Biomedical subjects

J H Check

Publications and source records attributed to J H Check.

At least 37 records · Page 2Linked to original sources

PubMed2005

Leukocyte immunotherapy improves live delivery rates following embryo transfer in women with at least two previous failures: a retrospective review.

PURPOSE: To determine whether leukocyte immunotherapy (LIT) could improve live delivery rate following embryo transfer (ET) in women who were not successful in prior attempts. METHODS: Paternal leukocytes were intradermally injected in some women who had failed to have a successful pregnancy following at least two prior ETs approximately two weeks prior to fresh or frozen ET and repeated at the time of the 3rd rising serum beta human chorionic gonadotropin level and at eight weeks if a pregnancy occurred. Clinical pregnancy and live pregnancy rates (PRs) were compared to those women having ETs during the same time period not receiving LIT. RESULTS: Thirty-six of 94 (38.3%) patients receiving LIT (group 1) conceived following fresh or frozen ET vs 98 of 341 (28.7%) for women not receiving LIT (group 2) (p = NS). The live delivery rate per ET cycle was 30.8% (39/94) vs 19.7% for group 2 (p = .02). For the subset of women failing despite five previous ETs 17 of 37 (45.9%) group 1 women had a clinical pregnancy vs 18 of 64 (28.1%) group 2 women (p = .07%) and live delivery rates were 35.1% (13/37) vs 15.6% (10/64) (p = .024). CONCLUSIONS: These retrospective data encourage a prospective study of LIT combined with progesterone vs controls receiving progesterone only for recalcitrant patients having ETs.

Adult↗

PubMed2005

A comparison of luteal phase support in graduated estradiol/progesterone replacement cycles using intramuscular progesterone alone versus combination with vaginal suppositories on outcome following frozen embryo transfer.

PURPOSE: To compare pregnancy outcome following frozen embryo transfer according to type of progesterone (P) support given in the luteal phase. METHODS: Retrospective cohort analysis of frozen embryo transfer (ET) cycles in which ovulation was suppressed by graduated estradiol in the follicular phase. Two P regimens in the luteal phase were compared: P vaginal suppositories and intramuscular P vs intramuscular alone. RESULTS: The clinical and viable pregnancy rates were significantly higher for the women receiving only intramuscular P (57.6% and 43.7%) vs those receiving combined therapy (45.9% and 35.6%, respectively). The implantation rates were not significantly different (22.6% vs 19.5%). CONCLUSION: The increased pregnancy rates with intramuscular P may have been related to a higher number of embryos transferred (3.69 vs 3.26). Nevertheless, intramuscular P alone is at least as effective, if not more effective, than combined therapy for frozen embryo transfers.

Adult↗

PubMed2005

Ectopic pregnancy is not more likely following fresh vs frozen embryo transfer.

PURPOSE: To determine if the risk of ectopic pregnancy is greater following frozen vs fresh embryo transfer (ET). METHODS: Retrospective review of pregnancy outcome from January 1, 1997 to November 30, 2003. Cryopreservation was used as a simple freezing method and one-step removal of cryoprotectant. The cycles consisted mostly of graduated estradiol and progesterone supplementation. RESULTS: The ectopic pregnancy rate in 1,445 clinical pregnancies from fresh ET was 2.6% vs 2.0% of 975 clinical pregnancies resulting from frozen ET. CONCLUSION: In contrast to the conclusions of two previous studies, the present study evaluating twice as many clinical pregnancies than the two aforementioned studies combined failed to show any greater risk of ectopic pregnancy when transfers were performed on day 3.

Adult↗

PubMed2005

Successful pregnancy in a 45-year-old woman with elevated day 3 serum follicle stimulating hormone and a short follicular phase.

PURPOSE: To determine if a successful pregnancy is possible in a woman aged 45 with elevated day 3 serum follicle stimulating hormone (FSH), a short follicular phase, and failure to attain a mature follicle before ovulating. METHODS: Ethinyl/estradiol (20 microg daily) was given from day 2 of the menstrual cycle until follicular maturation was attained. Progesterone support of 200 mg twice daily progesterone vaginal suppositories were given in the luteal phase. RESULTS: A mature follicle was attained on day 12 with a serum estradiol of 335 pg/ml. Successful pregnancy and delivery were attained. CONCLUSIONS: This is the third reported case of a successful pregnancy in a woman > or = 45 years old with hypergonadotropism, and the first one reported that was also complicated by a short follicular phase.

Dose-Response Relationship, Drug↗

PubMed2005

A case report to influence therapeutic philosophy when presented with the findings on laparoscopy of a unilateral hydrosalpinx with a contralateral diseased but patent fallopian tube without hydrosalpinx.

