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Biomedical subjects

J H Check

Publications and source records attributed to J H Check.

At least 91 records · Page 5Linked to original sources
PubMed2001

A successful pregnancy from zygotes cryopreserved for >9 years: case report.

PURPOSE: To evaluate the longest interval that embryos can remain frozen and still result in a viable pregnancy after thaw and transfer. METHODS: Case report. RESULTS: A 42-year-old woman conceived and successfully completed the first trimester after transfer of frozen donated embryos from a 32-year-old woman whose eggs had been cryopreserved for over nine years. CONCLUSIONS: Patients can now be informed that there is anecdotal evidence that embryos can survive and result in successful pregnancies even after nine years of cryopreservation. This information may affect legislative decisions in requiring destruction of these stored embryos.

Adult↗
PubMed2001

Maternal/paternal sharing of DQ-Alpha type II histocompatibility antigens not associated with pregnancy outcome following in vitro fertilization (IVF)-embryo transfer (ET).

PURPOSE: To determine if maternal/paternal sharing of DQ alpha major histocompatibility (MHC) type II antigens is associated with reduced pregnancy and implantation rates following in vitro fertilization-embryo transfer (IVF-ET). METHODS: Prospective study with type II MHC DQ alpha alleles detected by polymerase chain reaction (PCR) technology using Perkin Elmer Amyli-type HLA DQ alpha PCR amplification and typing kit. The tests were only performed on patients having their first IVF cycle. RESULTS: No difference was found in clinical pregnancy rates per transfer between those couples sharing DQ alpha I alleles and those who did not (43.7% vs 40%). There were no spontaneous abortions in the group sharing DQ alpha I alleles. CONCLUSION: Maternal/paternal sharing of DQ alpha I antigens does not reduce fecundity following IVF-ET.

Adult↗
PubMed2001

Cumulative pregnancy rates after four embryo transfers of either fresh or frozen embryos.

PURPOSE: To evaluate in the modern era of in vitro fertilization (IVF) cumulative probability of pregnancy for the first four embryo transfers (ET) irrespective of whether the embryos were fresh or frozen. METHODS: Retrospective review over a 2 1/2 year period. Cumulative probability of pregnancy for four consecutive cycles of either fresh or frozen ETs divided into four age groups. RESULTS: The cumulative clinical and viable pregnancy rates after four ETs were 92% and 88%; 87% and 82%; 83% and 69%; and 68% and 52% for age groups <30, 30-34, 35-39, and 40-44. The cumulative rates decline with age. CONCLUSIONS: Pregnancy rates per transfer for the first four ETs regardless of age are similar even in IVF centers that emphasize frozen ETs.

Adult↗
PubMed2001

Cryptic infertility and therapeutic options.

Too often infertile patients are given a "herd type" fertility investigation which ultimately leads to expensive, time consuming, and risky in vitro fertilization. However, attention to certain simple details available by non-invasive methods, e.g., checking for premature luteinization, luteinized unruptured follicle syndrome, or performing the post-coital test at the appropriate interval, can lead to a quick solution of the infertility problem. Caution about persistent infertility related to iatrogenic factors, e.g., development of poor post-coital tests or excessively thin endometrium from clomiphene citrate, or development of luteinized unruptured follicle syndrome or premature luteinization by taking follicle maturing drugs, or creating a hostile environment from taking follicle maturing drugs when the woman already made a mature follicle (and would have had a higher success rate with luteal phase support with progesterone) will help achieve pregnancies without necessarily proceeding to the most expensive and invasive procedure of in vitro fertilization. Finally, many wasted cycles of treatment could be avoided by including the simple but very important hypo-osmotic swelling test and measurement of sperm autoantibodies with the first initial semen analysis.

Female↗
PubMed2001

A case report demonstrating that follicle maturing drugs may create an adverse uterine environment even when not used for controlled ovarian hyperstimulation.

PURPOSE: To evaluate whether follicle maturing drugs used in lower dosages for luteal phase defects rather than controlled ovarian hyperstimulation may have an adverse effect on successful implantation. METHODS: Unique case report. RESULTS: A 40-year-old woman who failed to conceive after six years of follicle maturing drugs with or without progesterone supplementation and four years of in vitro fertilization with embryo transfer (92 embryos transferred in 10 cycles) successfully conceived with the first cycle after the exclusive use of vaginal progesterone in the luteal phase. CONCLUSIONS: This case provides convincing evidence that for some women follicle maturing drugs, even when used in lower dosages, can adversely affect the uterine environment.

Adult↗
PubMed2001

Marked improvement in clinical pregnancy rates following in vitro fertilization-embryo transfer seen when transfer technique and catheter were changed.

PURPOSE: To compare in vitro fertilization (IVF) outcome with two different embryo transfer (ET) catheters: the Frydman and Wallace catheters. METHODS: Retrospective review of outcome of IVF cycles where there was at least one embryo that had assisted hatching prior to transfer at 72 hours according to which catheter was used. RESULTS: Pregnancy rate 17.6% per transfer with Frydman (FET-SET) vs 44.2% for fresh ETs and 15.4% and 43.2% for frozen ETs. The implantation rates for fresh ETs were 7.6% vs 20.0% for fresh and 5.7 vs 21.1% for frozen ETs. CONCLUSION: The soft Wallace catheter is superior to the stiffer Frydman catheter when transferring embryos subjected to assisted embryo hatching.

