Search PubMed⌕ Search

Biomedical subjects

J H Check

Publications and source records attributed to J H Check.

At least 127 records · Page 7Linked to original sources
PubMed1997

Comparison of pregnancy outcome of natural twin pregnancies versus multifetal pregnancies selectively reduced to twins.

The high rate of multiple gestations following ovulation induction with and without assisted reproductive technologies (ART) has led to an increased interest in selective reduction. The aim of this study was to compare pregnancy outcome of 6 triplet and 2 quintuplet pregnancies following selective reduction to twins to a group of 30 natural twin pregnancies delivered during the same time period. Outcome variables compared included birth weights, gender, gestational age at delivery, route of delivery, and neonatal complications. Results failed to demonstrate an adverse effect of selective reduction on pregnancy outcome.

Adult↗
PubMed1997

A comparison of early gestational age markers in viable twin pregnancies resulting from in vitro fertilization-embryo transfer versus spontaneous conception with ovarian stimulation.

The objective of this study was to determine whether there were differences in gestational age markers in dizygotic twin pregnancies resulting from in vitro fertilization-embryo transfer (IVF-ET) when compared with dizygotic twin pregnancies spontaneously conceived following ovulation inducing therapy drugs without assisted reproductive techniques (ART). Thirty-one sets of twins conceived by IVF-ET and 33 sets of twins conceived without ART were monitored by serum beta human chorionic gonadotropin (B-hCG) levels and transvaginal sonographic measurements of sac size (SS) and crown-rump length (CRL). Comparison between groups found that SS was significantly smaller in the IVF-ET group as compared to the non-ART group 21-35 days post-ovulation (p < .05). The CRL was similar in both groups as well as the doubling times of B-hCG. These data indicate that in dizygotic twin pregnancies initial development of SS may be slower following IVF-ET than in spontaneously conceived twins.

Adult↗
PubMed1996

Pregnancy achieved with pronuclear-stage embryos that were cryopreserved and thawed twice: a case report.

PURPOSE: Our purpose was to determine if pronuclear-stage embryos (2PN) could be thawed, then frozen again with subsequent survival and cleavage after thawing. METHODS: A simplified cryopreservation protocol was used in which a slow cooling program is started at the seeding temperature of -6 degrees C in an alcohol-bath controlled-rate freezer. 1,2-Propanediol (1.5 M) was added to embryos before cooling. A fast thawing technique at room temperature was used. The cryoprotectant was removed in one step using a 1 M sucrose solution. RESULTS: Three months after refreezing, the three 2PN embryos were thawed and all three cleaved after 24 hr in culture. Following embryo transfer a pregnancy was achieved and a healthy full-term baby girl was born. CONCLUSIONS: This is the third case reported of successful pregnancies after transfer of human embryos that were frozen twice before transfer and the first case where the second freeze occurred at the pronuclear stage. This is also the first successful refreezing of human embryos using a simplified freezing and thawing technique with one-step addition and removal of cryoprotectant.

Adult↗
PubMed1996

The relationship of early follicular phase serum LH and pregnancy rates in women with regular menses.

OBJECTIVE: To investigate the relationship of early follicular phase serum LH levels and pregnancy rates in ovulatory women with regular menstrual cycles. METHODS: One hundred consecutive couples seeking help for infertility who had bilateral tubal patency, a minimum motile sperm-density-of 2.5 million/mL, and regular menstrual cycles were enrolled in the study. Baseline serum measurements of LH, FSH, and testosterone were obtained before treatment. Patients were treated with clomiphene citrate, human menopausal gonadotropin, or progesterone supplementation, as needed. Treatment continued for 6 months or until conception occurred. The 6-month pregnancy rates were correlated with baseline early follicular phase serum levels and age. RESULTS: The 6-month viable pregnancy rates did not decrease with an increase in baseline LH serum levels; they were 50% if LH was 10 mIU/L or less, 15.3% if LH was 11-20 mIU/mL, and 71.4% if LH was more than 20 mIU/mL. The 16.7% pregnancy rate in women whose baseline FSH exceeded 25 mIU/mL was significantly lower than the 56.3% rate in women whose FSH was 25 mIU/mL or lower. The pregnancy rates also declined significantly with age. When we controlled for age, FSH did not have an independent effect on conception rates. CONCLUSION: Early follicular phase serum levels of LH were not associated with pregnancy rates in infertile ovulatory women who were treated with progesterone in the luteal phase when needed. However, early follicular levels of FSH and age at treatment were found to be related to pregnancy rates.

