Biomedical subjects

J H Check

Publications and source records attributed to J H Check.

At least 19 recordsLinked to original sources

PubMed2006

Successful pregnancy with spontaneous ovulation in a woman with apparent premature ovarian failure who failed to conceive despite four transfers of embryos derived from donated oocytes.

PURPOSE: To show that successful pregnancy is possible in a woman in apparent premature ovarian failure despite a serum follicle stimulating hormone (FSH) > 100 pg/ml. METHODS: The high serum FSH was lowered with ethinyl estradiol. Progesterone (P) supplementation was to be used if ovulation was achieved. RESULTS: Successful ovulation x2 was achieved by using .02 mg ethinyl estradiol. Progesterone vaginal suppositories (200 mg) twice daily were used in the luteal phase. Unfortunately pregnancy was not achieved. The couple elected to try donor oocytes after failing to ovulate on the third cycle. The patient spontaneously ovulated and conceived immediately after failing to become pregnant with four donor-oocyte transfers. CONCLUSIONS: The suspicion was that the graduated dosage of estrogen used for the donor-oocyte cycles suppressed the FSH allowing her to respond to endogenous gonadotropins.

Adult↗

PubMed2006

Moderate or severe depression is uncommon in women seeking infertility therapy according to the beck depression inventory.

PURPOSE: To determine what percentage of infertility patients have depression. METHODS: The Beck Depression Inventory test was given to new infertility patients on a voluntary basis. RESULTS: There were no women with moderate or severe depression. In fact only 10% (3/30) scored mild depression. For those women without or with minimal depression 37% (10/27) conceived on their first cycle vs none (0/3) of those with mild depression. CONCLUSIONS: The numbers with mild depression were too small to make valid conclusions. However, this group had a significantly longer length of infertility. Thus even if a more extensive study shows similar data it may well be that the length of infertility causes only mild depression rather than that depression leads to infertility. However the possibility still exists that even mild depression may to some degree impair success with infertility therapy.

Adult↗

PubMed2006

The diagnosis and treatment of infertility. One person's philosophic approach.

PURPOSE: To justify and at the same time present caveats from one reproductive endocrinologist discussing diagnoses and treatment of various aspects of infertility. METHODS: Sources of basis of knowledge revealed. RESULTS: Sources for chapter writing includes personal experience, publications (predominantly from the author with some additional sources), national and international meetings, reading of various infertility journals and textbooks. CONCLUSIONS: Hopefully, the chapters will be provocative and provide new insights into diagnosis and treatment of infertility. Only areas where the author is most experienced will be discussed. The author promises a non-conventional approach which will lead to lots of controversy.

Congresses as Topic↗

PubMed2006

Pharmacological options in resistent ovary syndrome and premature ovarian failure.

PURPOSE: To present methods of treating women in apparent ovarian failure to allow them to ovulate and conceive. METHODS: Ethinyl estradiol was used to lower elevated serum follicle stimulating hormone (FSH) levels to restore down-regulated FSH receptors on the follicle. Ovulation and pregnancy rates were then determined. Aggressive progesterone (P) therapy in the luteal phase was also used. Lowering elevated serum FSH with gonadotropin releasing hormone agonists was also successful in inducing ovulation in these patients. RESULTS: Several anecdotal studies have demonstrated that ethinyl estradiol therapy can induce ovulation in women in apparent menopause and achieve live births. CONCLUSIONS: The advantage of ethinyl estradiol over other estrogens to induce ovulation in hypergonadotropic women is that it does not cross-react in the assay for serum estradiol and can allow detection of estradiol secretion by the follicle. Thus estrogen therapy is by far the most effective treatment.

Adjuvants, Immunologic↗

PubMed2006

Successful pregnancies from embryos cryopreserved more than ten years: two case reports.

PURPOSE: To determine the efficacy of using embryos cryopreserved more than ten years in a donor embryo program. METHODS: Embryos were cryopreserved using a simplified freezing protocol and then donated for anonymous use after the donor had had a successful pregnancy and was sure she did not want to conceive again. RESULTS: Two women in the donor embryo program transferred embryos that had been cryopreserved longer than ten years. Both patients delivered healthy babies. CONCLUSIONS: Embryos cryopreserved over ten years can result in successful pregnancies.

Adult↗

PubMed2006

Idiopathic orthostatic cyclic edema as a unique etiology for vasomotor flushing in a normal estrogenic woman with normal day 3 follicle stimulating hormone--case report.

