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Biomedical subjects

J B Lessing

Publications and source records attributed to J B Lessing.

At least 163 records · Page 9Linked to original sources
PubMed1994

Uterine rupture at 33 weeks' gestation subsequent to hysteroscopic uterine perforation.

A 40-year-old woman underwent operative hysteroscopy for suspected submucosal myoma, during which the uterine fundus was perforated. At laparotomy the perforation site was sutured. In a subsequent pregnancy she had a sudden onset of abdominal pain. Laparotomy revealed a uterine rupture with a partially protruding placenta. A healthy newborn was delivered by a low-segment cesarean section.

Adult↗
PubMed1994

Outcome of donor versus husband insemination in couples with unexplained infertility treated by in vitro fertilization and embryo transfer.

OBJECTIVE: To examine the IVF-ET outcome of couples with unexplained infertility treated by husband versus donor sperm. DESIGN: A retrospective analysis of the IVF-ET outcome of couples with unexplained infertility treated by either husband or donor sperm and in a subgroup of patients treated simultaneously by husband and donor sperm. SETTING: IVF Unit, Serlin Maternity Hospital, Tel Aviv, Israel. PATIENTS: Couples diagnosed as having unexplained infertility underwent IVF at our Unit; included were 96 couples treated by husband insemination (group A), 27 couples who received donor insemination because of azoospermia (group B), and 8 couples who sought donor insemination after having previously failed IVF (group C). RESULTS: No statistically significant difference was found between groups A and B regarding age of the females, duration of infertility, number of IVF cycles, fertilization rate, number of ETs, and pregnancy rate. Oocytes collected in group C were subdivided further into two groups: 45 were incubated with husband sperm and 46 were incubated with donor sperm. Fertilization rates were 46.6% and 50%, respectively. One pregnancy occurred. CONCLUSION: In couples with unexplained infertility who had undergone IVF-ET with husband insemination, the fertilization and pregnancy rates were similar to those of couples who were treated by donor sperm.

Adult↗
PubMed1994

Endometrial receptivity in the light of modern assisted reproductive technologies.

OBJECTIVE: To review the different aspects of endometrial receptivity as it is reflected in the various modalities of modern assisted reproductive technologies. DESIGN: The importance of endometrial receptivity and the factors that affect it such as the type of treatment, age, and ovarian function are discussed in this review. Novel approaches to determine receptivity such as Doppler ultrasonography and molecular biology are considered; assisted hatching is also discussed. CONCLUSIONS: Endometrial receptivity cannot, as yet, be directly assessed. Circumstantial evidence suggests that receptivity declines with age, is adversely affected by controlled ovarian hyperstimulation, and is possibly affected by ovarian function. Future studies will have to focus on molecular cell biology and physiology of the endometrium.

Aging↗
PubMed1994

Circulating autoimmune antibodies may be responsible for implantation failure in in vitro fertilization.

OBJECTIVE: To investigate the role of autoimmune factors as a possible cause for implantation failure as manifested by chemical pregnancy after IVF and ET. DESIGN: Anticardiolipin, anti-double-stranded DNA (dsDNA), antinuclear antibody, lupus anticoagulant, and rheumatoid factor serum levels were examined in patients with chemical pregnancies and in matched controls. SETTING: An IVF unit, university-based IVF program. PATIENTS: The study group included 21 patients who had one or more chemical pregnancies and no deliveries. The control group consisted of 21 patients who had conceived and delivered after IVF-ET treatment, without any history of fetal wastage, matched for age, type and duration of infertility, and number of previous IVF cycles. RESULTS: The incidence of circulating autoimmune antibodies in the study group was 33.3% (7/21). Three patients (14.2%) were positive for anticardiolipin, two (9.5%) were positive for antidsDNA, one (4.7%) for antinuclear factor, and one (4.7%) for rheumatoid factor. Autoimmune antibodies were not detected in any of the control group. CONCLUSION: Autoimmunity may play a role in implantation failure in IVF-ET. Circulating autoimmune antibody screening is therefore recommended after chemical pregnancy.

Adult↗
PubMed1994

Retrograde ejaculation.

