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Biomedical subjects

J Balasch

Publications and source records attributed to J Balasch.

At least 19 recordsLinked to original sources
PubMed1992

Monoclonal enzyme immunoassay measurement of estradiol and progesterone receptors in in vitro fertilization and spontaneous cycles.

So far, the few studies performed on endometrial steroid receptors in in vitro fertilization (IVF) cycles have been carried out by the dextran-coated charcoal (DCC) method. Despite widespread efforts to standardize the DCC assay method, assay results still vary and thus, data obtained in IVF cycles are controversial. In the present article, late luteal estradiol (E2) and progesterone (P) receptor (R) levels were measured by a new monoclonal enzyme immunoassay (EIA) method in endometrial samples obtained from 21 patients in an IVF program who received no embryo transfer (ET) after ovarian stimulation with follicle-stimulating hormone/human menopausal gonadotrophin/human chorionic gonadotrophin under pituitary suppression with buserelin. Plasma levels of E2, P and prolactin (PRL) were measured in three blood samples collected in the midluteal phase. Results were compared with those obtained in a control group of 21 spontaneous cycles. E2, P and PRL were significantly higher in stimulated than in spontaneous cycles. The level of E2R was decreased in endometrium in IVF stimulated cycles, but PR remained unchanged.

Adult↗
PubMed1992

The comparison of two gonadotropin-releasing hormone agonists in an in vitro fertilization program.

OBJECTIVE: To compare two gonadotropin-releasing hormone agonists (GnRH-a), buserelin acetate and leuprolide acetate [LA], used in combination with gonadotropins in ovarian stimulation for in vitro fertilization (IVF). DESIGN: Randomized prospective study. SETTING: Assisted Reproduction Unit of the Hospital Clínic i Provincial in Barcelona. PATIENTS: Thirty-five pairs of IVF patients who were matched on age, indication, and number of attempts. These women were randomized to receive either buserelin acetate plus gonadotropins (group B) or LA plus gonadotropins (group L). MAIN OUTCOME MEASURES: Luteolysis, ovarian response, and IVF outcome. RESULTS: The mean time for total ovarian arrest and the total dose of gonadotropins and estradiol levels on the day of human chorionic gonadotropin administration were similar in the two groups of patients. The number of follicles punctured, the number of oocytes retrieved, and the percentage of mature oocytes in group L were significantly higher. The number of embryos suitable for replacement and cryopreservation was higher in group L compared with group B approaching statistical significance. CONCLUSION: Our results warrant further studies to compare different GnRH-a as therapeutic tools in IVF.

Adult↗
PubMed1992

Transvaginal intratubal insemination, ectopic pregnancy and treatment by single-dose parenteral methotrexate.

We report a case of a woman with ectopic pregnancy with fetal cardiac activity after ovulation induction and transvaginal intratubal insemination by tactile sensation. The patient was successfully treated by single-dose methotrexate (MTX) (77 mg or 50 mg/m2 given intramuscularly). Control hysterosalpingograms showed no tubal patency on the involved side. Potential advantages and hazards of transvaginal intratubal insemination and single-dose MTX for ectopic pregnancy are discussed.

Adult↗
PubMed1992

Results of routine syphilitic and human immunodeficiency virus (HIV) serology in infertility.

While it has been accepted practice to screen women undergoing infertility evaluation for syphilis, there are few data in the literature regarding the seroprevalence of human immunodeficiency virus (HIV) infection in infertile patients despite the increasing number of HIV-positive women. In the present study, six out of 2137 infertility patients were seropositive for syphilis (0.28%) and four out of 791 were HIV positive (0.5%). All four women with HIV antibodies had negative tests for syphilis and none of them related any risk factor for HIV infection on their initial visit. The 0.5% sero-positivity rate found in our study warrants routine HIV testing in infertile patients.

Adult↗
PubMed1992

The usefulness of endometrial biopsy for luteal phase evaluation in infertility.