Catheterization↗
PubMed2000

Recovery of spermatogenesis and successful conception after bone marrow transplant for acute leukaemia: case report.

A case is presented of a young adult male diagnosed with acute myeloid leukaemia who was treated with busulphan and cyclophosphamide, but not total body irradiation, with subsequent bone marrow transplantation. After surviving for 5 years, he and his wife experienced a period of infertility. Interestingly, the problem was found to be with the female partner and the man's sperm evaluation seemed normal. A successful pregnancy ensued following the surgical removal of a large endometrioma and treating a luteal phase deficiency. Though this may be the fifth case of proven parentage in cases of bone marrow conditioning and bone marrow transplantation in a male for control of leukaemia, we believe it is the first documented case showing a normal semen analysis despite treatment. Further studies are needed to see if chemical conditioning with busulphan and cyclophosphamide preserve the chances of sperm production better than total body irradiation.

Adult↗
PubMed2000

Hyperreactio luteinalis despite the absence of a corpus luteum and suppressed serum follicle stimulating concentrations in a triplet pregnancy.

Hyperreactio luteinalis is characterized by moderate to marked cystic enlargement of the ovaries related to multiple theca lutein cysts and is associated with very high sex steroid concentrations. It is a rare condition especially in the first trimester. The case described below is believed to be the only case of hyperreactio luteinalis reported following frozen embryo transfer. This case provides an opportunity to gain further insight into the mechanism responsible for this unusual condition. The 30 year old woman demonstrated a slightly elevated LH/FSH ratio (5 and 3 mIU/ml respectively) and normal baseline androgen concentrations. Two years following oocyte retrieval she had a second frozen embryo transfer. The ovaries were normal size when the embryos were transferred and androgens were still normal. The ovaries did not begin to enlarge until 51 days from transfer. A dichorionic intrauterine pregnancy with monozygotic twins in the left gestational sac was seen. Eventually, 86 days from transfer, the ovaries enlarged to 145x103x116 mm right; and 83x95x117 mm left. Serum oestradiol was 30 078 pg/ml, beta-human chorionic gonadotrophin (HCG) 239 920 mIU/ml, serum progesterone >160 ng/ml, total testosterone 2254 ng/dl, free testosterone 42.3 pg/ml and androstenedione 7328 ng/dl. Throughout the first trimester, serum FSH was <1 mIU/ml. Thus, neither FSH nor a corpus luteum is necessary to initiate this syndrome.

Adult↗
PubMed2000

Non-homogeneous hyperechogenic pattern 3 days after embryo transfer is associated with lower pregnancy rates.

The purpose of this study was to investigate the relationship between mid-luteal phase echo patterns and IVF-embryo transfer outcome in women who have demonstrated adequate endometrial development by the late proliferative phase. A prospective study was carried out of 86 patients undergoing IVF-embryo transfer and 86 patients undergoing frozen embryo transfer who all underwent sonographic monitoring of the endometrium 3 days after embryo transfer. The cycles were classified into two groups: those with the homogeneous hyperechogenic (HH) pattern and those without it. The women who had an HH pattern had higher clinical pregnancy (32.8 versus 10.7%, P < 0.05) and implantation rates in stimulated cycles (14.3 versus 4.1%, P < 0.05 respectively) than those that did not. There was no significant difference in the clinical pregnancy or implantation rates by echo pattern (18.2 and 8.1% for non-HH and 18. 7 and 8.0% for HH respectively) in frozen embryo transfer cycles. These data demonstrate that in embryo transfer cycles where ovarian stimulation was used, there were decreased pregnancy and implantation rates in cycles where the HH pattern was not observed 3 days after transfer. The failure of the endometrium to display this pattern may indicate some endometrial abnormality resulting in implantation defects.

Adult↗
PubMed2000

No evidence of increased uterine vascular impedance with patient ageing following IVF.

A study was conducted to determine if uterine vascular impedance increases with advancing age in women undergoing ovarian stimulation for IVF. A group of 162 women who had undergone conventional IVF and embryo transfer was subdivided into three subgroups by age: 30-34 years (n = 49), 35-39 years (n = 79) and 40-44 years (n = 34). The pulsatility index (PI) and resistance index (RI) of the right and left uterine arteries were measured at baseline, on the day of oocyte retrieval, and at the mid-luteal phase. There were no differences in the average PI or RI by age at any phase of the cycle. In all age groups, the luteal phase values of PI and RI were lower than those observed earlier in the cycle. Endometrial thickness was not associated with age. There was no significant correlation between PI, RI and serum oestradiol and progesterone concentrations at any phase of the cycle. Ovarian response, as measured by average number of oocytes retrieved, decreased significantly with age. Thus, reduced pregnancy rates in older women undergoing ovarian stimulation are more likely to occur because of oocyte quality and quantity rather than uterine senescence. If future studies determine that the use of ovarian stimulation does decrease implantation rates more in older versus younger women, a mechanism other than increased uterine vascular impedance must be sought.