Retrograde ejaculation is an uncommon cause of male infertility. It should be suspected in any case of azoospermia, and might be congenital, acquired or idiopathic in origin. When pharmacological attempts to restore anterograde ejaculation fail, it is suggested that spermatozoa should be recovered from post-ejaculation urine to be applied in one of the modern techniques of assisted reproduction. The successful recovery of viable spermatozoa from the urine is dependent upon careful regulation of pH and osmolarity of the urine at the time of ejaculation. Careful handling of the retrieved spermatozoa enables isolation of sperm cells with good quality for insemination of ovulated oocytes (in vivo) or retrieved oocytes (in vitro).

Ejaculation↗
PubMed1994

Analysis of the fourth to eighth in-vitro fertilization treatments after three previously failed attempts.

The fourth to eighth in-vitro fertilization cycles of patients who had previously reached the stage of embryo transfer without conceiving were evaluated. A total of 426 cycles were received in women ranging in age from 25 to 46 years. The patients underwent from four (169 women) to eight (27 women) treatment cycles, using four established protocols for induction of ovulation. There was no statistical difference in the age, aetiology, duration of infertility and distribution of the various protocols among the analysed groups. The pregnancy rates in cycles 4-8 were 19.5, 15.4, 10.8, 16.7 and 11.8% respectively (mean 16.2% per cycle) and were not statistically different. There was no trend of reduced success when the number of attempts increased. The overall live birth rate was 12.4%. The pregnancy rate was comparable between age groups. No protocol proved to be significantly superior to others when pregnancy rate per embryo transfer was assessed. We concluded that the pregnancy rate in cycles 4-8 was stable, including those of patients up to 42 years of age. Continuous efforts are therefore advised for at least up to this age and number of attempts. A change of an induction protocol in subsequent cycles, after repeated failure, is not statistically justified.

Adult↗
PubMed1994

Infected endometriotic cysts secondary to oocyte aspiration for in-vitro fertilization.

Two weeks after oocyte aspiration for in-vitro fertilization, a 38-year-old woman with a history of endometriosis presented with abdominal pain and fever. On exploratory laparotomy, both ovaries were enlarged and contained seropurulent fluid. Unilateral oophorectomy and drainage of the other ovary were performed. Pathological examination revealed infected endometriotic cysts.

Adult↗
PubMed1994

Management of bilateral nonpalpable testes: laparoscopic diagnosis and orchidectomy.

Bilateral nonpalpable testes in the adult human are associated with testicular malignancy, infertility and other abnormalities. Investigation for localization of the testes is mandatory, and either orchidopexy or orchidectomy is indicated. Laparoscopy was performed in an azoospermic male with bilateral unpalpable testes. A diagnosis of intra-abdominal testes was made and bilateral orchidectomy was performed. Laparoscopy is recommended for diagnosis and precise localization, as well as for orchidectomy, thus avoiding open abdominal operation in cases of intra-abdominal testes.

Adult↗
PubMed1993

Endometrial receptivity: the age-related decline in pregnancy rates and the effect of ovarian function.

OBJECTIVE: To assess the effect of age and ovarian function on endometrial receptivity. DESIGN: Retrospective comparison between standard IVF and ovum donation in younger and older patients (< 40 and > or = 40 years of age, respectively). PATIENTS: In standard IVF, there were 325 transfer cycles in older patients and 1,103 transfer cycles in younger ones. In ovum donation, there were 236 transfer cycles in older patients and 222 cycles in younger women. Ovum recipients were then redivided into two groups, according to ovarian function: ovarian failure group (219 cycles) and eugonadal group (239 cycles) in patients with retained ovarian function as manifested by regular menstrual cycles and normal gonadotropins. RESULTS: In standard IVF, clinical pregnancy rates (PRs) were significantly lower in older patients (12.9% versus 23.8%, respectively). In ovum donation, clinical PRs were also significantly lower in older patients (21.2% versus 29.3%, respectively). A significantly higher clinical PR (31.1%) was noted in patients with ovarian failure, compared with both eugonadal patients undergoing ovum donation (19.7%) and standard IVF patients (21.3%). CONCLUSIONS: The decrease in endometrial receptivity with age is responsible for the higher rate of implantation failure in older women. Patients with nonfunctioning ovaries do better than eugonadal patients in ovum donation programs.

Adult↗
PubMed1993

When multiple gestational sacs are seen on ultrasound, 'take-home baby' rate improves with in-vitro fertilization.

