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Biomedical subjects

J H Check

Publications and source records attributed to J H Check.

At least 181 records · Page 10Linked to original sources
PubMed1993

Origin of first trimester 17-hydroxyprogesterone levels as determined in pregnancies by donor oocyte fertilization.

The study presented herein measured 17-hydroxyprogesterone (17-OHP) levels in women with ovarian failure who conceived by transfer of embryos which resulted from donor oocytes fertilization. A significant increase in 17-OHP during the first trimester was seen compared to baseline nonpregnant levels. The 17-OHP levels increased from a baseline average of 47.7 +/- 9.7 ng/dl to a first-trimester average of 175.8 +/- 80.6 ng/dl in the donor oocytes recipients vs. 63.0 +/- 38.0 ng/dl baseline to 295.0 +/- 83.9 ng/dl first-trimester in the control group. Initially these data may appear to contradict previous findings demonstrating a lack of 17-OHP secretion by the first-trimester placenta. However, by comparing the first-trimester progesterone (P) levels of normal pregnant women, and also measuring 17-OHP in patients with natural menopause and surgical menopause given exogenous P we concluded the following about the origin of first-trimester sera 17-OHP levels: hydroxylation of P to 17-OHP by the ovaries, some secretion by the first trimester placenta; and also increased adrenal conversion of P to 17-OHP. Contributing to the total serum 17-OHP level is the fact that there is cross-reactivity with P to 17-OHP.

17-alpha-Hydroxyprogesterone↗
PubMed1993

Fetal outcome of triplets in a Turner mosaic.

Pregnancies are now being reported resulting from fertilization of donor oocytes in women with ovarian failure. A case of triplets in a Turner mosaic is reported herein following transfers of embryos resulting from donor oocytes. She had previously demonstrated a normal sized uterine cavity by hysterosalpingography. The opinion from our group was that she should consider selective reduction but a perinatology consult thought she should have a favorable outcome. Her pregnancy was complicated by polyhydramnios, pre-term labor, and eventual fetal demise at 25 and 27 weeks of all three fetuses. Natural pregnancies in patients with gonadal dysgenesis have been reported in at least 138 patients. Many aborted or had stillbirths and this high rate of fetal mortality has been ascribed to chromosomal abnormalities. The continued use of donor oocytes will provide data to evaluate whether there will continue to be a higher spontaneous abortion rate and complications in second and third trimesters in Turner's pregnancies even in single pregnancies. The outcome of this case can at least be provided to future gonadal dysgenesis patients with triplets to help them in their decision as to whether or not to have selective reduction.

Adult↗
PubMed1993

The effects of multiple gestation and selective reduction on fetal outcome.

A group of 32 women with at least 3 or more viable fetuses by sonography at approximately 8 weeks gestation were given the option of selective reduction. They were advised that this was a relatively new procedure but heretofore in a small series was not associated with a significant increase in fetal demise. Only 7 of 32 women chose this option. six of these 7 had triplets reduced to twins, 1 woman had quadruplets reduced to twins. Thirteen of 14 viable babies were successfully delivered at a mean of 36.8 weeks gestation; 2 of 7 (28.6%) delivered before 37 weeks. In contrast, 7 of 25 (24%) not having reduction lost all babies (6 triplets, 1 quadruplet). Four other women lost at least 1 of their gestations (total of 5 babies). Pre-term deliveries (< 37 weeks) occurred in 16 of 18 (88.8%) patients delivering at least 1 live baby, with a mean of 33.7 weeks gestation. Thus the high rate of total fetal loss and prematurity for multiple gestation and the low pregnancy wastage and pre-term delivery rate following selective reduction might make the latter a reasonable therapeutic option to patients interested in having the best chance of delivering healthy viable babies.

Abortion, Therapeutic↗
PubMed1993

A conservative treatment protocol with human menopausal gonadotropins aimed at reducing multiple births.