PURPOSE: To determine if a patent fallopian tube associated with hydrosalpinx can be associated with unexplained implantation failure of morphological superior embryos. METHODS: Salpingectomy was performed on a woman with a patent fallopian tube who had failed to conceive despite the previous transfer of 27 superior quality embryos. A single embryo was transferred using minimal stimulation. RESULTS: Conception and normal delivery occurred. CONCLUSIONS: A patent tube with a hydrosalpinx may be associated with failure of embryos to implant. Salpingectomy can correct this defect.

Adult↗

PubMed2005

Monochorionic-diamniotic twins resulting from the transfer of a single embryo in a woman with decreased egg reserve: a case report.

PURPOSE: To report the first case of identical twins born to a woman with decreased oocyte reserve having a single embryo transfer (ET). METHODS: Minimal stimulation with gonadotropins (no more than 75 IU/day of human menopausal gonadotropins) for a few days followed by oocyte retrieval. RESULTS: The woman, aged 37, had seven in vitro fertilization (IVF) cycles with minimal or no gonadotropin stimulation. An embryo was formed in four of seven retrieval cycles (57.1%). She conceived on her seventh cycle and delivered monochorionic diamniotic twins. This pregnancy was achieved with the transfer of six embryos over eight cycles (counting a hyperstimulated cycle performed previously in another IVF center following traditional controlled ovarian hyperstimulation). CONCLUSIONS: This case demonstrates that successful pregnancies are possible with single embryo transfers in women with decreased egg reserve including identical twins.

Adult↗

PubMed2005

Matched control study of efficacy of lymphocyte immunotherapy in donor oocyte recipients to support or refute the concept of need for histocompatibility antigen sharing of the couple for benefits.

PURPOSE: To determine if lymphocyte immunotherapy (LIT) improves outcome in recalcitrant donor oocyte recipients. If LIT was found to be similarly effective in this group, the theory of shared maternal/paternal histocompatibility antigens would seem less plausible because the donor oocyte introduces another group of histocompatibility antigens. METHODS: Donor oocyte recipients with a history of failure to conceive despite at least two previous ETs using donor oocytes were given the option of having LIT. They were matched with the very next recipient who declined LIT therapy. Lymphocyte immunotherapy using the male partner's lymphocytes was given two weeks before transfer and twice more if pregnant. RESULTS: Only three controls delivered versus recipients treated with LIT. CONCLUSIONS: The fact that benefit from LIT extended to oocyte recipients challenges the concept that lymphocyte immunotherapy is most beneficial for couples sharing histocompatibility antigens.

Case-Control Studies↗

PubMed2005

A novel method to evaluate pregnancy rates following in vitro fertilization to enable a better understanding of the true efficacy of the procedure.

PURPOSE: To propose a new method of evaluating in vitro fertilization (IVF)-embryo transfer (ET) outcome so that statistics are not biased against IVF centers that have strong cryopreservation programs. METHODS: A retrospective review was made of all patients undergoing IVF-ET in a four and a half year time period having at least two embryos transferred. There were no other exclusions. All types of problems and controlled ovarian hyperstimulation protocols were used. Data were analyzed according to four age groups: < or =35, 36-39, 40-42, > or =43. Pregnancy rates were calculated according to a given oocyte harvest where a pregnancy was counted if the woman conceived on the fresh transfer or any succeeding frozen ET from embryos obtained from oocytes retrieved on that harvest. Also pregnancy rates per transfer and retrieval were evaluated. RESULTS: For women < or =35 to age 39 the new category of clinical pregnancy rate per oocyte harvest was significantly higher than the pregnancy rate per transfer. The pregnancy rate per transfer was significantly higher than the pregnancy rate per retrieval in women up to age 42. CONCLUSIONS: We propose that calculating pregnancy rate per harvest is the best method to evaluate the true efficacy of IVF-ET especially from programs with a strong emphasis on cryopreservation.

Adult↗

PubMed2005

Three successful pregnancies with in vitro fertilization embryo transfer over an eight year time span despite elevated basal serum follicle stimulating hormone levels. Case report.

PURPOSE: To demonstrate that elevated basal follicle stimulating hormone (FSH) does not necessarily signify poor quality eggs. METHODS: In vitro fertilization-embryo transfer (IVF-ET) performed because of unexplained infertility and male factor related to low hypo-osmotic swelling test. RESULTS: Three live pregnancies following lowering of elevated serum FSH with ethinyl estradiol followed by gonadotropin therapy. The patient had seven attempted oocyte retrievals and five led to ET. Despite markedly elevated basal serum FSH levels she achieved a delivered pregnancy rate of 42.8% per retrieval, 60% per transfer and an implantation rate of 27.2%/embryo transfer. CONCLUSIONS: This study clearly shows that high serum FSH in a woman of younger reproductive age does not mean egg quality is poor. The case also shows that since ovulation induction was still possible eight years later that the paucity of eggs in younger women is more likely related to a previous catastrophic event that markedly diminished egg reserve but that egg atresia proceeds at the normal rate thereafter.