During a 5.5 year period, 309 clinical pregnancies were recorded in our in-vitro fertilization (IVF) unit. A single gestational sac was identified by early ultrasonography in 233 patients, while in 76 others, multiple gestational sacs were noted. 'Take-home baby' rate, in patients in whom multiple sacs were observed, was higher than that in patients with a single sac. Delivery of at least one live newborn occurred in only 73.8% of patients with a single sac, compared with 93.3% and 91.7% in patients with two and three gestational sacs, respectively. Conversely, the early and late abortion rates were decreased in patients with multiple sacs. Embryonic implantation rate, defined as the ratio of gestational sacs observed to the number of embryos transferred, was found to be a valuable prognostic factor for a live delivery, and can serve as a tool in assaying the prognosis of pregnancy detected by early sonography. The observation of a higher 'take-home baby' rate in cases with multiple sacs identified by ultrasound and with higher embryonic implantation rate, might be the result of a better embryo quality and/or improved uterine receptivity, promoted by a favourable hormonal milieu or by as yet unknown endometrial factors.

Abortion, Spontaneous↗
PubMed1993

Repeated aspiration of ovarian follicles and early corpus luteum cysts in an in-vitro fertilization programme reduces the risk of ovarian hyperstimulation syndrome in high responders.

A retrospective analysis of ovarian hyperstimulation syndrome in high responders undergoing in-vitro fertilization (IVF) is presented. High responders were defined as having > 20 follicles and serum oestradiol > 3000 pg/ml after treatment with human menopausal gonadotrophin. Of the initial 30 IVF cycles in high responders, 23 developed a moderate-to-severe ovarian hyperstimulation syndrome (76.7%). Subsequently, 15 other IVF cycles in high responders were combined with a repeated aspiration of ovarian follicles and corpus luteum cysts just prior to embryo transfer. Only three patients (20%) developed a moderate ovarian hyperstimulation syndrome (P = 0.0004). We conclude that repeated follicular aspiration is safe and results in a significant reduction in the incidence and severity of this condition in high responders undergoing IVF.

Adult↗
PubMed1993

Nifedipine versus ritodrine for suppression of preterm labour.

OBJECTIVE: To compare the efficacy of tocolysis with specific regimens of nifedipine and ritodrine. Maternal side effects and neonatal outcome also were evaluated. DESIGN: A prospective, randomised trial. SUBJECTS: Seventy-one women, including 11 with twin pregnancies, who had uterine contractions and observed cervical changes. MAIN OUTCOME MEASURES: Prolongation of pregnancy for 48 h, seven days and until 36 weeks of pregnancy were evaluated for each treatment. Maternal side effects and haemodynamic changes were compared, as well as neonatal outcomes. RESULTS: Delivery was delayed for 48 h, seven days, and until the 36th week of gestation in 83%, 67%, and 50%, respectively, of women in the nifedipine group, compared with 77%, 63% and 43%, respectively, of women in the ritodrine group (no significant difference). Maternal side effects were significantly less common in the ritodrine group (no significant difference). Maternal side effects were significantly less common in the nifedipine group (27%) than in the ritodrine group (77%) (P < 0.001). The neonatal outcome was similar in the two groups. The fall in mean arterial and diastolic blood pressure, and the rise in maternal heart rate were significantly greater in the women who received ritodrine compared with those treated with nifedipine. CONCLUSIONS: Nifedipine is as effective as ritodrine in suppressing preterm labour. Its use is associated with less frequent side effects.

Adult↗
PubMed1993

A second thought on second look laparotomy.

Between 1982 and 1987, 43 patients with epithelial ovarian carcinoma, identified as International Federation of Gynaecology and Obstetrics Stages I-IV, underwent second-look laparotomy as a part of their treatment protocol. Twenty-nine patients (67%) had no evidence of residual disease, five (11.6%) had residual disease < or = 1 cm, and nine patients (20%) had residual disease > or = 1 cm at re-exploration. Persistent disease at the second operation was positively correlated with the initial clinical stage, and negatively correlated with the extent of the original cytoreductive surgery. Fifteen of 29 patients with negative findings (52%) developed recurrent disease within two years. All recurrences were limited to the abdominal cavity only. Three and five years survival, for the patients with negative findings, was 62% and 48% respectively. No documented benefit to the patients could be demonstrated by adopting second-look laparotomy as a routine procedure in the management of patients with epithelial ovarian carcinoma. In view of our data, as well as that of others, such operations cannot be considered a valuable routine procedure. At this point, second-look laparotomy may have a role in evaluating the efficacy of a post-surgical new chemotherapy treatment regimen.

Adult↗