Adult↗
PubMed1996

The effect of assisted hatching on pregnancy rates after frozen embryo transfer.

OBJECTIVE: To compare clinical pregnancy and implantation rates after transfer of frozen-thawed embryos prepared according to an assisted hatching protocol or a nonassisted hatching protocol. DESIGN: A historical cohort study in which a cohort of patients who underwent an assisted hatching protocol was matched for clinical parameters to an external historical cohort treated before assisted hatching was available. SETTING: In vitro fertilization-ET facility of a university-based practice. PATIENTS: Seventy-nine matched pairs. INTERVENTIONS: Nonassisted hatching patients: embryos were thawed, cultured in human tubal fluid + 0.5% bovine serum albumin until 48 hours and transferred. Assisted hatching patients: embryos thawed, cultured in human tubal fluid + 10% synthetic serum substitute until 72 hours, had assisted hatching and transferred. MAIN OUTCOME MEASURES: Clinical pregnancy (gestational sac) and implantation rates. RESULTS: Twelve (15.2%) clinical pregnancies per transfer in nonhatched group versus 24 (30.4%) in hatched group. Nonhatched group: 284 embryos transferred; 15 (5.3%) implanted. Three pregnancies (25.0%) had two sacs. Hatched embryos: 269 were transferred; 37 (13.7%) implanted. Eleven pregnancies (45.8%) were multiple gestations (9 twins, 2 triplets). CONCLUSION: Clinical pregnancy and implantation rates were higher for group having assisted hatching protocol. It is not clear whether the improvement is due to the overall methodology change or to assisted hatching. Assisted hatching using the zona-drilling technique is not detrimental to frozen-thawed human embryos and may be beneficial.

Adult↗
PubMed1996

Transfer of cryopreserved embryos improved pregnancy rates in patients with damage to the functional integrity of the sperm membrane as measured by the hypo-osmotic swelling test.

OBJECTIVE: To compare the pregnancy rates (PRs) after transfer of cryopreserved embryos in patients who have damage to the functional integrity of the sperm membrane as measured by the hypo-osmotic swelling test to those without this defect. DESIGN: Prospective clinical study. SETTING: University-associated IVF center. PATIENTS: Fifty-four patients enrolled in a matched prospective study to evaluate the effects of low HOS scores (<50%) on PRs after IVF-ET were followed to determine the PR after transfer of cryopreserved embryos. MAIN OUTCOME MEASURE: Clinical PRs and implantation rates. RESULTS: Fourteen patients with low hypo-osmotic swelling test scores underwent 21 frozen ET cycles, achieved for clinical pregnancies for a PR per cycle of 19.0% and an implantation rate of 7.1%. Twelve patients with normal hypo-osmotic swelling test scores underwent 21 frozen ET cycles, achieved five preganancies for a clinical PR per cycle of 23.8% and an implantation rate of 9.3%. CONCLUSION: Previous studies have demonstrated an adverse effect of low hypo-osmotic swelling test scores on PRs after IVF-ET despite normal fertilization. This adverse effect was not found in the transfer of cryopreserved embryos from males with hypo-osmotic swelling test scores. Further investigation is required to determine how cryopreservation improves the chances of implantation of these embryos.

Cell Membrane↗
PubMed1996

Progesterone induced blocking factor seen in pregnancy lymphocytes soon after implantation.

