Search PubMed⌕ Search

Biomedical subjects

J H Check

Publications and source records attributed to J H Check.

At least 145 records · Page 8Linked to original sources
PubMed1995

Pregnancy after zona drilling of cryopreserved thawed embryos: case report.

OBJECTIVE: To confirm successful implantation of IVF, cryopreserved human embryos after assisted hatching with acidic Tyrode's solution. DESIGN: Case report. SETTING: In vitro fertilization-ET facility of a university-based practice. PATIENT: A 28-year-old female with nonoperable bilateral tubal occlusion and > 1 1/2 years of primary infertility. INTERVENTIONS: The patient was stimulated for egg retrieval after an hMG-controlled ovarian hyperstimulation regime. Luteal phase leuprolide acetate (1 mg) was administered SC for 10 days. The dose was then reduced to 0.5 mg, and she was given hMG and FSH IM twice daily until two lead follicles reached 20 mm average diameter. The patient was administered 10,000 IU hCG 36 hours before retrieval. MAIN OUTCOME MEASURES: Viable pregnancy documented by ultrasound (US). RESULTS: After the transfer of five cryopreserved-thawed human embryos that were subjected to assisted hatching using acidic Tyrode's solution, the patient established a triplet gestation as documented by US. CONCLUSION: This case report demonstrates that zona drilling can be successfully applied to frozen-thawed pronuclear stage embryos that were cultured to 72 hours without damaging them, as evidenced by continued cleavage and resulting implantation.

Adult↗
PubMed1995

Poor fertilization may be related to oocyte or zona pellucida recognition defects specific to certain hyperstimulation regimens and limited to some males but not others: a case report.

OBJECTIVE: To determine if the controlled ovarian hyperstimulation (COH) regimen may cause sperm to appear subfertile only to improve considerably by changing the COH protocol. DESIGN: Case report with retrospective review of previous fertilization rates according to COH protocol used. MAIN OUTCOME MEASURES: Fertilization and pregnancy rates (PRs) after IVF-ET. RESULTS: Known fertile donor sperm failed to fertilize any of 11 oocytes compared with 14 of 18 for processed retrograde ejaculate using the same oocyte pool. Retrospective analysis of other cycles for different female patients but same donor found 16.6% fertilization rate whenever luteal phase leuprolide acetate (LA)-hMG regimen was used compared with 70.6% with short-flare regimen. CONCLUSION: Some COH regimens may cause oocyte or zona pellucida changes that create recognition defects for some sperm but not others. Interestingly, the sperm with the binding defect with the luteal phase LA-hMG COH protocol exhibited good fertilization rates with oocytes prepared with the short-flare protocol and demonstrated high in vivo PRs after IUI.

Adult↗
PubMed1995

Evaluation of the mechanism for higher pregnancy rates in donor oocyte recipients by comparison of fresh with frozen embryo transfer pregnancy rates in a shared oocyte programme.

The objective of this study was to determine the mechanism for higher pregnancy rates in oocyte recipients by comparing the pregnancy rates following fresh and frozen embryo transfers in a shared oocyte programme. A prospective study was carried out of 135 matched pairs of donors and recipients who equally share the donors' pool of oocytes. Recipients were subclassified by ovarian function: 69 were in ovarian failure and 66 retained ovarian function. A total of 474 standard in-vitro fertilization cycles using the same ovarian stimulation protocol as the donors were also evaluated. The main outcome measures were the clinical pregnancy and implantation rates for donors and recipients following fresh and frozen embryo transfers. The clinical pregnancy rates per transfer for fresh embryo transfers were 17.5% for donors, 20.4% for recipients with ovarian function and 46.3% for recipients in ovarian failure (P < 0.05). The pregnancy rates for frozen embryo transfers were 15.3% for donors, 17.2% for recipients with ovarian function and 23.8% for recipients in ovarian failure (not significantly different). The implantation rates for fresh transfers were 7.5% for donors, 8.6% for recipients with ovarian function and 15.6% for recipients in ovarian failure (P < 0.05); for frozen cycles, the implantation rates were 5.1, 5.2 and 7.1% respectively (not significantly different). When classified by age and ovarian function, the clinical pregnancy rates per transfer for recipients with ovarian function were 14.0% for those aged > or = 40 and 22.2% for those aged < 40 years. For recipients in ovarian failure, the pregnancy rates were 33.3% for the older group of women and 39.4% for the younger group. A logistic regression analysis found that ovarian function was the only factor to have an independent effect on outcome. The demonstration of higher pregnancy and implantation rates in recipients versus donors following fresh embryo transfer, despite the use of a common pool of oocytes, strongly suggests that the well-known higher fecundity found in recipients is not predominantly related to the use of better quality oocytes. The demonstration of an implantation rate twice as high following fresh versus frozen embryo transfer in recipients with ovarian failure suggests that the frozen embryo is not as hardy as the fresh embryo. Thus, the fact that both the pregnancy and implantation rates in donors were the same with fresh versus frozen embryo transfer suggests that the ovarian stimulation regimen has a negative effect on outcome. However, the clear demonstration of higher pregnancy rates in recipients with ovarian failure compared with those with ovarian function suggests that, in addition, these higher rates may be linked to a superior uterine environment in patients with ovarian failure. Alternatively, the use of gonadotrophin-releasing hormone agonists may have a negative effect on implantation in patients with ovarian function.