PURPOSE: To describe a unique cause and therapy for vasomotor flushing. METHODS: Serum follicle stimulating hormone (FSH) and estradiol, renal and liver function studies and urinalysis were performed as well as a water load test. RESULTS: All laboratory tests were normal but the water load test showed inadequate four-hour urine excretion when she was erect but normal when supine. Complete relief from vasomotor symptoms occurred shortly after treatment with sympathomimetic amines. CONCLUSIONS: Idiopathic orthostatic cyclic edema can cause vasomotor flushing even with normal estrogen and serum FSH, and treatment of the edema state with the drug of choice dextroamphetamine sulfate can effectively control these symptoms.

Adult↗

PubMed2006

The infertile male--diagnosis.

PURPOSE: To discuss a variety of tests used to diagnose the subfertile male and to impart based on clinical experience, reading, and personal research, this editor's view of the relative value of these tests. METHODS: The tests discussed include motile density, sperm morphology, the hypo-osmotic swelling test, antisperm antibodies, sperm chromatin structure assay, DNA integrity tests, reactive oxygen species, sperm penetration assay, sperm-zona pellucida binding tests, sperm creatine kinase activity, plasma membrane mannose-ligand receptor assay, and nuclear morphology. RESULTS: Except when extremely low (< 2.5 x 10(6)/ml) motile density does not identify the subfertile male very well. In contrast to other studies, my group's data suggest that neither low normal morphology by WHO standards or strict criteria identify the subfertile male. The best predictor of male subfertility is the hypo-osmotic swelling test when it is < 50%, which does not result in fertilization failure, but implantation failure. A high percentage of sperm coated by antisperm antibodies is very predictive of fertilization failure. CONCLUSIONS: The physician must be careful when concluding that the male is subfertile or fertile based on standard tests of concentration, motility, and especially morphology.

Humans↗

PubMed2006

Diagnosis and treatment of cervical mucus abnormalities.

PURPOSE: To present causes of cervical mucus problems leading to poor postcoital tests and options for treatment. METHODS: Presentation of mostly original research dealing with diagnosis and treatment of cervical mucus abnormalities. RESULTS: The simplest but least effective therapy was guaifenesin. Short-term use of ethinyl estradiol can be effective. Sometimes the ethinyl estradiol must be used for a longer time period which suppresses follicular maturation, so exogenous gonadotropin must be used to counteract suppression. CONCLUSIONS: In contrast to the conclusions of a meta-analysis by Griffith and Grimes the author believes that performing a postcoital test is a very valuable tool in investigating infertility as long as it is performed at the appropriate time as determined by serum estradiol, progesterone, luteinizing hormone and ultrasound. Clomiphene citrate therapy is the most common etiology for abnormal postcoital tests in the modern era.

Cervix Mucus↗

PubMed2006

A reassessment of comparative pregnancy and implantation rates following embryo transfer in recipients vs their infertile donors also trying to conceive in the background of performing salpingectomy for hydrosalpinx.

PURPOSE: To compare pregnancy and implantation rates in egg donors trying to conceive vs their recipients in the background of salpingectomy for hydrosalpinx prior to IVF-ET. METHODS: A retrospective six-year review of all donor egg cycles where the eggs are supplied by an infertile donor trying to conceive herself was carried out. Salpingectomy for hydrosalpinx was performed prior to IVF-ET. RESULTS: Clinical and delivered pregnancy rates (PRs) following fresh ET were not significantly different in donors vs recipients (60.0%, 45.8% vs 56.8%, 50.8%). Implantation rates were 27.3% vs 32.6%. The respective implantation rates following frozen ET were 13.8% and 14.4%. CONCLUSIONS: In the background of salpingectomy for hydrosalpinges the much higher PRs in recipients vs donors is no longer seen. The trend for higher implantation rates in recipients (about 20%) following fresh but not frozen transfer could still reflect some adverse effect of the controlled ovarian hyperstimulation regimen in a minority of women.

Adult↗

PubMed2006

The treatment of idiopathic edema, a cause of chronic pelvic pain in women: effectively controlled chronic refractory urticaria--case reports.