In multicenter studies involving 3002 courses of human menopausal gonadotropins (hMG) therapy in 1286 patients, 20% of the patients who delivered had multiple gestations; 75% of these were twins and 25% were triplets or higher parity. Our stimulation regimen is very conservative in that we 1) try to allow a female with LPD and regular cycles but not reaching a mature follicle to first select her dominant follicle and wait until the serum E2 reaches approximately 100 pg/mL then add the hMG. With anovulatory women we frequently begin with only 75 IU hMG and gradually increase the hMG dosage. Using this approach we have usually attained at least a 70% pregnancy rate in six months. A study was performed to see if this conservative approach resulted in a decreased multiple birth rate percentage especially with triplets or more. The study was to evaluate the outcome of 241 consecutive pregnancies in which hMG was the sole therapy. There were 203 with one gestation and 38 with multiples. Twins--32; triplets--6. Thus 15% (38/241) had multiple births; six of 38 (15%) of the multiples had triplets or more. Though our multiple birth rate and especially higher parity rate appears to be lower than average no statistical difference was found. Thus even with conservative use of hMG multiple births cannot be easily avoided.

Estradiol↗
PubMed1993

Effects of Percoll discontinuous density gradients vs SpermPrep II vs Sephadex G-50 gel filtration on semen parameters.

There are various methods of separating sperm from seminal plasma for subsequent intrauterine insemination (IUI) and for in vitro fertilization (IVF). The purpose of the present study was to assess and compare semen parameters following Sephadex, Percoll and SpermPrep II separation techniques. The SpermPrep II is also a Sephadex preparation but uses a different bead size, less Sephadex and is a quicker method. The specimens (n = 16) were initially evaluated for count, (C; x 10(6)/ml)% motility (MO), grade of motility (GR; %), and HOS test scores. Each specimen was then divided into 3 equal aliquots and prepared as follows: 1) layered onto a modified Percoll discontinuous density gradient column; 2) processed using SpermPrep II; and 3) filtered through a Sephadex gel filtration column (G-50). The results show all 3 treatments yielded lower (p < 0.01) counts as compared to control values but no differences were noted among them. Percoll and SpermPrep II increased MO (p < 0.01) where Sephadex reduced it (p = NS). Percoll and SpermPrep II improved the % of best quality sperm but not Sephadex with SpermPrep II being higher than Percoll. There were increases (p < 0.05) in HOS values in all experimental treatments with SpermPrep II being the best. However, this study did not show as many males with HOS scores below 50% as noted in other studies. Finally, Percoll and SpermPrep II seem equally effective methods for producing high quality sperm for IUI or IVF although SpermPrep II is quite faster.

Centrifugation, Density Gradient↗
PubMed1993

Comparison of hCG versus GnRH analog for releasing oocytes following ultra low-dose gonadotropin stimulation.

Previous data have suggested there is a higher incidence of luteinized unruptured follicle (LUF) syndrome (defined as failure to release any oocyte as determined by sonography) in gonadotropin-treated patients following human chorionic gonadotropin (hCG) versus the gonadotropin releasing hormone agonist (GnRH-a) leuprolide acetate. The present study was designed to determine if an ultra low-dose gonadotropin regimen, designed not to raise the serum estradiol level much above normal for non-stimulated cycles, might result in a decrease in LUF following hCG treatment, and even reduce the rate to that seen following leuprolide acetate. The hypothesis tested was that the higher estradiol levels might suppress the pre-ovulatory follicle stimulating hormone (FSH) surge which, in turn, would inhibit plasmin production, thus preventing detachment of the oocyte from the follicle. The data did show a reduced rate of LUF incidence with either hCG or leuprolide acetate in ultra low-dose human menopausal gonadotropin-(hMG-) treated patients compared to data from previous studies with conventional hMG/hCG therapy. Pregnancy rates were also similar following hCG or leuprolide acetate for release in low-dose hMG-treated patients. Preliminary data show that leuprolide acetate is superior to hCG for causing oocyte release when stimulation is with low-dose purified FSH, and possibly also that low-dose hMG is superior to low-dose purified FSH for producing superior pregnancy rates.

Adult↗
PubMed1993

Embryo transfer technique as a cause of ectopic pregnancy in in vitro fertilization.

A randomized prospective study was performed to compare the effects of a midfundal versus a deep fundal transfer technique on subsequent intrauterine and ectopic PRs after IVF. The clinical intra-uterine PR after the deep fundal transfer was 12.4% per cycle with a 1.5% ectopic PR (which represented 12.2% of the pregnancies) versus 14.2% IUPs per cycle with a 0.4% ectopic rate (representing 3% of pregnancies) after midfundal transfers. The midfundal technique appears superior to deep fundal procedures because of a lower percentage of EPs without any sacrifice of the intrauterine PR after midfundal transfers.

