Biomedical subjects

J H Check

Publications and source records attributed to J H Check.

At least 343 records · Page 19Linked to original sources

PubMedDate not supplied

Midcycle steroidal levels after ultra-low-dose pure follicle-stimulating hormone stimulation versus human menopausal gonadotropin stimulation in euestrogenic women with follicular maturation defects.

OBJECTIVE: To compare the midcycle endocrine steroidal variables in 32 infertile women with follicular maturation defects treated with ultra-low-dose pure follicle-stimulating hormone (FSH) or human menopausal gonadotropins (hMG). METHODS: A crossover design was used in which women were randomly assigned to a treatment modality (pure FSH or hMG) in the first cycle, and the alternative treatment was used in the second cycle. In the ultra-low-dose regimen, the dosage began at 1 ampule/day (75 IU) and could increase to a maximum of 1.5 ampules/day. The mean midcycle serum levels determined at the time of peak follicular maturation and before the administration of human chorionic gonadotropin or gonadotropin-releasing hormone for release of oocytes were compared. RESULTS: In the pure FSH cycle, the mean estradiol (E2), progesterone, and luteinizing hormone (LH) levels were 316 +/- 119 pg/mL, 0.6 +/- 0.4 ng/mL, and 23 +/- 22 IU/L, respectively; in the hMG cycle, the mean E2, progesterone, and LH levels were 361 +/- 193 pg/mL, 0.5 +/- 0.4 ng/mL, and 21 +/- 18 IU/L, respectively. CONCLUSION: Ultra-low-dose gonadotropin therapy produces similar midcycle steroidal levels (E2, progesterone, and LH) whether or not LH is present in addition to FSH in the medications used for follicle stimulation.

Clinical Trial↗

PubMedDate not supplied

Prospective study of serum androgen levels stratified by increased or normal serum follicle-stimulating hormone in infertile women with regular menses.

OBJECTIVE: To evaluate serum androgen levels in infertile perimenopausal women who were still euestrogenic and had regular menses. METHODS: We compared 48 women who had early follicular serum follicle-stimulating hormone (FSH) levels of =10 mIU/mL (group 1) with 50 women who had early follicular serum FSH levels of >15 mIU/mL (group 2). RESULTS: No differences were detected between groups 1 and 2 in early follicular mean levels of dehydroepiandrosterone sulfate (DHEAS) (157 versus 167 mg/dL). Mean serum testosterone, free testosterone, and androstenedione levels, however, were significantly lower in the group with higher FSH levels (group 2) than in group 1 (27.6 versus 35.8 ng/dL, 1.3 versus 2.1 pg/mL, and 130 versus 164 ng/dL, respectively; P<0.05). No differences were detected between groups 1 and 2 in the frequency of increased DHEAS, testosterone, free testosterone, or androstenedione levels as well as the frequency of low serum DHEAS levels. The group with FSH levels of >15 mIU/mL, however, had a significantly greater frequency of patients with low levels of testosterone, free testosterone, and androstenedione than did the group with lower FSH levels: 54% versus 33%; 26% versus 10%; and 26% versus 10%, respectively (P<0.05). CONCLUSION: We found no evidence that infertility problems in perimenopausal women are complicated by increasing androgen levels. The mechanism for lower androgen levels is not apparent.

Journal Article↗

PubMedDate not supplied

Efficacy of intrauterine insemination without ovarian hyperstimulation for male or cervical factor in women aged 40 or over.

The efficacy of intrauterine insemination (IUI) for male or cervical factor by age of female partner was determined in a retrospective analysis. Patients who underwent IUI therapy for cervical and/or male factor (n = 281) were classified by age at first IUI cycle: <40 years (n = 232), > or =40 years (n = 49). The indication for IUI was cervical factor if a postcoital test failed to show sperm with good forward progression at time of mature follicle; male factor was diagnosed if the semen analysis demonstrated either low count, low motility, antisperm antibodies, or subnormal hypoosmotic swelling test. Intrauterine insemination was performed in either natural cycles or following ovarian stimulation for the treatment of anovulation or follicular maturation defects. Cumulative probability of ongoing pregnancy (viable at end of first trimester) following 3 cycles of IUI was evaluated. Cumulative probability of ongoing pregnancy following 3 cycles of IUI was 28.2% for the younger group and 0.0% for the older group. The age groups did not differ in terms of infertility history, use of ovarian stimulation, or baseline semen parameters. Thus, the treatment of male and/or cervical factor by IUI is ineffective for women > or =40 years.