To assess the usefulness of the late luteal phase endometrial biopsy in infertility, we evaluated a total of 1492 biopsies performed in 1055 patients. Of these women, 699 underwent one biopsy during spontaneous ovulatory cycles, 288 had two, 57 had three, nine had four, and five biopsies were done in two patients. As controls we included 45 fertile women who were requesting contraception. We analysed histological dating of the endometrium and its abnormality rates in first and successive biopsy specimens, as well as the association of the pregnancy outcome with the endometrial patterns and treatment for luteal phase deficiency (LPD). Our results show firstly that diagnosis of LPD in both infertile and fertile women represents only a chance event; secondly, histological endometrial adequacy or inadequacy in the cycle of conception or in previous cycles is not related to the outcome of pregnancy in infertile patients. Finally, treatment of LPD does not improve pregnancy outcome in infertile women. Thus, luteal phase evaluation by histological dating of the endometrium is not worthwhile.

Adolescent↗
PubMed1992

Pituitary-ovarian suppression by the standard and half-doses of D-Trp-6-luteinizing hormone-releasing hormone depot.

A total of 20 women with regular menstrual cycles normal ovulatory function were randomized to receive 3.75 mg or 1.87 mg of D-Trp-6-luteinizing hormone-releasing hormone (LHRH) in microcapsules either in the early follicular phase (day 2) or during the mid-luteal phase (day 21) of the menstrual cycle. Pituitary--ovarian function was studied by sequential plasma measurements of oestradiol, follicle stimulating hormone, luteinizing hormone and progesterone. Our results show that the full, standard dose (3.75 mg) of D-Trp-6-LHRH depot and the half-dose (1.87 mg) were equally effective in their desensitizing action, and that desensitization occurs more rapidly with early follicular phase administration of the analogue.

Adult↗
PubMed1992

Infertility factors and pregnancy outcome in women above age 35.

Infertility factors and pregnancy outcome were investigated in 65 infertile couples in which the female partner was over 35 years of age (Group 1). The results were compared with those obtained in a control group of couples of which the woman was aged less than 35 years (Group 2). A complete infertility evaluation, including laparoscopy, was performed in all couples. In Group 1, the commonest was tubal factor (35.4%), significantly lower than in Group 2 (20%) (p less than 0.05). Ovulatory factor was present in 6.1% of women in Group 1 and in 15.4% of patients in Group 2 (p less than 0.02). The overall pregnancy rates in Groups 1 and 2 were 37% and 45%, respectively (p = 0.37). There was a significantly higher incidence of first-trimester abortion in Group 1 (33.5%) than in Group 2 (10.3%) (p less than 0.05%).

Adult↗
PubMed1991

Lupus anticoagulant as a marker of autoimmunity in recurrent pregnancy loss; a case report.

We present a patient with primary antiphospholipid syndrome, as defined by nine pregnancy losses, the presence of lupus anticoagulant (LAC), and the absence of clinical signs and symptoms of autoimmunity. A successful pregnancy was achieved by treatment with low-dose prednisone (15 mg daily) and aspirin (100 mg daily). The patient was followed-up throughout her two last pregnancies and a 6 months postpartum period. Our data indicate that LAC serves as a marker of disease in women with previous pregnancy wastages, and that aspirin-prednisone therapy is beneficial in carefully selected patients.

Abortion, Habitual↗
PubMed1991

Influence of various acute stressors on the activity of adult male rats in a holeboard and in the forced swim test.