Adult↗
PubMed2000

Three pregnancies despite elevated serum FSH and advanced age: case report.

Although the transfer of fertilized donor oocytes is the most efficacious mode of conception for infertile women with hypergonadotrophism associated with incipient or apparent ovarian failure, there are many individuals who, for religious, ethical, or personal reasons, would prefer to try to conceive with their own oocytes. The three cases presented here represent extremes to date for (i) highest serum FSH concentration in a woman with incipient ovarian failure (n = 2), and (ii) the oldest woman with apparent overt ovarian failure (n = 1) to have successful pregnancies. All three cases were treated for only a short time with pharmacological dosages of ethinyl oestradiol with luteal phase support with progesterone. The peak FSH (mIU/ml) in cases 1 and 2 was 143 and 127 respectively. The precedents set in these cases can help physician-patient consultation when patients enquire whether there is a certain critical FSH concentration above which pregnancy is not possible or an age over which successful pregnancy could not be achieved even if ovulation despite ovarian failure was possible.

Adult↗
PubMed2000

A study to determine if certain sonographic uterine parameters are associated with multiple gestation.

The objective was to determine if lower uterine artery vascular impedance is associated with a greater likelihood of multiple gestation. Color Doppler parameters of pulsatility index, resistance index, endometrial thickness and echo patterns were measured in oocyte/retrieval cycles on days of human chorionic gonadotropin injection, oocyte retrieval, and mid-luteal phase in cycles where at least 3 embryos were transferred. Comparisons of these parameters were made in patients with single versus multiple gestations. There was no association between uterine environment as measured by vascular impedance and endometrial thickness and number of embryos implanted. Thus, a more ideal uterine environment, at least as determined by these sonographic parameters, does not seem to facilitate multiple embryo implantations.

Adult↗
PubMed2000

Successful pregnancy following in vitro fertilization-embryo transfer despite imminent ovarian failure.

There have been previously published several anecdotal cases of women in apparent or imminent ovarian failure who subsequently ovulated and became pregnant. Many of these women had been treated with estrogen. A series of cases were reported where women with hypergonadotropic hypogonadism who failed to stimulate despite gonadotropin therapy were able to ovulate when treated with pharmacologic doses of estrogen alone or in combination with human menopausal gonadotropins. Presented herein is a case of a woman with imminent ovarian failure with tubal disease who failed to stimulate with gonadotropins alone but was successful with estrogen and gonadotropins. We believe this is the first successful case of hypergonadotropic hypogonadism to conceive by in vitro fertilization.

Adult↗
PubMed2000

The presence of small uterine fibroids not distorting the endometrial cavity does not adversely affect conception outcome following embryo transfer in older recipients.

PURPOSE: To determine if uterine fibroids have a negative impact in older patients having embryo transfer (ET). METHODS: Comparison of clinical and viable pregnancy rates, implantation rates, and spontaneous abortion rates in older (>35) oocyte or embryo recipients with uterine leiomyomata compared to comparable patients without fibroids. RESULTS: The clinical pregnancy rate per transfer was 56% in the fibroid group vs 64% for the controls. Implantation rates were also very similar (33 vs 32%7). There were no spontaneous abortion or preterm deliveries <32 weeks in the fibroid group and the average term of pregnancies was also similar. CONCLUSION: Small fibroids not distorting the uterine cavity do not seem to negatively affect conception outcome even in older women.

Adult↗
PubMed2000

Successful pregnancy despite advanced age and elevated serum follicle stimulating hormone levels--a case report.

PURPOSE: To determine if a woman over age 45 with elevated serum follicle stimulating hormone (FSH) levels in the early follicular phase could still successfully conceive. METHODS: Female partner was treated with guaifenesin to improve cervical mucus quality and vaginal progesterone in the luteal phase. Careful monitoring of follicular maturation was performed. RESULTS: A successful pregnancy after 14 months of progesterone therapy was achieved. CONCLUSIONS: It is possible for a 46-year-old infertile woman with elevated serum FSH to achieve a pregnancy even when the male partner is taking calcium channel blockers for heart problems.

Aging↗
PubMed2000

Comparable implantation rates with fresh vs frozen embryo transfer suggests that controlled ovarian hyperstimulation has an adverse effect on conception outcome.

PURPOSE: A retrospective comparison of fresh vs frozen embryo pregnancy rates. METHODS: All frozen embryos transferred used in the analysis including deselected embryos from the oocyte retrieval cycle, and twice-frozen embryos. RESULTS: Pregnancy and implantation rates following fresh or frozen embryo transfers were similar. CONCLUSION: The similar outcomes despite the obvious disadvantages for the frozen-thawed embryo suggests that some other factor reduces the chance of embryo implantation on oocyte-retrieval cycles. An adverse affect of controlled ovarian hyperstimulation on the uterine environment is a strong possibility.

Adult↗