Adult↗

PubMedDate not supplied

In vitro fertilization with intracytoplasmic sperm injection is an effective therapy for male factor infertility related to subnormal hypo-osmotic swelling test scores.

The aim of the study was to determine if intracytoplasmic sperm injection (ICSI) would be an effective therapy for mates with subnormal hypo-osmotic swelling test (HOST) scores, a condition known to prevent implantation of embryos despite allowing normal fertilization and embryo formation. Couples in whom the male partner had a HOST score of <50% and failed to achieve a pregnancy despite at least 3 cycles of intrauterine insemination with chymotrypsin-galactose-treated sperm were treated with in vitro fertilization (IVF) with ICSI. The clinical and viable pregnancy rates were 49.0% and 45.3% (n = 53). The implantation rate was 27.1%. These data thus demonstrate that ICSI is an effective therapy for infertile couples in whom the male partner has a subnormal hypo-osmotic swelling (HOS) score. Previous studies using conventional IVF without ICSI when HOS was subnormal found normal fertilization rates but a marked reduction in pregnancy and implantation rates. The very acceptable pregnancy and implantation rates demonstrated in this study with ICSI is consistent with the hypothesis that the defect associated with sperm that have subnormal HOST scores is not related to the single spermatozoon that is responsible for fertilizing the oocyte but may be related to a toxic factor associated with the supernumerary sperm attached to the zona pellucida.

Adult↗

PubMedDate not supplied

Comparison of various therapies for the luteinized unruptured follicle syndrome.

A study was initiated to evaluate the prevalence of the luteinized unruptured follicle (LUF) syndrome in a group of 355 women with infertility. The diagnosis was established by carefully observing daily sonograms along with measuring estradiol, progesterone, and luteinizing hormone (LH) levels. Two distinct types of LUF syndrome were identified: mature follicle LUF, in which release of an ovum was not demonstrated after a follicle attained maturity (serum estradiol reached 200 pg/mL while serum progesterone remained less than 2.5 ng/mL), versus premature luteinization LUF, where the serum progesterone increased above 2.5 ng/mL before follicular maturation was attained. The use of either hCG alone or hCG in combination with hMG in a single injection at the time of follicular maturation successfully corrected mature follicle LUF in 21 of 46 patients (46%), whereas ovulation-inducing drugs plus hCG or hCG and hMG corrected LUF in 24 of 25 patients (96%). Clomiphene citrate proved inferior to hMG in that it corrected LUF in 3 of 25 patients (12%) versus 12 of 22 patients (95%) who had undergone hMG therapy. Thus, hMG-hCG therapy is the most efficacious for mature follicle LUF, but because release can occur spontaneously on occasion by an appropriately timed single gonadotropin injection, one could offer the less costly options first. For premature luteinization, speeding up follicular maturation with gonadotropin therapy is effective. Upon failure of this technique, the more costly endogenous gonadotropin suppression followed by hMG can be employed.

Adult↗

PubMedDate not supplied

Influence of serum progesterone levels at the time of hCG on the release of ova during hMG cycles.

A study was designed to monitor release of ova by sonography in hMG-treated patients following hCG and to determine if failure to release ova correlates with critically low or high progesterone levels. This was a retrospective study of 292 consecutive patients treated with hMG. The requirement for treatment was that hCG be given when at least one follicle attained a 17-mm diameter with a serum estradiol level of at least 200 pg/mL per mature follicle. If the serum progesterone assay was greater than or equal to 1.8 ng/mL, then hCG would be given as long as there was at least one dominant follicle and a serum estradiol level greater than 200 pg/mL. The patients were divided into four groups for study based on the progesterone level at the time of hCG administration. There were no statistically significant differences in the ability to achieve ova release whether serum progesterone was very low or close to 2 ng/mL when hCG was given. The rise in the progesterone level prior to ovulation has been proposed to enhance egg release. However, the data presented herein do not support the necessity for a critical level of serum progesterone at the time of hCG injection in hMG-treated women.