The effects of various acute stressors on the activity of adult male rats in a holeboard and in the forced swim test were studied. When tested immediately or 24 h after 1 h exposure to noise, restraint in tubes or tail shock, no changes in either defecation rate or activity in the holeboard were observed. In contrast, immediately after 1 h immobilization in wood-boards, a reduction of the number of areas crossed and the number of head-dips was found. The inhibitory effect of immobilization on head-dips persisted 24 h later. The behavior of the rats in the forced swim test was classified into three categories: struggling, mild swim and immobility. The changes in behavior were critically dependent on the type of stressor, and more specifically on its intensity, that was evaluated with three different physiological parameters (serum prolactin, corticosterone and glucose levels). Thus, if tested immediately after stress, noise did not alter the response of the rats, restraint in tubes and tail shock-reduced immobility, and the latter stressor increased mild swim. In the second experiment, immobilization in wood-boards reduced struggling. Twenty-four hours after stress, noise, restraint in tubes or tail shock were without effect, but immobilized rats showed increased immobility and reduced mild swim activity. The present data clearly indicate that behavior of rats in a holeboard and in a forced swim situation are not related, and that acute stress could have a differential effect on the various categories of behavior in a forced swim situation.

Animals↗
PubMed1991

Prevalence of human immunodeficiency virus in an infertile population.

OBJECTIVE: To assess the prevalence of human immunodeficiency virus (HIV) antibody in infertility. DESIGN: Prospective cross-sectional blind study. SETTING: An infertility clinic in Barcelona. PATIENTS: Three hundred thirty-five consecutive patients (308 infertile women and 27 spontaneous recurrent aborters) were seen between January 1989 and May 1990. MAIN OUTCOME MEASURE: Human immunodeficiency virus serostatus. RESULTS: The rate of seropositivity in the group of patients studied was 0.3% (95% confidence interval 0% to 0.9%). CONCLUSION: Further studies are desirable to establish the value of routine HIV testing in infertility patients as a population of women actively seeking pregnancy.

Adult↗
PubMed1991

Diethylstilbestrol-induced müllerian abnormalities, septate uterus, genital tuberculosis and twin pregnancy with term delivery after in-vitro fertilization.

We report a case of a twin pregnancy at term obtained after five multiple embryo transfers in a patient who presented diethylstilbestrol (DES)-associated cervical and uterine structural abnormalities, a septate uterus and bilateral tuberculous salpingitis. The suitability of in-vitro fertilization/embryo transfer in DES-exposed women is discussed.

Adult↗
PubMed1991

Hormonal and histological evaluation of the luteal phase after combined GnRH-agonist/gonadotrophin treatment for superovulation and luteal phase support in in-vitro fertilization.

A hormonal and histological study of the luteal phase was performed in 21 stimulated in-vitro fertilization (IVF) patients not undergoing embryo transfer. Ovarian stimulation was carried out with gonadotrophins [follicle stimulating hormone (FSH) + human menopausal gonadotrophin (HMG)] under pituitary suppression with buserelin. Ovulation was induced with 5000 IU human chorionic gonadotrophin (HCG) and additional doses of 5000, 2500 and 2500 IU were given on the day of follicular aspiration, and 2 and 5 days later respectively, to support the luteal phase. Supraphysiological levels of oestradiol (E2) and progesterone in plasma were found in the midluteal phase of all women, while prolactin was in the normal range. An endometrial biopsy taken in the late luteal phase was normal in 90.5% (19/21) of patients, most of them (15/19, 79%) having E2 greater than 1500 pg/ml on the day of HCG. Conversely, both patients with defective endometrial biopsies had E2 levels less than 1500 pg/ml.

Adult↗
PubMed1991

The 'primary' antiphospholipid syndrome: antiphospholipid antibody pattern and clinical features of a series of 23 patients.

