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Biomedical subjects

J H Check

Publications and source records attributed to J H Check.

At least 199 records · Page 11Linked to original sources
PubMed1992

Successful delivery of twins in a woman with a unicornuate uterus.

The presence of a unicornuate uterus is a rare congenital condition which represents only 1-2% of uterovaginal anomalies. Previous reports have demonstrated an increase in the number of cases of primary infertility, pregnancy loss and preterm labor associated with the unicornuate uterus. Herein, we present a case in which a patient conceived following a thawed frozen embryo transfer. She had been given the option of selective reduction, because of the high risk associated with this pregnancy, but refused and her pregnancy successfully continued to 35 weeks and delivery of twins.

Adult↗
PubMed1992

Serum progesterone and 17-hydroxyprogesterone in the diagnosis of ectopic pregnancies and the value of progesterone replacement in intrauterine pregnancies when serum progesterone levels are low.

The corpus luteum function was evaluated in patients with surgically confirmed ectopic pregnancy (EP) in a multicenter study. In addition, the minimal threshold of serum progesterone (P) concentration required for salvaging intrauterine pregnancies (IUP) was also examined. Results show that single P or 17-OHP measurements are not diagnostic for EP, since mean P levels in EP were similar to those with spontaneous abortion though significantly lower than those in controls. 17-OHP levels in EP overlapped in 50% with IUP, and the mean levels were significantly lower only at 6-7 weeks. The 17-OHP levels when compared to hCG supports the view that corpus luteum defect is primary. In IUP, P levels < 8 ng/ml still were associated with viable (60%) pregnancy; thus no minimal threshold could be established.

17-alpha-Hydroxyprogesterone↗
PubMed1992

Effect of the short follicular phase on subsequent conception.

The present study was designed to evaluate whether there is a lower pregnancy rate in women with short follicular phases, as defined by attaining the peak estradiol level before day 11 of the cycle. Thirty-two early ovulators with mature follicles were matched with 32 women being treated for similar infertility problems, who ovulated between days 12-20. Pregnancies were achieved by 9 (28.1%) of the early ovulators compared to 19 (59.4%) of the controls. The mean number of cycles required to achieve a pregnancy was 8.6 in the early ovulators compared to 6.4 in the controls. Using the clinical life table method, the 12-month pregnancy rate was estimated to be 31.4% for early ovulators as compared to 66.3% for controls. Whether lengthening the follicular phase by drug treatment will improve pregnancy rates remains to be seen.

Adult↗
PubMed1992

Comparison of first trimester serum estradiol levels in aborters versus nonaborters during maintenance of normal progesterone levels.

This study was designed to measure the average serum estradiol (E2) levels in the first trimester for women whose serum progesterone (P) levels were carefully maintained at normal levels by the use of exogenous P, and to compare the mean serum E2 levels in women who aborted with those in women who did not. The study group consisted of 94 pregnant women supported with exogenous natural P therapy from the luteal phase through the first trimester. Beginning at week 5, and continuing through the first trimester, the mean serum E2 levels for nonaborters were significantly higher than those for aborters.

Abortion, Habitual↗
PubMed1992

Multiple follicles in an unstimulated cycle despite elevated gonadotropins in a perimenopausal female.

The presence of estrogen deficiency associated with elevated gonadotropins usually signifies menopause. However, there have been a few case reports of ovulation and pregnancy despite hypergonadotropic hypogonadism. Described herein is a case of a perimenopausal woman who not only failed to ovulate in response to clomiphene citrate therapy but also failed to generate a level of serum estradiol (E2) over 30 pg/ml. Following pharmacologic suppression of her elevated gonadotropins with ethinyl estradiol, she spontaneously formed 3 mature follicles, and her serum E2 climbed to 868 pg/ml. This case suggests that some perimenopausal women may respond to their own endogenous elevated gonadotropins as if they are taking ovulation-inducing drugs and may, as a consequence, form multiple follicles.

Adult↗
PubMed1992

The effect of follicle-maturing drugs on mid-cycle androgen levels in women with normal baseline levels.

Theoretically, clomiphene citrate or human menopausal gonadotropins might have a higher chance of inducing pregnancy per cycle were it not for the concomitant rise in androgens induced by these follicle-maturing drugs. In the present study, mid-cycle androgen levels were evaluated in anovulatory women with normal baseline early follicular levels who were treated with either clomiphene citrate or human menopausal gonadotropins. The only mid-cycle androgen to rise above the normal range was androstenedione. However, no negative effects of elevated androstenedione levels on pregnancy rates were apparent. Thus, at least in women with normal baseline androgen levels, the use of follicle-maturing drugs does not appear to cause a rise in androgen levels except for androstenedione, and the rise in androstenedione at mid-cycle appears to have no adverse effect on conception.

Androgens↗
PubMed1991

Influence of endometrial thickness and echo patterns on pregnancy rates during in vitro fertilization.

Previous data has suggested that improved PRs were seen in women with increased endometrial thickness as determined by sonography before oocyte retrieval. The hyperstimulation protocol used was CC-hMG. The study presented herein was initiated to evaluate if a similar trend was evident in women whose hyperstimulation protocol included the long LA-hMG therapy. We also demonstrated an improved PR in women with greater endometrial thickness, but in general, the endometrium was thicker in the pregnant women treated with the gonadotropin-releasing hormone agonist than in those treated with CC.