Anovulation↗

PubMedDate not supplied

Evidence that difference in size of fraternal twins may originate during early gestation: a case report.

We describe a woman who conceived by in vitro fertilization (IVF) and embryo transfer (ET). Transvaginal ultrasound demonstrated at least 1 week's difference in size of twin gestations from 1 month post-transfer of embryos to delivery. Differences in sac size, crown-rump length, and gestational growth are discussed, as are implications of ultrasound in early pregnancy.

Adult↗

PubMedDate not supplied

Late luteal phase progestogen-dependent endometrial protein levels in women with in-phase biopsies--can low levels predict a subfertile group?

A group of infertile women who had luteal phase defects (LPD), but in whom follicular maturation was deemed normal, were treated with progesterone until the endometrial biopsy was corrected. At the time the corrected biopsy was obtained, serum was taken and the progestogen-dependent endometrial protein (PEP) concentration was determined. Serum PEP concentration in patients who successfully conceived was 102.5 +/- 62.6% units/mL, while PEP concentrations in patients who failed to conceive were 57.9 +/- 34.4% (P = .003). In patients whose PEP value was more than two standard deviations below the corresponding mean control PEP, pregnancy was achieved in 6/17 (35.3%). The conception rate was significantly greater (25/35, 71.4%) in patients with values higher than this. Thus, the PEP concentration in serum may identify a group of patients with persistent LPD despite apparent normalization of the morphology of late secretory phase endometrium, which might explain some cases of cryptic, unexplained infertility.

Biopsy↗

PubMedDate not supplied

Effect of treating antibody-coated sperm with chymotrypsin on pregnancy rates following IUI as compared to outcome of IVF/ICSI.

Males with 100% of their sperm coated by antisperm antibody have a very small chance of achieving a pregnancy by intercourse or conventional intrauterine insemination (IUI). A previous study found that treatment of the sperm with the protein digestive enzyme chymotrypsin improved the efficacy of IUI. The present study was designed to corroborate or refute this previous study and compare efficacy to IVF with ICSI. This time the subjects were an even more difficult group with 100% of the sperm coated by autoantibodies.

Antibodies↗

PubMedDate not supplied

Ovulation-inducing drugs versus specific mucus therapy for cervical factor.

Ovulation disorder as a possible cause of a cervical factor problem was evaluated in 30 patients with poor postcoital tests. The diagnosis of an ovulatory defect was based on follicular maturation studies included in serial pelvic ultrasonography and serial assays of serum estradiol and progesterone. Patients were divided into three groups with cervical factor presumably due to (1) immature follicular development, (2) premature luteinization, and (3) pure cervical factor. A higher pregnancy rate was achieved in the group with pure cervical factor when the therapy was directed exclusively toward improving the cervical mucus. However, a significant improvement in pregnancy rate was observed when therapy was aimed at correcting both abnormal follicular maturation and the cervical mucus problem. Combined use of pelvic sonography and quantitation of serum estradiol and progesterone allow the clinician to select the treatment for cervical factor that is most likely to achieve successful pregnancy.

Cervix Mucus↗

PubMedDate not supplied

17-Hydroxyprogesterone level as a marker for corpus luteum function in aborters versus nonaborters.

Weekly serum levels of 17-hydroxyprogesterone (17-OHP) levels and serum progesterone (P) levels were measured in 378 pregnant women. Normal levels of 17-OHP were established in women taking ovulation-inducing drugs (OVID) versus those conceiving on normal cycles. Weekly levels of 17-OHP were measured in women who aborted and were compared with the established norms. The levels of 17-OHP in aborters were lower than in normals for their specific category established in nonaborters. These results suggest that a failing corpus luteum may contribute to some abortions. Careful attention to 17-OHP levels dropping below normal during the first trimester may alert the clinician to the need to increase progesterone exogenously and possibly prevent an abortion.