Twenty-three patients with the 'primary' antiphospholipid syndrome were studied over 2-6 years. Twenty-two (96%) had antiphospholipid antibodies detected by ELISA (87% had antibodies to thromboplastin and 70% to cardiolipin), and 18 out of the 21 tested patients (86%) had lupus anticoagulant activity by coagulative assays. Mean age of the cohort was 29.9 years and the sex ratio (female:male) 4.75:1. Eleven patients presented 18 venous and/or arterial thrombosis and 13 had 25 foetal losses (84% occurred during the second and third trimester). Other clinical features were migraine, livedo reticularis, and epilepsy. Three patients had relatives with systemic lupus erythematosus. Thrombocytopaenia was seen in 33%, antinuclear antibodies in low or moderate titre in 30%, and haemolytic anaemia in 13%. During the follow-up, two patients presented recurrent thrombosis despite anticoagulant therapy, one of them dying because of recurrent pulmonary thromboembolism. Four patients achieved successful term pregnancies after treatment with aspirin and a further patient after treatment with aspirin and low dose prednisolone. No patient developed systemic lupus erythematosus or any other definable connective tissue disease. The 'primary' antiphospholipid syndrome may exist as a distinct clinical entity and all younger patients presenting with thrombotic events, foetal losses and/or thrombocytopaenia, without any evidence of a well defined disease, should be tested for antiphospholipid antibodies in order to rule out this syndrome.

Adult↗
PubMed1990

Early follicular phase follicle-stimulating hormone treatment of endometrial luteal phase deficiency.

Fifteen infertile women with inadequate luteal phase, histologically documented in at least two separate cycles, and normal midluteal plasma levels of progesterone (greater than or equal to 10 ng/mL), estradiol (70 to 300 pg/mL), and prolactin (less than 20 ng/mL) received "pure" follicle-stimulating hormone (pFSH), 150 IU intramuscularly, for 4 days (days 1 to 4 of the cycle). The endometrial defect was corrected in 7 of the 15 (46.7%) patients during the first treated cycle. Hormonal levels were similar in control and treatment cycles. Two of 5 patients with no additional infertility factors except luteal phase deficiency (LPD) became pregnant and carried to term singleton pregnancies. In 5 additional infertile patients with normal luteal function as assessed by endometrial histological study (2 cycles) and hormone measurements (first study cycle), a third biopsy was performed in a consecutive cycle under pFSH administration. In no case was the normal secretory pattern impaired. It is concluded that (1) some forms of LPD may be successfully treated by early follicular pFSH therapy and (2) pFSH does not alter the normal endometrial secretory pattern.

Adult↗
PubMed1990

Antiphospholipid antibodies in unselected patients with repeated abortion.

We have studied, prospectively, the incidence of several antiphospholipid antibodies (lupus anticoagulant, anticardiolipin, anti-phosphatidylserine, anti-phosphatidic acid, anti-phosphatidylinositol and anti-thromboplastin antibodies) in 65 consecutive patients with two or more (range 2-8, mean 3.1) abortions. Lupus anticoagulant activity was detected in seven (10.7%) patients and all of them exhibited other antiphospholipid antibodies. Of the previous pregnancies in these seven women, 88% had ended in spontaneous abortion. Four of them achieved pregnancy after low-dose aspirin therapy was started, and carried successfully to term. It is concluded that antiphospholipid antibodies, namely lupus anticoagulant, should be routinely screened in the recurrent spontaneous aborter.

Abortion, Habitual↗
PubMed1990

Ovarian steroid hormones and endometrial response.

As a bioassay of the steroidogenic function of the corpus luteum, endometrial biopsy has been proposed as the most efficient way of diagnosing corpus luteum insufficiency. However, analysis of our data on luteal phase evaluation in infertility shows that most cases (86%) of endometrial luteal inadequacy are associated with normal hormone (progesterone, estradiol) stimulation. This apparent lack of endometrial progestational response may be explained by an end organ defect localized to the endometrial steroid receptors.

Abortion, Habitual↗
PubMed1989

Further data against HLA sharing in couples with recurrent spontaneous abortion.

Class I human leucocyte antigens (HLA-A, -B) and class II (HLA-DR) antigens were determined in 57 couples with primary recurrent abortions of unknown origin and in 57 normal fertile couples. No difference between abortion and control fertile couples was observed regarding HLA sharing. Analysis of 10 series in the literature, including our own results, is against the concept that compatibility in determinants of the major histocompatibility complex has a major role in recurrent spontaneous abortion (RSA).

Abortion, Habitual↗