Adult↗

PubMed2005

A novel highly effective treatment of interstitial cystitis causing chronic pelvic pain of bladder origin: case reports.

PURPOSE: To determine if a very effective therapy for idiopathic orthostatic cyclic edema--dextroamphetamine sulfate--would alleviate symptoms of chonic pelvic pain of bladder origin/interstitial cystitis. METHODS: Two women with interstitial cystitis that had been refractory to various therapies were treated with dextroamphetamine sulfate (20 mg/day) without any other treatment. The diagnosis of idiopathic edema was made by abnormal water load test and interstitial cystitis diagnosed by elevated scores on the pelvic pain and urgency and frequency symptom scale. RESULTS: Both patients quickly improved their bladder symptoms and all pain and urgency was gone within a week. The interstitial cystitis remained in remission as long as the women stayed on their medication. One woman proved Koch's postulates by stopping the medication because of forgetting it and symptoms resumed quickly only to disappear again upon resuming therapy. CONCLUSIONS: Dextroamphetamine sulfate can be a very effective therapy for recalcitrant cases of interstitial cystitis. Prospective placebo controlled studies are needed to determine what percentage of patients with this debilitating condition have concomitant idiopathic edema as determined by abnormal water load test and how well a larger series will respond to this novel therapy.

Adult↗

PubMed2004

Neither sildenafil nor vaginal estradiol improves endometrial thickness in women with thin endometria after taking oral estradiol in graduating dosages.

PURPOSE: To determine if sildenafil improves endometrial thickness better than vaginal estradiol (E2) in women with a history of thin endometria. METHODS: Women failing to attain an 8 mm endometrial thickness on either the oocyte retrieval cycle or their first frozen embryo transfer (ET) despite an oral graduated E2 regimen were treated again with graduated oral E2 and were also randomly assigned to vaginal sildenafil or vaginal E2 therapy. Endometrial thickness was compared between the groups. RESULTS: Neither vaginal E2 nor sildenafil significantly improved endometrial thickness or blood flow in the subsequent frozen ET-cycle. CONCLUSIONS: These data fail to corroborate previous claims that 25 mg sildenafil four times daily intravaginally can improve endometrial thickness.

Administration, Intravaginal↗

PubMed2004

Evidence using a shared oocyte pool that the sperm rather than the oocyte in some cases may be responsible for the production of embryos with a high percentage of fragmented blastomeres--case report.

PURPOSE: Hypothesis--a sperm defect rather than an oocyte problem may occasionally be responsible for blastomere fragmentation. METHODS: The morphology of embryos in pairs of women producing embryos from a common pool of oocytes but fertilized by two different sperm sources was performed to see if a pair could be detected where one woman produced embryos with very little blastomere fragmentation vs the other woman having embryos with extensive fragmentation. RESULTS: An oocyte donor was identified who produced 49 oocytes resulting in 17 embryos for the infertile donor to evaluate and 13 for the recipient. Almost all of the donor embryos showed extensive fragmentation vs very little for the recipient embryos. CONCLUSION: The sperm, in some cases at least, may be the etiologic factor for blastomere fragmentation.

Adult↗

PubMed2004

A comparison of in vitro fertilization outcome by culture media used for developing cleavage-stage embryos.

PURPOSE: To determine whether removing glucose and phosphate from media used for developing cleavage-stage embryos improves outcome following transfer of fresh or frozen embryos. Furthermore the study would evaluate the efficacy of adding nonessential amino acids and glutamate to media. METHODS: Embryo development was rotated on a weekly basis in human tubal fluid (HTF), versus two media relatively devoid of glucose and phosphate (e.g., P1), with one having the addition of essential amino acids and glutamate (Quinn's Advantage Medium). RESULTS: For fresh cycles, the implantation rate was significantly higher for Quinn's. There was less fragmentation with P1 and Quinn's. For frozen cycles, the viable pregnancy, implantation rates and embryo quality were higher for Quinn's and P1 than HTF. CONCLUSION: Removal of glucose and phosphate for day-2 embryos improves in vitro fertilization outcome after embryo transfer. It is not clear if adding certain non-essential amino acids and glutamate provides further improvement.

Adult↗

PubMed2004

Outcome of in vitro fertilization-embryo transfer according to age in poor responders with elevated baseline serum follicle stimulation hormone using minimal or no gonadotropin stimulation.

