies, Anticardiolipin↗
PubMed1998

Plasma interleukin-12 is elevated in patients with preeclampsia.

PROBLEM: Abnormal immune activation has been suggested as a contributor to the development of preeclampsia. We hypothesized that intact interleukin (IL)-12 directly, or through its main mediator, interferon (IFN)-gamma, contributes to the altered immune response observed in preeclampsia. METHOD OF STUDY: Plasma samples were collected from 20 patients with preeclampsia and 20 normotensive patients with uncomplicated pregnancies who were matched with the preeclamptic patients by age, gestational age, and parity. Samples were collected before the onset of labor, induction, or medical intervention. The samples were assayed for IL-12 and IFN-gamma by specific enzyme-linked immunoassays. RESULTS: IL-12 was detected in 35% of the preeclamptic patients and in 5% of the patients with normal pregnancies (P < 0.01). The detection rate and mean concentration of IFN-gamma were comparable in both groups. CONCLUSION: Intact plasma IL-12 is detected more frequently in preeclamptic patients, suggesting the involvement of this cytokine in the enhanced immune response observed in preeclampsia.

Adult↗
PubMed1998

Can labor with breech presentation be induced?

Our objective was to evaluate the efficacy and safety of labor induction in women with a breech presentation, and an unripe cervix. We conducted a retrospective, matched-paired study on patients with breech presentation and an unripe cervix (n = 23), who underwent induction of labor using extra-amniotic saline instillation. The women were compared to three matched control groups: 46 women with vertex presentation and an unripe cervix, whose labor was induced by the same method, 23 with breech presentation who underwent a vaginal trial of labor, and 23 women with breech presentation who underwent a cesarean section without a trial of labor. In the study group, 12 women (52.2%) delivered vaginally. Rates of Apgar score, birth trauma, and maternal morbidity were similar in all groups. Induction of labor in patients with a breech presentation and an unripe cervix may be attempted in selected cases as it seems to be efficacious (vaginal delivery rate of 52.2%) and safe for both fetus and mother.

Adult↗
PubMed1998

Reproducibility of transvaginal ultrasonographic measurements of endometrial thickness in patients with postmenopausal bleeding.

The aim of the study was to establish the reproducibility of transvaginal sonographic measurements of endometrial thickness in patients with postmenopausal bleeding (PMB). In a prospective blind study, two examiners measured the endometrial thickness in 48 patients presenting with PMB by transvaginal sonography on two separate occasions, 30 min apart. The analysis of variance performed at each endometrial thickness measured by the two examiners revealed no statistical difference. However, it was shown that the most accurate measurements are up to the level of 4 mm (mean deviation of 0.1 +/- 0.2 mm, range 0.7). Once the endometrial thickness reaches 5-6 mm the mean deviation becomes 0.3 +/- 1.2 mm with a range of variation of 4 mm. In conclusion, measurements of endometrial thickness in patients presenting with PMB can be repeated quite accurately up to a level of 4 mm thickness.

Endometrium↗
PubMed1998

Umbilical cord blood acid-base values in uncomplicated term vaginal breech deliveries.

BACKGROUND: This prospective study was conducted to compare the umbilical cord blood acid-base values of uncomplicated, assisted, vaginal-breech-delivery term neonates with those of uncomplicated, cephalic-vaginal delivery term neonates and to determine whether a different metabolic status should be expected in neonates born by way of uncomplicated vaginal breech delivery. METHODS: Umbilical cord artery and vein blood samples were obtained from 30 term neonates with frank or complete breech presentations who were born by uncomplicated assisted vaginal breech delivery. All these neonates had an Apgar score of >7 at 5 min and an uneventful neonatal course (study group). For each neonate in the study group the two consecutive term neonates who were delivered by uncomplicated cephalic spontaneous vaginal delivery, and had uneventful neonatal courses, served as controls (control group). RESULTS: The umbilical cord artery blood pH and pO2 were significantly lower (p<0.001 and <0.01, respectively) and the pCO2 was significantly higher (p<0.001) in newborns of the study group, compared to the controls. The umbilical cord vein blood pH was significantly lower (p<0.01), and the pCO2 significantly higher (p<0.01) in the study group. CONCLUSIONS: The umbilical cord blood acid-base values of uncomplicated, vaginal-breech-delivery term neonates differ significantly from those of uncomplicated, cephalic-vaginal delivery neonates. These differences may represent a greater degree of acute cord compression that reflects the different mechanisms of labor in vaginal breech delivery.

Adult↗
PubMed1998

Alternatively spliced mRNA transcripts encoding the extracellular domain of the FSH receptor gene. Expression in the mouse ovary during the ovulatory cycle.