Cryopreservation↗
PubMed1995

A challenge to the concept of tubal reflux to explain the rise and fall of CA125 in serum during the first trimester.

Although amniotic fluid concentrations of cancer antigen (CA) 125 rise during the first two trimesters of pregnancy, the serum concentrations of CA125 peak during the first trimester and drop to non-pregnant values in the second and third trimester. A previous hypothesis to explain this phenomenon was that in the early first trimester decidual CA125 gains access to the maternal compartment via 'tubal reflux' and subsequent absorption by peritoneal lymphatics. However, as pregnancy advances, the decidua capsularis fuses with the decidua parietalis, thus obliterating the endometrial cavity at 10-12 weeks; the Fallopian tubes thus become functionally obstructed. To test this hypothesis, we evaluated early first trimester CA125 concentrations in women conceiving by in-vitro fertilization (IVF) and embryo transfer with patent tubes (group 1) and in those conceiving by IVF and embryo transfer with bilateral tubal occlusion (group 2). We also compared those conceiving with human menopausal gonadotrophin therapy for ovulation induction without assisted reproduction (group 3) and those conceiving without fertility drugs in assisted reproduction (group 4). Mean CA125 concentrations were similar in groups 1-3; the mean CA125 concentration in group 4 was lower but this difference was not statistically significant, probably due to the small sample size. These data do not support the concept that tubal reflux explains the rise and fall of serum concentrations of CA125, since these were equal in IVF conceptions with or without tubal patency.

CA-125 Antigen↗
PubMed1995

Use of a new CA 125 assay in the diagnosis of endometriosis.

Serum CA 125 concentrations are elevated in some women with endometriosis; however, the low sensitivity and specificity of the assay have made it impractical to use it as a diagnostic test for endometriosis. Recently a second-generation CA 125 assay has been developed. The purpose of this study was to compare serum CA 125 concentrations in women with and without endometriosis using both the older assay and the new CA 125 assay and to determine if the new assay concentration improves the clinical utility of CA 125 in the diagnosis of endometriosis. A total of 123 patients with endometriosis, pelvic pain or infertility were enrolled. Blood for CA 125 was drawn in the cycle preceding laparoscopy or laparotomy, and concentrations found by the older and newer assays were correlated with the patients' endometriosis stage using the revised American Fertility Society classification of endometriosis. The CA 125 concentrations determined by the new assay were highly correlated with concentrations determined by the older assay in patients with and without endometriosis (r = 0.96). The sensitivity and specificity were slightly improved using the new CA 125 assay; however, this assay did not dramatically improve detection of endometriosis.

Biomarkers↗
PubMed1995

The relationship of endometriosis to endometrial sonographic studies prior to administration of human chorionic gonadotrophin in patients undergoing in-vitro fertilization and embryo transfer.

The objective of this prospective comparative study was to investigate the relationship of endometriosis to endometrial thickness and sonographic echo pattern prior to the administration of human chorionic gonadotrophin (HCG). Patients were matched by age and ovarian stimulation protocol. A total of 210 patients undergoing in-vitro fertilization (IVF) and embryo transfer at a university-related IVF centre were enlisted. Of these, 105 women with laparoscopic confirmation of endometriosis were compared to an equal number of patients with laparoscopic confirmation of no endometriosis. Mean endometrial thickness did not differ between the groups (12.7 +/- 2.9 versus 12.2 +/- 2.5 mm). The distribution of echo patterns was also the same, irrespective of diagnosis. Evaluation of clinical pregnancy rates showed no reduction in patients with endometriosis, regardless of stage, nor when comparing patients to controls. Endometriosis has no effect on the endometrial thickness or echo pattern measured by sonography prior to administration of HCG or the pregnancy rates following IVF and embryo transfer.

Adult↗
PubMed1995

A comparative prospective study using matched samples to determine the influence of subnormal hypo-osmotic test scores of spermatozoa on subsequent fertilization and pregnancy rates following in-vitro fertilization.