PURPOSE: To corroborate or refute a previous case report from 20 years ago whether treatment with sympathomimetic amines is effective in controlling chronic urticaria. METHODS: All cases of chronic urticaria in our reproductive endocrinology and infertility practice were identified. All four had been treated with dextroamphetamine sulfate. Quickness and duration of response were then determined. RESULTS: Four women were identified. All showed improvement within the first month. The marked improvement did not dissipate including two patients whose duration of improvement was 8.5 and 13 years, respectively. CONCLUSIONS: Gynecologists should consider idiopathic edema as an etiology when facing chronic pelvic pain and urticaria. Since allergists and dermatologists do not seem to be aware of this treatment option, the initiation of therapy may need to come from the gynecologist.

Chronic Disease↗

PubMed2006

Evaluation of the effect of endometriosis on oocyte quality and endometrial environment by comparison of donor and recipient outcomes following embryo transfer in a shared oocyte program.

PURPOSE: To determine whether endometriosis has an effect on the uterine environment vs the oocyte itself. METHODS: A retrospective study comparing pregnancy outcome of infertile donors sharing oocytes with donor egg recipients according to whether the donor or recipient had endometriosis or not was carried out. RESULTS: There were 26 transfers from donors with endometriosis vs 144 in donors without endometriosis. The clinical and viable PRs and implantation rates were 42.9%, 38.1%, and 29.4% for the endometriosis group vs 60.9%, 51.9%, and 33.2%, respectively, for donors without endometriosis (p = NS). The clinical and viable PRs and implantation rates for donors with endometriosis per ET was 41.2%, 35.3%, and 20.4% vs 50.4%, 48.0% and 28.4% for donors without endometriosis, respectively (p = NS). CONCLUSIONS: Though no significant differences were found in donors with or without endometriosis in any parameters, there did appear to be a trend for lower PRs and implantation rates in women undergoing controlled ovarian hyperstimulation.

Adult↗

PubMed2006

Fertilization by intracytoplasmic sperm injection (ICSI) does not impair subsequent pregnancy outcome following frozen embryo transfer (ET) as determined by a large retrospective analysis.

PURPOSE: To determine if fertilization by intracytoplasmic sperm injection (ICSI) adversely affects pregnancy outcome following frozen embryo transfer (ET). METHODS: Retrospective analysis of frozen ETs where the oocytes were fertilized by conventional insemination vs ICSI was carried out. RESULTS: No difference in pregnancy outcome was found in women up to age 42. There was a non-significant trend for lower pregnancy rates in women age 43 and older. CONCLUSIONS: In the largest series to date by far these data convincingly show that fertilization by ICSI does not impair outcome following frozen ET.

Adult↗

PubMed2005

Sperm may be associated with subfertility independent of oocyte fertilization.

In vitro fertilization-embryo transfer seems to be an effective treatment for unexplained infertility. Some IVF centers always perform intracytoplasmic sperm injection in these circumstances being concerned that fertilization failure may occur by conventional oocyte insemination. However, other IVF centers perform intracytoplasmic sperm injection on half of the oocytes and do conventional insemination on the other half. However, if the group with conventional oocyte insemination had a good fertilization rate, in the future intracytoplasmic sperm injection would not be performed. Other IVF centers would inseminate all the oocytes with conventional insemination and not consider intracytoplasmic sperm injection in the future unless there were poor fertilization rates. The aforementioned studies suggest that prior to considering conventional insemination that as a minimum the simple inexpensive hypo-osmotic swelling test be performed and strong consideration also be given to the sperm stress test and SCSA. Similarly, even though IUI is less risky and costly than IVF-ET, there still is a moderate expense and risk involved, especially when superovulation is used. Thus, consideration for performing these tests should also be given even prior to IUI. This is especially important for subnormal HOST scores where pretreatment of the sperm with the protein digestive enzyme chymotrypsin when preparing the sperm has been demonstrated to markedly improve pregnancy rates.

Abortion, Spontaneous↗

PubMed2005

Miscarriage in the first trimester according to the presence or absence of the progesterone-induced blocking factor at three to five weeks from conception in progesterone supplemented women.