PROBLEM: The immunomodulatory effect of progesterone (P) in pregnancy manifested via a protein named the P-induced blocking factor (PIBF) was previously reported. The goal of this study was to measure and compare the PIBF expression on lymphocytes between pregnant and non-pregnant women especially in early pregnancy. METHODS: PIBF expression was determined by immunocytochemistry using a PIBF-specific polyclonal antibody. Levels were assessed during the mid-cycle, luteal phase, and first trimester of pregnancy. RESULTS: PIBF expression was found in 24.9% of mid-cycle sera, 49% of luteal phase sera of women who failed to conceive, and 75% of luteal phase sera of women who conceived. CONCLUSIONS: These data indicate that the percentage of PIBF expressing lymphocytes increases as a result of pregnancy and that the stimulus for PIBF induction occurs soon after implantation. These data support the concept that PIBF may play an important role in early implantation possibly by inhibiting the destructive function of natural killer lymphocytes.

Antigens, Neoplasm↗
PubMed1996

Relative resistance of a macroprolactinoma to bromocriptine therapy during pregnancy.

A woman presented with a pituitary macroadenoma with extensive suprasellar extension. Her initial response to bromocriptine therapy was good, allowing subsequent trans-sphenoidal surgical treatment. The tumor grew during pregnancy despite continued bromocriptine therapy, but it returned to prepregnancy size postdelivery. There have been conflicting reports regarding the growth of pituitary tumors in pregnancy. Most recognize that some growth may occur, but only a small percentage of patients are reported to become symptomatic from the growth. Resistance to bromocriptine has been reported in non-pregnant patients. Patients who have had surgery or radiation therapy and did not receive bromocriptine treatment during pregnancy have been reported to have symptomatic growth of their residual tumor. This case demonstrates an unusual tumor that became resistant to bromocriptine during pregnancy, but whose sensitivity to the drug returned postdelivery.

Adult↗
PubMed1996

Low-dose gonadotrophin stimulation for luteal phase defects--does absence of LH help pregnancy rates?

Based on data suggesting that higher serum LH levels during the follicular phase may decrease subsequent pregnancy rates and increase spontaneous abortion rates, the study presented herein was designed to compare the pregnancy and abortion rates in patients treated with gonadotrophin preparations with and without LH content. Infertile patients with luteal phase defects related to releasing eggs prior to complete follicular maturation were randomized into two treatment arcs: ultra-low-dose (75IU) human menopausal gonadotrophin (hMG) versus pure FSH. However, they were given the right to refuse the recommended treatment and use the other one if they preferred. Pregnancy and spontaneous abortion rates were determined for first cycle of therapy. The pregnancy rates for hMG versus pure FSH was 22.7 percent and 20.3 percent, respectively. The spontaneous abortion rates were also similar (8 percent and 9.1 percent). There were no multiple births resulting from these 36 pregnancies. Ovarian hyperstimulation syndrome was not observed in any of the 164 stimulation cycles. These data demonstrate that the use of an ultra-low-dose gonadotrophin stimulation regimen is an effective method of correcting infertility related to luteal phase defects related to follicular maturation defects since the overall pregnancy rate per first cycle of treatment was 22 percent despite a minimum of 10 months of infertility duration. Furthermore, an ultra-low-dose gonadotrophin regimen is safe for treating luteal phase defects in that there was no ovarian hyperstimulation or multiple births demonstrated. These results also show no advantage of choosing a preparation devoid of LH, thus giving the patient the opportunity to purchase the least expensive medication that is available.

Abortion, Spontaneous↗
PubMed1996

Comparison of an enzyme-linked immunosorbent assay vs radioimmunoassay for measuring serum progesterone at low levels.

Reports have suggested a correlation between low serum progesterone (P) levels prior to human chorionic gonadotropin (hCG) administration and increased pregnancy rates in patients undergoing in vitro fertilization (IVF) patients. We have published two opposite conclusions, dependent upon the methodology used. Pregnancy rates were higher when P by radioimmunoassay (RIA) was < 1 ng/mL, but no increase in pregnancy rates were found when P was measured by the same company's non-isotopic assay. To test if the lack of correlation was attributable to the P method, sera from IVF patients were assayed by two methods, RIA and enzyme linked immunosorbent assay (ELISA). There was 81.8% agreement between methods. Further studies are needed to determine the importance of low P; however, if non-isotopic methods are used, the IVF center should carefully determine the accuracy of their assay in the low range.