Embryo Transfer↗
PubMed1993

CA 125 levels measured in different phases of the menstrual cycle in screening for endometriosis.

OBJECTIVE: To examine variations in CA 125 levels during the three phases of the menstrual cycle in women with and without endometriosis. METHODS: One hundred infertile women were studied prospectively. CA 125 levels were measured during menses and during the follicular and luteal phases before diagnostic laparoscopy. Subjects were divided into four groups: no evidence of endometriosis (35 women), stage I endometriosis (30 women), stage II endometriosis (21 women), and stages III and IV endometriosis (14 women). RESULTS: In the endometriosis groups, there was a significant difference in the mean CA 125 levels drawn at menses and those drawn in the follicular phase. In patients with severe endometriosis, there was also a difference in the mean CA 125 levels drawn at menses and in the luteal phase. This finding led to the development of a screening test based on the ratio of CA 125 levels at menses to levels in the follicular phase. The test based on this ratio (with a cutoff of 1.5) had a sensitivity of 62.5% and specificity of 75%, compared with a sensitivity of 26.8% and specificity of 100% for the test based on a single CA 125 level drawn at menses (with a cutoff of 35 U/mL). CONCLUSIONS: CA 125 levels during menses are elevated compared with those during the follicular phase in patients with endometriosis. Screening tests based on the relationship of multiple CA 125 levels taken throughout the menstrual cycle were more sensitive for detection of endometriosis than tests based on a single CA 125 level.

Adult↗
PubMed1993

Successful delivery after age 50: a report of two cases as a result of oocyte donation.

BACKGROUND: Because of donor oocyte programs, women who previously were considered too old to successfully achieve conception and delivery can now bear children. To our knowledge, there have been no previous reports of pregnancy outcome in women over age 50 who conceived using donor oocytes. This study presents the pregnancy and delivery data on two women who delivered at age 52. CASES: Case 1 was a 51-year-old woman, gravida 3, para 3, whose three children had been conceived with her first husband more than 20 years previously. She had remarried 18 years before presentation and had been actively trying to conceive for the last 7 years. She was diagnosed as being in menopause based on elevated gonadotropins, amenorrhea, and failure to have progesterone-withdrawal menses. She conceived on her first embryo transfer cycle with embryos derived from donor oocytes and fertilized by her husband's sperm (oocytes were donated by a woman who was undergoing retrieval for in vitro fertilization). During pregnancy she remained healthy, but had uterine prolapse at 20 weeks. She delivered a normal healthy male at 40.5 weeks; cesarean was performed because of a presumptive diagnosis of fetal distress after 3 hours of labor, when monitoring revealed fetal heart decelerations. Case 2 was also a 51-year-old woman, gravida 6, para 4, who wished to conceive with her second husband's sperm through the donor oocyte program. She had amenorrhea of 2 years' duration and elevated gonadotropins. Conception occurred after fertilization of a donor oocyte by her husband's sperm. She had an uneventful pregnancy, but labor was induced at 38 weeks' gestation given the supposed high-risk status of this age group. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. CONCLUSION: Theoretically, the risks of pregnancy complications in older patients are magnified given the aging maternal cardiovascular system, which may predispose these women to placental insufficiency. These first two cases of donor oocyte pregnancies in women over age 50 found no maternal or fetal age-related complications. We hope these reports will encourage all researchers to share their findings so that prospective patients can make better, more informed decisions as to whether they want to participate in donor oocyte programs.

Embryo Transfer↗
PubMed1992

A guanine nucleotide-binding regulatory protein in human sperm mediates acrosomal exocytosis induced by the human zona pellucida.