OBJECTIVE: To evaluate regulation of follicle-stimulating hormone (FSH) receptor expression in the mouse ovary during different stages of an artificially induced ovulatory cycle. STUDY DESIGN: Follicular maturation was achieved in pubertal female mice by pregnant mares' serum gonadotropin (PMSG). Ovulation was induced 48 hours later by human chorionic gonadotropin (hCG). Ovaries were harvested before treatment, at 24 and 48 hours after PMSG and at 3, 9 and 12 hours after hCG. RNA was extracted using a single-step isolation method and used for reverse transcription. The cDNA was amplified by polymerase chain reaction (PCR) using primers designed to amplify a 512-basepair product corresponding to the extracellular fragment of the FSH receptor. RESULTS: PCR products, resolved by electrophoresis on agarose gels, showed four bands corresponding to four discrete, alternatively spliced forms of the FSH receptor. Expression of the various transcripts varied at different stages of the ovulatory cycle such that the larger transcripts increased up to 48 hours following PMSG and began to decrease thereafter, reaching a trough 12 hours following hCG administration. Conversely, a smaller transcript reached a peak 9 hours following hCG administration and decreased thereafter. CONCLUSION: The various transcripts represent different FSH receptor mRNA splicing and may mediate changes in receptor function. Since these alternative spliced forms encode different portions of the extracellular domain, it is possible that they have altered hormone-binding affinity serving a regulatory purpose, such as decreasing hormone binding affinity.

Alternative Splicing↗
PubMed1998

Intrauterine irrigation with prostaglandin F2-alpha for management of severe postpartum hemorrhage.

BACKGROUND: Severe postpartum hemorrhage is a significant contributor to maternal morbidity and mortality. The use of prostaglandin F2-alpha to control severe postpartum hemorrhage may avert surgery for the control of bleeding. METHODS: After ruling out the possibility of genital tract injuries, 18 patients with severe postpartum hemorrhage caused by uterine atony were enrolled in the study. None of the patients responded to treatment with oxytocin, methylergonovine, or uterine massage. A Foley catheter was introduced into the uterine cavity and the balloon was inflated with 5 ml sterile saline solution. The catheter was connected to an infusion line of 500 ml saline solution containing 20 mg prostaglandin F2-alpha. The solution was infused at a rate of 3-4 ml/minute for the first 10 min, and then reduced to 1 ml/minute for a period of 12 24 hours. RESULTS: In 17 patients (94.4%) bleeding ceased within several minutes of initiation of intrauterine prostaglandin F2-alpha infusion, the uterus was firmly contracted and uterine bleeding did not recur. In one patient with placenta increta bleeding continued and hysterectomy was performed. None of the patients had any side effects. CONCLUSIONS: Intrauterine irrigation with low concentrations of prostaglandin F2-alpha is a simple, rapid and effective treatment for severe postpartum hemorrhage and facilitates constant and continuous hemostasis. Moreover, the minute dosage used eludes potentially complicating side effects.

Dinoprost↗
PubMed1997

The procoagulant activity of red blood cells from patients with severe preeclampsia.

OBJECTIVE: Our purpose was to determine whether red blood cells from patients with severe preeclampsia may exhibit increased membrane exposure of procoagulant phospholipids (i.e., phosphatidylserine), which may initiate intravascular clotting and platelet activation. STUDY DESIGN: The study group comprised 28 women: 9 with severe preeclampsia in the third trimester of pregnancy, 10 normotensive with uncomplicated pregnancies, and 9 age-matched, nonpregnant, healthy women. The exposure of phosphatidylserine on the outer membrane phospholipid layer was analyzed with use of isolated, washed red blood cells that were added as a source of phospholipids to a "prothrombinase" coagulation complex. RESULTS: The resultant thrombin formed was measured by an amidolytic assay. Thrombin generation significantly increased on the addition of red blood cells from women with preeclampsia (741 +/- 132 mU/ml/min) compared with red blood cells from normotensive pregnant (422 +/- 228 mU/ml/min) and nonpregnant women (316 +/- 268 mU/ml/min, p = 0.0008). CONCLUSION: This study indicates that in patients with preeclampsia the red blood cells exhibit a significant procoagulant surface that may trigger thrombin formation, thereby playing a role in the hypercoagulable state.

Adult↗
PubMed1997

The ratio between carcinoma antigen-125 levels in the seminal plasma and serum may be a marker for fertilization in intracytoplasmic sperm injection.

OBJECTIVE: To assess the relationship between tumor marker carcinoma antigen-125 levels in seminal plasma and serum and fertilization rates in an IVF program, using intracytoplasmic sperm injection (ICSI). DESIGN: A prospective study. SETTING: IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. PATIENT(S): Twenty-five infertile patients with severe oligo-terato-asthenospermia syndrome and 25 fertile male donors. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Serum and seminal plasma carcinoma antigen-125 concentrations and fertilization rate per cycle. RESULT(S): In the infertile group, the seminal plasma carcinoma antigen-125 levels ranged from 22.0 to 1,284.0 U/mL (mean level +/- SD, 229.9 +/- 274.2 U/mL). In the normospermic fertile male donors, the seminal plasma carcinoma antigen-125 concentrations ranged from 12.2 to 336.7 U/mL (mean level +/- SD, 110.1 +/- 91.6 U/mL). This difference was statistically significant. The mean +/- SD ratio between the seminal plasma/serum carcinoma antigen-125 levels differed significantly between the infertile group (47.9 +/- 61.3) and the fertile male donors (5.7 +/- 3.5). In the infertile group, the ratio between the seminal plasma/serum carcinoma antigen-125 levels was found to be negatively correlated with the oocyte fertilization rate. CONCLUSION(S): The ratio between carcinoma antigen-125 levels in the seminal plasma and serum may be an indirect marker for male infertility and fertilization rate in IVF treatment using ICSI.