Embryo Transfer↗
PubMed1991

Premature luteinization: treatment and incidence in natural cycles.

The incidence of premature luteinization was evaluated in 400 women with a history of infertility (greater than or equal to 18 months). After its diagnosis, this condition was treated with ovulation-inducing drugs in the early follicular phase in an attempt to accelerate follicular maturation before the luteinizing hormone (LH) surge. Premature luteinization was diagnosed if serum progesterone levels greater than 1.5 ng/ml were associated with an LH surge before the serum oestradiol level reached 200 pg/ml and before the follicle was mature. Fifty-two of 400 (13%) women demonstrated premature luteinization in two consecutive cycles. Fourteen of 52 (27%) women corrected the problem with a clomiphene citrate regimen, as compared with 32 of 38 (75%) treated with HMG and HCG; conception rates were 83 and 50%, respectively, for the patients who responded to the two regimens. Overall, regimens utilized in this study resulted in a 58% pregnancy rate in 6 months.

Female↗
PubMed1991

Correlation of serum progestagen-associated endometrial protein levels with endometrial biopsies serum steroid levels and therapy for luteal phase defects.

The progestagen-associated endometrial protein (PEP) level rises from the early to the late luteal phase. A study was performed in infertile women where late luteal phase endometrial biopsies and serum PEP levels were obtained. The objective of the study was to evaluate the correlation between the PEP levels and the endometrial biopsies and to determine if subnormal PEP levels could be improved by the same therapies used to correct endometrial defects. There was a poor correlation between PEP levels and endometrial biopsies (r = 0.17). Similarly, there was no significant correlation between PEP levels and levels of the following hormones: mid- and late-luteal phase progesterone (P) (r = 0.186 and 0.282 respectively), mid-luteal phase 17-hydroxyprogesterone (17-OHP) (r = 0.139) and mid-luteal phase oestradiol (r = 0.135). Furthermore, there was no correlation between PEP levels and the dosage of progesterone used in therapy (r = 0.07). There were no statistically significant differences in PEP values (U/ml) depending on whether any fertility drug was taken. Thus our data suggest that progesterone may only have a permissive role, with some other factor(s) controlling the actual rise and fall of PEP.

17-alpha-Hydroxyprogesterone↗
PubMed1991

Ipsilateral versus contralateral ovary selection of dominant follicle in succeeding cycle.

There is still confusion as to whether ovulation in a succeeding cycle is a random event or is more likely to occur at the ipsilateral or contralateral ovary. Both histologic and sonographic data support alternating ovulation. Some ultrasound studies have suggested that ipsilateral ovulation is more likely in succeeding cycles, and another found right-sided ovulation to be more common. Because many of the studies are based upon small numbers, we initiated a large study to determine the more likely side of ovulation. Furthermore, the present investigation attempted to confirm biochemically the true existence of the dominant follicle by demonstrating appropriate serum estradiol levels. Evaluation of natural cycles (286 pairs) demonstrated 52.4% ipsilateral ovulation and 47.6% contralateral ovulation. Right-sided ovulation occurred in 54.5% of cycles. Our data suggest that the side of ovulation in successive cycles is not influenced by the side of ovulation in the preceding cycle.

Female↗
PubMed1991

Extreme elevation of serum CA-125 in two women with severe endometriosis: case report.

Two women with elevated preoperative serum CA-125 levels were found to have extensive endometriosis - one, the highest level related to endometriosis ever reported in the English literature. Endometriosis was found to be etiologic as seen by the prompt reduction in serum CA-125 levels following surgical treatment limited to endometriosis. Thus, a very high CA-125 level does not necessarily forebode ovarian malignancy.

Acute Disease↗
PubMed1991

Relationship of small-for-dates sac size to crown-rump length and spontaneous abortion in patients with a known date of ovulation.

Spontaneous abortion after established sonographic viability is rare. This study prospectively evaluated 39 late first-trimester abortions after fetal viability was established by ultrasound. The average crown-rump length measurement and mean sac diameter in this group were determined and compared with predicted values based on known conception dates, and the discrepancy between actual and predicted measurements was noted. The same calculations were then made on 39 prospectively matched non-aborting controls. We also determined the difference between sac size and crown-rump length in both groups. Significant differences were found for all three measures. Small-for-dates sac size and small-for-dates crown-rump length were defined as having a discrepancy score greater than 1 standard deviation (SD) above normal. Small-for-dates sac/crown-rump length was defined as having a discrepancy score less than 1 SD below normal. A high percentage of aborters was correctly predicted by a mean sac diameter (82%) or crown-rump length (77%) that was greater than +1 SD, with few false positives (12.8 and 5.1%, respectively). The cutoff for differences of sac minus crown-rump length measurements (10.1 mm) was less sensitive (56%), but just as specific (82%). When both the mean sac diameter and crown-rump length were smaller than expected (according to known date of ovulation), the ability to predict abortion was 71% with few false positives (3.5%).

Abortion, Spontaneous↗