Guanine nucleotide-binding regulatory proteins play key intermediary roles in regulating zona pellucida-mediated acrosomal exocytosis in mouse and bull sperm. Since human sperm possess a Gi-like protein and undergo the acrosome reaction in response to the human zona pellucida, we investigated whether this G protein plays a regulatory role in this exocytotic process. Zonae pellucidae isolated from eggs that had been inseminated but had shown no signs of fertilization after retrieval for in vitro fertilization and embryo transfer were pooled into groups of greater than or equal to 50 in order to reduce variability in biological responses due to the possible presence of ZP that had undergone modifications associated with the polyspermy block. Acid-solubilized zonae pellucidae were incubated with capacitated sperm, and the sperm then assessed for the acrosome reaction using both the P. sativum agglutinin and chlortetracycline fluorescence assays; both assays gave similar results. Sperm incubated with solubilized zonae pellucidae at a final concentration of 2, 4, or 6 ZP/microliter underwent acrosomal exocytosis to a similar extent as compared with A-23187. Sperm were incubated with 1 microgram/ml pertussis toxin during capacitation to functionally inactivate the Gi-like protein. Pertussis toxin treatment of sperm did not affect sperm motility and the ability of the cells to bind to structurally intact zonae pellucidae. Pertussis toxin, however, completely inhibited the percentage acrosome reactions induced by solubilized zonae pellucidae. By contrast, the A-23187-induced acrosome reaction was insensitive to PT treatment. Pertussis toxin inhibition of the zona pellucida-induced acrosome reaction occurred in a concentration-dependent manner with maximal effects observed at 100 ng/ml PT.(ABSTRACT TRUNCATED AT 250 WORDS)

Acrosome↗
PubMed1992

Comparison of pregnancy rates following in vitro fertilization-embryo transfer between the donors and the recipients in a donor oocyte program.

Our in vitro fertilization (IVF) program provides a unique opportunity to evaluate influences of hormonal milieu on pregnancy outcome, by using a shared pool of oocytes obtained by donors (in exchange for financial assistance). The study presented herein evaluated 38 retrieval cycles (28 oocyte donors/22 recipients). No difference in mean number of embryos transferred was seen (2.7 in the donors vs 2.8 in the recipients). However, a statistically significant difference was seen in the pregnancy rates per retrieval (10.5% donors vs 29% recipients) and per transfer (4/35, 11.1%, vs 11/34, 32.3%). Abortion rates were similar (25% donor, 27.2% recipients). These data suggest that other reports of higher pregnancy rates from donor oocyte programs may not be due exclusively to better-quality oocytes. Possibly a negative effect of hyperstimulation or adverse endometrial environment of the donor (possible chronic endometritis) may explain these data.

Abortion, Spontaneous↗
PubMed1992

Effect of swim-up, Percoll and Sephadex sperm separation methods on the hypo-osmotic swelling test.

The separation of spermatozoa from the seminal plasma is required to prepare the spermatozoa for intrauterine insemination, in-vitro fertilization and sex selection. This study evaluated the effects of sperm preparation techniques on the functional integrity of the sperm membrane, as measured by the hypo-osmotic swelling test (HOS). Thirty-four semen specimens obtained from the male partner of infertile couples were evaluated. A semen analysis and HOS test were performed on each specimen. The remainder of the specimen was divided into three equal aliquots, the first prepared using Percoll, the second using a swim-up method and the third using a Sephadex column. After the preparation, a semen analysis and HOS test was performed on each aliquot. The mean and standard deviation for the HOS test was 72.9 +/- 8.5% initially, 71.2 +/- 13.1 after Percoll, 75.2 +/- 15.1 after swim-up and 62.4 +/- 14.5 after Sephadex. Analysis of variance showed that the mean HOS score was the same after Percoll and swim-up as it was initially but significantly lower after preparation with Sephadex. There was also a higher proportion of abnormal semen specimens (HOS less than 50%) after preparation with Sephadex than after the other preparation methods. We recommend the use of the HOS test as part of a screening panel for sperm separation.

Cell Membrane↗
PubMed1992

Comparison of short versus long-term leuprolide acetate--human menopausal gonadotrophin hyperstimulation in in-vitro fertilization patients.

The use of leuprolide acetate for at least 10 days beginning in the mid-luteal phase prior to initiating human menopausal gonadotrophin (HMG) stimulation has been fairly successful in preventing cancellations for premature luteinization and allowing retrieval of more oocytes, which in turn provide more embryos for cryopreservation. However, it is theoretically possible that the long-term use of leuprolide may have some adverse effect on either pregnancy rates or on mean survival after cryopreservation and thawing. Recently, a short 3 day regimen of a gonadotrophin-releasing hormone agonist, buserelin effectively prevented premature luteinization during HMG stimulation. The present study indicated that substitution of a 3 day course of leuprolide acetate also effectively prevented premature luteinization but was less expensive, required statistically fewer ampoules of HMG and much less leuprolide.

Adult↗
PubMed1992

The effect of follicle maturing drugs on side of ovulation in successive cycles.