The achievement of pregnancies in vivo is rare in couples where the male partner has defective sperm membranes as shown by hypo-osmotic swelling (HOS) test scores of < 50%. However, there have been mixed reports on the value of the HOS test in predicting outcome following invitro fertilization; some studies suggest reduced fertilization rates and others find little, if any, predictability of decreased fertilization. The assumption has been made that fertilization rates are proportional to pregnancy rates; however, this may not necessarily be true since defective spermatozoa could lead to a less viable pre-embryo and therefore a decreased viable pregnancy rate. We performed a comparative prospective study using matched controls to evaluate fertilization rates and to determine subsequent pregnancy rates. The mean HOS scores were 70.0 and 36.7% respectively, with mean motile sperm concentrations of 35.7 and 34.0 x 10(6)/ml in 27 matched pairs. There was no difference in the mean number of oocytes retrieved, fertilization rates or number of embryos transferred between the two groups by HOS score. The clinical and viable pregnancy rates and implantation rates were 25.9, 18.5 and 9.9% for normal versus 3.7, 3.7 and 1.1% for subnormal groups. These data suggest that low HOS scores may be associated with the formation of defective embryos, leading to low pregnancy rates but normal fertilization rates.

Female↗
PubMed1995

Chymotrypsin-galactose treatment of sperm with antisperm antibodies results in improved pregnancy rates following in vitro fertilization.

PROBLEM: To determine if chymotrypsin-galactose (CG) treatment of sperm bound with antisperm antibodies (ASA) improves pregnancy rates (PRs) following in vitro fertilization (IVF). METHOD: Patients with > 50% ASA who failed to conceive despite six intrauterine insemination (IUI) cycles were included. Initially the sperm treatments were randomized with CG vs culture medium; subsequently only CG treatment was used. RESULTS: There was a significantly lower fertilization rate in those patients inseminated with sperm incubated in culture medium vs CG (27% vs 47%, P < .05 t-test). Similarly, a higher percentage of patients receiving culture medium treatment of sperm had failed fertilization (45%) compared to CG (11%). Though the clinical PRs were higher with CG (21%) tham medium (9.5%), there was no statistical difference. CONCLUSIONS: Though the percentage of sperm bound with antibodies are not reduced, we hypothesize that the CG treatment improves fertility by possibly mitigating the antagonistic action of these antibodies.

Autoantibodies↗
PubMed1995

Evidence for a leukocyte adhesion factor produced by the early embryo.

PROBLEM: To determine if the embryo may induce adhesive molecules needed for implantation. METHOD: Determination of whether platelet rosetting around lymphocytes might occur when exposed to sera from pregnant, but not nonpregnant patients and from culture fluid from embryos but not oocytes. RESULTS: 90.2% of women with positive sera beta human chorionic gonadotropin (beta-hCG) levels taken at least 12 days postovulation demonstrated platelet rosette factor (PRF) vs only 18.7% when beta-hCG was negative. Using mid-luteal phase sera in women receiving hCG injection 1 wk before, 64.7% had positive PRF when serial beta-hCG levels were positive as did 100% of samples taken from in vitro fertilization (IVF) patients; however, only 15.3% were positive with negative serial hCG levels. Culture media from fertilized oocytes and embryos tested positive for PRF, but follicular fluid and media from unfertilized oocytes were negative. CONCLUSION: The early embryo secretes a factor(s) that gains access to maternal serum and promotes increased lymphocyte/platelet adhesiveness.

Blood Platelets↗
PubMed1995

The effect of sera antisperm antibodies in the female partner on in vivo and in vitro pregnancy and spontaneous abortion rates.

PROBLEM: To determine the incidence of antisperm antibodies (ASA) in female sera from infertile couples or those suffering from recurrent abortions. Also to determine if the pregnancy and/or abortion rates are any higher in those positive versus those negative for ASA. METHOD: All registered patients had sera drawn and ASA measured by indirect immunobead test on initial study. Pregnancy and abortion rates were determined for patients undergoing in vivo or in vitro therapy. RESULTS: There was a low incidence of ASA in patients having in vivo or in vitro treatment. There was no decrease in pregnancy rates (PRs) or increase in spontaneous abortions (SAB) in those positive for ASA. CONCLUSION: Antisperm antibodies in female sera do not seem to be etiologic in causing infertility or SAB. Future studies might consider changing the antigen source from donor sperm to husband's sperm.

Abortion, Habitual↗
PubMed1995

Relationship of endometrial thickness and echo patterns on pregnancy rates in patients with luteal phase defects.

The objective of this prospective comparative study was to investigate the relationship of sonographic measurements of the endometrium at the time of peak follicular maturation to conception outcome in patients treated for luteal phase defects (as determined by out-of-phase endometrial biopsies). Treatments for luteal phase defects included progesterone supplementation with or without follicle-maturing drugs, depending on whether the patient attained a follicle of at least 18 mm and a serum estradiol of > 200 pg/ml. No differences in pregnancy rates were found by the thickness of endometrium (< 10 vs. > or = 10 mm) or echo pattern in any of the treatment modalities. Thus, contrary to findings in stimulated cycles for in vitro fertilization, endometrial thickness at the time of peak follicular maturation is not predictive of outcome in patients treated for luteal phase defects in natural cycles.