17-alpha-Hydroxyprogesterone↗

PubMedDate not supplied

An in vivo technique for screening immunologic factors in the etiology of the unexplained poor postcoital test.

A study was designed to determine the incidence and etiology of the unexplained poor postcoital test. An in vivo comparison of sperm penetration by husband's versus donor sperm in the wife's estrogen-stimulated mucus was performed. The 8 of 30 women showing improvement of husband's penetration in mucus (group 1) were treated with high-dose estrogen (HDE) and hMG, and 4/8 conceived. Anti-sperm antibodies (ASA) were insignificant in this group. In group 2, in which donor sperm penetrated but husband's sperm did not, 8 men of 17 were found to have an ASA level over 50% on the sperm surface; 6/8 treated with high-dose methylprednisolone (MP) had an improved postcoital test, and 5 achieved a pregnancy. Two patients with levels under 50% were still treated with MP, and one achieved a pregnancy. In five group-3 couples, positive ASA were found in the cervical mucus of two women; and one woman improved on the postcoital test and conceived following MP therapy. The 30 unexplained poor postcoital tests occurred in 5,000 couples evaluated. In general, those patients considered to have significant clinical antibody had levels over 50%. Because side effects of MP may be severe, and positive ASA may be found in normal donors, it is important to use a comparison penetration test to help determine if treatment with corticosteroids seems reasonable.

Cervix Mucus↗

PubMedDate not supplied

Opposite responses to the addition of leuprolide acetate to human menopausal gonadotropin therapy in two perimenopausal women.

Leuprolide acetate was used to suppress the endogenous gonadotropins in order to prevent premature luteinization in two women under ovulation induction therapy. One patient had previously developed premature luteinization with clomiphene citrate, but consistently produced only one mature follicle with hMG therapy. However, when leuprolide acetate was started prior to hMG during an attempt for in vitro fertilization, it failed to stimulate even a mild rise in her serum estradiol. The other patient, who was not able to make a mature follicle with hMG alone because of premature luteinization, was enabled to make mature follicles with leuprolide therapy alone (without hMG). The exact mechanism for these totally different responses to leuprolide acetate in two perimenopausal women is not known.

Adult↗

PubMedDate not supplied

Empirical therapy of the male with clomiphene in couples with unexplained infertility.

Unexplained infertility may be secondary to a cryptic male or female factor. Although most often empirical therapy of the female partner may be attempted, clomiphene has been claimed, after uncontrolled studies, to improve fertility in men with subnormal spermograms. We chose to determine if clomiphene therapy of the male would improve fertility in couples with unexplained infertility despite normal-appearing semen parameters. One hundred husbands were randomized to treatment with clomiphene citrate, 25 mg daily for 25 days with 5 days' rest each month, if their social security numbers ended in an even number or ascorbic acid, 500 mg daily, if ending in an odd number. All female infertility factors had to be meticulously corrected for at least eight cycles for inclusion in the study, along with a minimum of 1 1/2 years' duration of infertility. Within 8 months, 29 of 50 couples (58%) with clomiphene therapy of the male achieved a pregnancy, but only 8 of 50 (16%) with ascorbic acid treatment of the male. There were no appreciable changes in sperm counts, motility, or morphology after either treatment, nor were there any significant differences in semen parameters in those conceiving versus those who did not. Further, improved fertility could not be accounted for by improvement in the hamster ova penetration test. Possibly, clomiphene improves some quality of the sperm that is defective but not measurable by standard androgenologic methods, or it improves some aspect of the seminal plasma. Perhaps, though, the results might be better explained on a psychogenic basis, i.e., clomiphene is a "better" placebo than ascorbic acid.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

Bromocriptine versus progesterone therapy for infertility related to luteal phase defects in hyperprolactinemic patients.