Chorionic Gonadotropin↗
PubMed1996

Relationship of early follicular phase sera follicle stimulating hormone and luteinizing hormone levels as measured by a radioimmunoassay and an enzyme-linked immunosorbent assay to number of oocytes retrieved.

A study was performed to see if the level of serum follicle stimulating hormone (FSH) or luteinizing hormone (LH) obtained in the early follicular phase could predict the number of oocytes retrieved following in vitro fertilization (IVF). For each patient the sera FSH and LH were measured by both an enzyme-linked immunosorbent assay (ELISA) and a radioimmunoassay (RIA) method. With the ELISA method when early follicular phase serum FSH was < or = to the group median (9.0 mIU/mL) 16.5 oocytes were retrieved vs 6.7 when FSH was greater than the median. Comparable values using the median of the RIA assay were 17.5 vs 8.1 oocytes. Similar analysis for serum LH failed to show any relationship between baseline LH and the number of oocytes retrieved. This study thus demonstrates that at least one non-isotopic method is equal to a specific RIA method in distinguishing good from average or poor responders.

Adult↗
PubMed1995

Serum CA 125 levels and spontaneous abortion.

OBJECTIVE: Previous reports have suggested that serum CA 125 levels in patients who spontaneously abort in the first trimester of pregnancy differ from the levels of patients who successfully complete their pregnancies. Low CA 125 levels have been suggested to predict spontaneous abortion, although an increased rate of first-trimester spontaneous abortion has also been reported in women with elevated CA 125 levels early in pregnancy. The purpose of this study was to prospectively compare serum CA 125 levels of women who abort in the first trimester with levels of those women whose pregnancies progress beyond 12 gestational weeks. STUDY DESIGN: A total of 188 pregnant patients had weekly serum CA 125 levels obtained after a prepregnancy baseline value was determined. Levels of the antigen in women who ultimately had a first-trimester spontaneous abortion were compared with CA 125 levels from women whose pregnancies continued past the first trimester. RESULTS: There was no statistically significant difference in the CA 125 levels of patients who aborted compared with those of women whose pregnancies continued. In addition, among patients with CA 125 values > 150 U/ml there was also no statistically significant difference in the proportion of patients who aborted compared with controls. CONCLUSION: Serum CA 125 levels are not predictive of spontaneous abortion in the first trimester of pregnancy.

Abortion, Spontaneous↗
PubMed1995

The effect of consecutive cycles of clomiphene citrate therapy on endometrial thickness and echo pattern.

OBJECTIVE: To determine whether successive cycles of clomiphene citrate affect endometrial thickness. METHODS: Thirty-four women presenting for treatment of anovulation, oligoovulation, or follicle maturation defects were given the smallest dose of clomiphene citrate necessary to attain a mature follicle. If no pregnancy ensued, the same dose was continued if a follicle 18-24 mm in diameter and a serum estradiol (E2) level greater than 200 pg/mL were achieved. Ethinyl E2 was supplemented for poor cervical mucus only. Endometrial thickness and echo patterns were measured each cycle at peak follicular maturation. RESULTS: There was no difference in mean endometrial thickness during the first six cycles of therapy, nor was there a trend for thickness to increase or decrease with successive cycles with or without the addition of ethinyl E2. There was no change in the distribution of echo patterns with successive cycles of clomiphene citrate. Post-treatment measures of thickness and echo pattern did not differ from baseline pre-treatment values. The homogeneous hyperechogenic pattern was the rarest. Mean serum E2 and progesterone levels at mid-cycle did not change with successive cycles. CONCLUSION: One proposed mechanism for the dichotomy between ovulation and pregnancy rates after clomiphene citrate therapy is that the drug adversely affects the endometrium. If clomiphene citrate does affect implantation adversely, the mechanism does not seem to be related to thinning the endometrium or causing an echo pattern that indicates a poor prognosis. The data also suggest that estrogen supplementation does not influence endometrial thickness and would best be used exclusively for hostile cervical mucus.

Adult↗