PURPOSE: To determine if the failure to detect the immonomodulatory protein progesterone induced blocking factor (PIBF) at three to five weeks of seemingly normal pregnancies in women supplemented by extra progesterone is associated with a higher miscarriage rate. METHODS: Progesterone-induced blocking factor expression by lymphocytes was measured by an immunocytochemistry technique. The serum beta human chorionic gonadotropin (hCG) and/or ultrasound were also deemed appropriate so that by these criteria there was no evidence of a poor pregnancy. The minimum progesterone dosage was 200 mg twice daily vaginal suppositories. RESULTS: Progesterone-induced blocking factor was detected in 17/39 (43.5%) of pregnant patients at this early time. There were three miscarriages by 12 weeks in this group (17.6%). The miscarriage rate was 6/21 (28.5%) in those where it was not detected. CONCLUSIONS: There was insufficient power to show significance. However there seems to be a trend for higher rates of miscarriage when PIBF is absent so these preliminary data encourage continuation of the study.

Abortion, Spontaneous↗

PubMed2005

Non-homogeneous hyperechogenic echo pattern three days after frozen embryo transfer is associated with lower pregnancy rates.

OBJECTIVE: To evaluate the association of mid-luteal phase echo patterns and pregnancy rates (PRs) following frozen embryo transfer (ET). METHODS: Sonographic evaluation of endometrial echo patterns was performed three days after ET in the first frozen ET cycle of women < 40 years of age who used their own oocytes as well as all donor oocyte recipients. RESULTS: The distribution of echo patterns and clinical PRs were similar in women using their own eggs and women who used donor oocytes; therefore all data was combined. The clinical PR was 49.5% with a hyperechogenic echo pattern vs 38.8% with a non-hyperechogenic pattern, p = .007. CONCLUSION: A larger study of frozen ET and mid-luteal echo pattern now demonstrates conclusions similar to the data from fresh ET in hyperstimulated in vitro fertilization (IVF)-ET cycles in that failure to attain a hyperechogenic echo pattern three days after ET is associated with lower pregnancy rates.

Adult↗

PubMed2005

Frozen embryo transfer outcome according to reason for freezing the embryos.

PURPOSE: To determine if cryopreservation influences pregnancy outcome following transfer. METHODS: Retrospective cohort analyses of frozen embryo transfer (ET) cycles divided into five different categories according to reason for freezing. RESULTS: Frozen embryos remaining as a result of failing to conceive with the previous fresh transfer or those remaining because of cancellation of fresh ET related to inadequate endometrial thickness, result in lower pregnancy rates (PRs). CONCLUSIONS: The fact that embryos never deselected in a group whose fresh ET was canceled because of risk of ovarian hyperstimulation did not have the best results suggests that these oocytes may not be of equal quality to those attained with a more modest response.

Abortion, Spontaneous↗

PubMed2005

Lymphocyte immunotherapy can improve pregnancy outcome following embryo transfer (ET) in patients failing to conceive after two previous ET.

PURPOSE: To determine if lymphocyte immunotherapy (LIT) can improve the outcome after embryo transfer (ET) in women failing to have a live delivery after at least two previous attempts. METHODS: Women failing to deliver a live baby despite at least two previous ET cycles at Cooper Center for IVF irrespective of previous failed ET cycles in other centers were offered the option of lymphocyte immunotherapy prior to their next ET. They were subsequently matched to the very next woman having ET but in whom LIT was never offered or was refused. The matching was based on age, number of previous failed ET cycles, type of ET (fresh or frozen), and serum follicle stimulating hormone (FSH) level. RESULTS: The clinical and viable pregnancy rate was 70.3% and 51.3% for the LIT group vs 45.9% and 16.2% for the controls (p < .05). CONCLUSIONS: Lymphocyte immunotherapy may help improve outcome following ET in women with previous failures. The data should encourage a larger multicenter prospective study.

Adult↗

PubMed2005

Live delivery following transfer of a single frozen-thawed embryo derived from a 42-year-old woman with marked decreased oocyte reserve.

PURPOSE: To determine if live birth is possible in a woman of older reproductive age and who has markedly decreased oocyte reserve following frozen embryo transfer of an oocyte fertilized by intracytoplasmic sperm injection of testicular sperm. METHODS: Ethinyl estradiol followed by ovarian stimulation with gonadotropins was used and a mature follicle was attained. Following oocyte retrieval 34 hours later, intracytoplasmic sperm injection of testicular sperm was performed. The embryo was cryopreserved. RESULTS: A live delivery of a full-term baby ensued. Following subsequent frozen embryo transfer, the baby was diagnosed with Down's syndrome and subsequently died. CONCLUSION: This is the first report of a live delivery following frozen embryo transfer in a woman of advanced reproductive age with marked decreased oocyte reserve.

Adult↗