PURPOSE: To determine whether decreased ovarian reserve or advancing age are more associated with decreased oocyte quality. METHODS: Women with baseline serum follicle stimulating hormone (FSH) > 12 mIU/ml who demonstrated previous poor response to controlled ovarian hyperstimulation (COH) had oocyte retrieval without gonadotropin stimulation in natural cycles or with minimal stimulation (maximum 75 IU gonadotropins) without agonists or antagonists were evaluated following in vitro fertilization-embryo transfer. RESULTS: The ongoing/delivered pregnancy rates were 27.3%, 30.8%, 21.7%, and 0.0%, respectively, with a mean of 1.06 embryos per transfer. The implantation rates were 33.3%, 28.6%, 14.7%, and 6.0%. Approximately half of the retrievals resulted in failed fertilization. CONCLUSION: Using these minimal or no drug COH regimens in a difficult group of women, age was found to be a more adverse infertility factor than elevated serum FSH.

Adult↗

PubMed2004

Effect of antagonists vs agonists on in vitro fertilization outcome.

PURPOSE: To compare outcome following in vitro fertilization-embryo transfer (IVF-ET) using controlled ovarian hyperstimulation (COH) regimens using either the gonadotropin-releasing hormone (GnRH) agonist leuprolide acetate vs the GnRH antagonist ganirelix. METHODS: Women needing IVF for conception were randomly assigned to 300 IU of gonadotropins with ganirelix used in the follicular phase when a follicle with a 14 mm average diameter was attained vs a regimen using leuprolide acetate from the mid-luteal phase of the previous cycle. RESULTS: There were no differences found in clinical, ongoing, delivered pregnancy rates or implantation rates between groups. CONCLUSIONS: The use of GnRH antagonists do not seem to reduce IVF outcome compared to using GnRH agonists in COH regimens.

Adult↗

PubMed2004

Effect of corporal fibroids on outcome following embryo transfer in donor-oocyte recipients.

PURPOSE: To evaluate the effect of intramural or subserosal fibroids in the uterine fundus or corpus on pregnancy outcome following transfer of embryos formed from donated oocytes methods. METHODS: Leiomyomata were measured in three dimensions by transvaginal sonography. Scanning was performed in two planes (sagittal and coronal) at the level of maximal width. The location was categorized by depth in the uterus. RESULTS: There was no difference in pregnancy rates in those with or without fibroids. However, there was a significantly higher miscarriage rate in the former group. CONCLUSION: Women with fibroids are generally older. Thus conclusions about the effect on miscarriage rates are complicated by the effect of the aging oocyte on miscarriages. This study eliminated the oocyte factor by using only younger donated oocytes.

Abortion, Spontaneous↗

PubMed2004

Shared donor oocyte system to determine if top embryos can be derived from oocyte factors or more likely from an oocyte/sperm interaction.

PURPOSE: To determine if top embryos require an unusual, and possibly fortuitous, combination of excellent oocyte quality and sperm, or whether some oocyte property alone leads to the formation of superior quality embryos on day 3. METHODS: The embryo quality of donor oocyte recipient cycles was evaluated to find a woman who made 100% top embryos. After finding such an individual, the quality of the recipient's embryos was also evaluated. The shared donor oocyte recipient cycles were also evaluated for pregnancy outcome. RESULTS: All 15 embryos were graded top. The six embryos transferred to the donor and recipient resulted in two sets of triplets. One of the fetuses of the recipient aborted related to trisomy 21. CONCLUSION: The data indicates that the formation of an extremely high percentage (100%) of top embryos can be related to an oocyte factor. It is extremely unlikely to find two male partners who produce sperm with a unique property that makes superior morphologic embryos implant.

Adult↗

PubMed2004

Pregnancy despite imminent ovarian failure and extremely high endogenous gonadotropins and therapeutic strategies: case report and review.

PURPOSE: To attempt ovulation induction in a woman with premature ovarian failure who had very high serum follicle stimulating hormone (FSH) levels (e.g., 164 mIU/ml) by merely using ethinyl estradiol without gonadotropins. METHODS: Ethinyl estradiol (20-40 microg) was used to lower serum FSH. Monitoring of follicular maturation was performed using sonography to determine follicle size and serum estradiol. Progesterone vaginal suppositories (200 mg twice daily) were used following demonstration of oocyte release from the follicle. RESULTS: Follicle maturation and ovulation was achieved in six of ten treatment cycles. A clinical pregnancy occurred in the ninth treatment cycle and a live delivery of a healthy baby occurred. CONCLUSIONS: Despite small ovaries, amenorrhea, and failure to have withdrawal menses following progesterone, absence of antral follicles on initial ultrasound, and consistently extremely high serum FSH, ovulation and pregnancy is possible by merely lowering the serum FSH.

Adult↗