Adult↗
PubMed1997

Autoimmunity and reproduction.

OBJECTIVE: To review the association between autoimmunity and reproductive failure. DESIGN: A MEDLINE search done from 1965 to 1996. More than 300 original and review articles were evaluated, from which the most relevant were selected. RESULT(S): Autoimmune processes now are accepted widely as one of the possible mechanisms of many human diseases. The presence of autoimmune disorders has been associated repeatedly with reproductive failure. On the other hand, reproductive failure may be the first manifestation of autoimmune disorders. CONCLUSION(S): When abnormal autoantibody levels are present in women with reproductive failure, the reproductive failure alone should be considered as one of the possible clinical expressions of autoimmune disorders. Two relevant questions of whether these patients should be treated for autoimmunity remain unsolved. A prospective, placebo-controlled trial is necessary to evaluate the importance of any treatment.

Abortion, Habitual↗
PubMed1997

Cervical dilatation during ovum pick-up in patients with cervical stenosis: effect on pregnancy outcome in an in vitro fertilization-embryo transfer program.

OBJECTIVE: To evaluate the results of cervical dilatation during an ovum pick-up session in patients with cervical stenosis who participated in an IVF-ET program. DESIGN: A retrospective study. SETTING: In vitro fertilization-ET unit. PATIENT(S): Forty-one treatment cycles in 22 patients with known cervical stenosis. In all patients previous transcervical ET had been either extremely difficult or impossible. INTERVENTION(S): Cervical dilatation under general anesthesia during an ovum pick-up session, 48 hours before transcervical ET. MAIN OUTCOME MEASURE(S): Ease of ET procedure and clinical pregnancy rate (PR). RESULT(S): Cervical dilatation was performed in 41 IVF-ET cycles and resulted in easier transcervical ET in 39 cycles, but only one clinical and one extrauterine pregnancy. CONCLUSION(S): Cervical dilatation during the ovum pick-up session leads to easier ET in patients with cervical stenosis, but PRs after this procedure are very low.

Adult↗
PubMed1997

Comparison of transmyometrial and transcervical embryo transfer in patients with previously failed in vitro fertilization-embryo transfer cycles and/or cervical stenosis.

OBJECTIVE: To compare ultrasound-guided transmyometrial and transcervical ET in patients with cervical stenosis or in patients who failed to conceive after at least three previous IVF-ET cycles. DESIGN: A prospective, randomized study. SETTING: The IVF-ET Unit at Serlin Maternity Hospital. PATIENT(S): Forty patients undergoing IVF-ET. INTERVENTION(S): Ultrasound-guided transvaginal, transmyometrial, versus transcervical ET. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate. RESULT(S): Transmyometrial ET was performed in 20 patients and resulted in one clinical pregnancy. Transcervical ET, performed in another 20 similar patients, resulted in three clinical pregnancies. CONCLUSION(S): No benefit was derived by electing transmyometrial ET in preference to transcervical ET in patients who had failed to conceive in previous cycles.

Adult↗
PubMed1997

Elevated levels of interleukin-6 in the follicular fluid at the time of oocyte retrieval for in vitro fertilization may predict the development of early-form ovarian hyperstimulation syndrome.

OBJECTIVE: To determine the possible predictive role of interleukin-2 (IL-2), IL-6, and tumor necrosis factor (TNF-alpha) in the development of early-form ovarian hyperstimulation syndrome (OHSS). DESIGN: Nested, case-control study. SETTING: An IVF unit, university-based program. PATIENT(S): Follicular fluid (FF) was obtained from 322 high responders. The study group and control group comprised 10 patients who developed early, severe OHSS and 10 who did not develop OHSS, respectively. An additional control group included 10 low-responder patients who did not develop OHSS. INTERVENTION(S): Ovulation induction with hMG combined with GnRH analogue. MAIN OUTCOME MEASURE(S): All FF samples were tested for IL-2, IL-6, and TNF-alpha. The patient's serum was tested for mean E2 and P concentrations. RESULT(S): Interleukin-6 levels in the FF were significantly higher in the OHSS group than in the two control groups, whereas no differences were found in IL-2 and TNF-alpha. No correlation was found between the FF concentrations of IL-2, IL-6, and TNF-alpha and the mean serum E2 levels or the number of oocytes retrieved. CONCLUSION(S): Elevated levels of IL-6 in the preovulatory FF at the time of oocyte retrieval for IVF may predict the development of early-form OHSS in high responders.

Adult↗