Several anecdotal reports suggested an association of luteal phase defects (LPD) and hyperprolactinemia. Some physicians treat LPD with ovulation-inducing drugs, whereas others recommend progesterone support of the luteal phase. A study was thus initiated to evaluate in cases of LPD associated with hyperprolactinemia which therapy would be more efficacious--bromocriptine or progesterone (P). LPD was divided into two types based on follicle dynamic studies: (1) LPD associated with immature follicles and (2) pure LPD when the follicle was mature. The objective was to determine if P or bromocriptine would be more effective depending on the type of LPD. Randomized therapy with either bromocriptine (BCT) or progesterone vaginal suppositories (PVS) was given to 60 patients with pure LPD (established by endometrial biopsy in the late luteal phase) and similarly randomized therapy was given to 40 women with LPD and immature follicles. The incidence of pregnancies during an 8-month treatment period was as follows: pure LPD--23 of 50 women (77%) treated by PVS versus 5 of 30 women (17%) treated by BCT; LPD associated with immature follicles--3 of 20 women (15%) treated by PVS versus 14 of 20 women (70%) treated by BCT. Those women failing to conceive were now given the alternate therapy for the next 8 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

The treatment of cervical factor with ethinyl estradiol and human menopausal gonadotropins.

Previously we have demonstrated that one can significantly improve the cervical factor in cases that have failed with conventional therapy by employing high doses of estrogen to stimulate the cervical mucus glands. The patients are concomitantly treated with human menopausal gonadotropins to stimulate ovulation, because of endogenous gonadotropin suppression by the estrogen. Monitoring of the hMG is accomplished by pelvic sonography. Unfortunately, the serum estradiol assay cannot also be used because it would measure not only endogenous estradiol but also exogenous estradiol from the conjugated estrogens employed. A modification of this technique is described wherein the estrogen now used is ethinyl estradiol. This estrogen has very little cross-reactivity in the 17-beta-estradiol assay. Thus, both ultrasound and serum estradiol monitoring can be used, resulting in a safer and more effective technique.

Adult↗

PubMedDate not supplied

The efficacy of progesterone in achieving successful pregnancy: I. Prophylactic use during luteal phase in anovulatory women.

We have previously shown that prophylactic supplementation of progesterone beginning in the luteal phase of patients treated with human menopausal gonadotropins (hMG) could reduce the risk of spontaneous abortions. The present study was initiated with 100 patients to evaluate the efficacy of a new progesterone therapeutic regime in patients requiring either hMG or clomiphene citrate. A significantly decreased risk of spontaneous abortion (6% vs. 28%) was seen in 50 patients prophylactically treated with progesterone as compared with 50 control patients. The progesterone regimen was then tried on 566 consecutive patients who were treated and conceived with hMG or clomiphene citrate, and approximately the same risk (6.2% by 20 weeks) was found. This incidence of spontaneous abortion is even less than the accepted risk for the general population.

Abortion, Spontaneous↗

PubMedDate not supplied

The efficacy of progesterone in achieving successful pregnancy: II. In women with pure luteal phase defects.

Controversy still exists as to the proper therapy of luteal phase defects. Some advocate using drugs to improve follicular dynamics, e.g., clomiphene citrate, while others treat luteal phase defects with progesterone. The possibility exists that in some cases the luteal phase defect is secondary to failure to produce a mature follicle, the better drug then being an ovulation-inducing drug, e.g., clomiphene. However, if the follicle is mature, then progesterone may be the best treatment. We defined mature follicle as one between 18 and 24 mm while the serum estradiol (E2) level is over 200 pg/mL. The efficacy of exclusive P therapy was evaluated in 50 women, all with a minimum of 1 1/2 years infertility and with no obvious fertility problems other than luteal phase defect. Seventy percent of the women conceived within 6 months. The abortion rate was 14.7%. The average period of infertility was 2.8 years in the 35 patients who conceived within 6 months. These data suggest that determining the degree of follicular maturation by serum E2 and pelvic sonography plus excluding the luteinized unruptured follicle syndrome by pelvic sonography helps determine the proper therapy for luteal phase defect.

Abortion, Spontaneous↗