Our previous study has demonstrated that ovulation in unstimulated cycles is random with an equal likelihood of ipsilateral or contralateral ovulation occurring in the following cycle. This study evaluated women taking ovulation-inducing drugs to see if the side of ovulation in the preceding cycle has an influence on the side of ovulation in the succeeding cycle. Ovulatory patterns in consecutive pairs of cycles in anovulatory women treated with ovulation-inducing drugs were evaluated through sonographic studies of follicular maturation. The results demonstrated that when unilateral ovulation occurred, there was an equal likelihood of ipsilateral or contralateral ovulation in the succeeding cycle. However, ovulation-inducing drugs increase the incidence of bilateral or multiple ovulation.

Clomiphene↗
PubMed1992

A randomized prospective study comparing pregnancy rates following clomiphene citrate and human menopausal gonadotrophin therapy.

The anti-oestrogenic effect of clomiphene citrate causes an increased rate of associated cervical factor problems. Theoretically, it may also cause an adverse effect on the endometrium. The hostile mucus may be completely or partially corrected by the use of additional oestrogen after stopping clomiphene, or by intrauterine insemination (IUI). The prospective randomized study presented here was designed to determine whether a higher pregnancy rate might be achieved using human menopausal gonadotrophin (HMG) compared to clomiphene citrate. Thirty-seven women treated with clomiphene citrate for 165 cycles were compared to 33 treated with HMG for 179 cycles. A pregnancy was achieved in 81.1% of clomiphene-treated women (18.2%/cycle) versus 72.7% (13.3% per cycle) of HMG-treated women. The abortion rates of 13.3 and 12.5% respectively, were similar. The data suggest no adverse effect of clomiphene compared to HMG as far as pregnancy rates are concerned. IUI seems to be an effective means of treating cervical factor problems induced by clomiphene.

Clomiphene↗
PubMed1992

An evaluation of couples with failure of fertilization in vitro.

Attempts at in-vitro fertilization (IVF) may be used as a method of evaluating whether in a given couple, the inability of the sperm to fertilize the oocyte may be the cause of infertility. We evaluated all IVF patients in our practice who had at least one cycle with no fertilization to determine how often this was an isolated event or was repeated in multiple cycles; would poor semen quality be found as a frequent cause; and how well can a donor sperm or oocyte 'probe' uncover which of the two is the problem? Of 35 couples who used their own gametes exclusively, 30 (85.7%) had at least one cycle with zero fertilization; 42.5% of those failing to fertilize in cycle 1 and 35% of those failing in cycle 2 had a subnormal concentration of motile spermatozoa, morphology or hypo-osmotic swelling test scores. The pregnancy rate per cycle with both husband's and wife's gametes was only 2.3% (3/130), but was 8.3% for those using donor spermatozoa (3/36) and 18.2% (2/11) for donor oocytes. Thus, failing to fertilize in a given cycle does not necessarily predict failure to fertilize in a subsequent cycle, but does predict a poor fertility outcome unless donor gametes are used.

Adult↗
PubMed1992

Analysis of serum human chorionic gonadotrophin levels in normal singleton, multiple and abnormal pregnancies.

Some researchers claim that first trimester beta-human chorionic gonadotrophin (beta HCG) levels have a constant doubling time; others suggest doubling time increases as pregnancy progresses. This study was designed to settle the debate by analysing a large series of serial serum beta HCG determinations from 143 pregnant women whose day of ovulation was precisely determined. Regression analysis was used to evaluate linear and quadratic models for the relationship of HCG with time in normal pregnancies. Doubling times were calculated for three time periods: 10-20 days post-ovulation (period 1); 21-30 days post-ovulation (period 2); greater than 30 days post-ovulation (period 3). Analysis of variance was used to compare the mean doubling time by time period and type of pregnancy (single, multiple, spontaneous abortion and ectopic). The analysis showed that a quadratic model best described the pattern of HCG rise in early normal pregnancy. Furthermore, for normal pregnancies, the mean doubling time increased significantly with advancing gestational age between time periods 1 and 2 and between periods 2 and 3. The mean doubling time was the same for single and multiple pregnancies. The doubling time was prolonged with ectopic pregnancy in period 1; and for aborters reaching ultrasound at 8 weeks, the doubling time was normal in period 1 but prolonged in period 2. Careful observation of the doubling time may aid clinicians in the detection of abnormal pregnancies.

Abortion, Spontaneous↗