Adult↗
PubMed1995

Relationship of endometrial thickness and sonographic echo pattern to endometriosis in non-in vitro fertilization cycles.

The objective of this study was to investigate the effect of endometriosis on the proliferation of the endometrium as determined by sonographic measurements of endometrial thickness and echo pattern at peak follicular maturation. A prospective study of 60 infertility patients was conducted in which the endometrium was evaluated sonographically, both before and after laparoscopy. Prior to laparoscopy, the mean endometrial thickness was 10.5 +/- 1.9 mm in the group without endometriosis (n = 20) and 11.7 +/- 2.8 mm in the group with endometriosis (n = 40) (p > 0.05). Following the laparoscopy, there was no change in the mean thickness within each group. The incidence of an unfavorable echo pattern was negligible in both groups. Endometriosis does not cause a reduction in endometrial thickness, nor does it appear to influence the development of an unfavorable echo pattern at time of peak follicular maturation.

Adult↗
PubMed1995

Comparison of efficacy of high-dose pure follicle-stimulating hormone versus human menopausal gonadotropins for in vitro fertilization.

The advent of recombinant DNA technology will soon produce for the market a product that has pure follicle-stimulating hormone (pFSH) but no luteinizing hormone. A prospective randomized study was performed to see if pFSH (Metrodin) was able to stimulate the same in vitro fertilization parameters as human menopausal gonadotropin when preceded by gonadotropin suppression by leuprolide acetate. The results showed similar parameters between the two drugs, i.e., number of oocytes, number of embryos, endometrial thickness at time of human chorionic gonadotropin, fertilization rates and pregnancy rates in a protocol purposely designed to stimulate as many follicles as safely as possible because of a shared oocyte and successful cryopreservation program.

Adult↗
PubMed1995

Evaluation of a new embryo-grading system to predict pregnancy rates following in vitro fertilization.

This study examines two descriptive parameters of embryo morphology to determine if either parameter correlates with subsequent pregnancy rates (PRs). The two parameters were the evenness (similarity in size) of the blastomeres and the degree of cellular fragmentation. A total of 242 embryo transfers in which 4 embryos were transferred were included. Sixty-nine (28.5%) clinical and 62 (25.6%) viable pregnancies resulted. In all cases 4 embryos were transferred, but the number of embryos with even round blastomeres (grade 1) varied from 0 to 4. Statistically, there was no correlation between PR and number of grade 1 embryos transferred. When 4 grade 1 embryos were transferred, the PR was 33.3 versus 28.1% when no grade 1 embryos were transferred. There was, however, a statistical difference in the implantation rate; a higher frequency of multiple gestations occurred when 3 or 4 of the embryos transferred were graded 1:12.7 as compared with 6.7% when < or = 2 embryos were grade 1. The significance of the degree of cellular fragmentation in the embryos was also assessed. There was no statistical difference in the PR according to the number (0-4) of embryos transferred that did not have fragments (grade A). When 4 grade A embryos were transferred, the PR was 18.2 versus 26.1% when there were no grade A embryos. Neither implantation nor multiple birth rates correlated with fragmentation.

Adult↗
PubMed1995

A randomized study comparing the efficacy of reducing the spontaneous abortion rate following lymphocyte immunotherapy and progesterone treatment versus progesterone alone in primary habitual aborters.

Presented herein is a randomized prospective study performed to evaluate the efficacy of the addition of lymphocyte immunotherapy (LI) to progesterone (P) therapy (LI/P) for the prevention of spontaneous abortion (SAB) in primary aborters with a history of three SABs. The incidence of intrauterine pregnancies in four cycles was 23 of 35 (65.7%) patients for LI/P vs. 14 of 31 (45.1%) patients treated with progesterone alone. SABs occurred in 6 of 23 (26.0%) LI/P-treated patients compared to 8 of 14 (57.1%) given progesterone alone. The mean number of previous abortions in both groups was 3.9. The mean age of the LI/P group was 34.1 vs. 33.6 years for the group treated with progesterone alone. These data could be interpreted to show that progesterone therapy and LI independently inhibit SAB or that LI/P acts synergistically to inhibit immune destruction. LI/P therapy was found to be more effective than progesterone therapy alone.

Abortion, Habitual↗
PubMed1995

Comparison of androgen levels in conception vs. non-conception cycles following controlled ovarian stimulation using the luteal phase gonadotropin-releasing hormone agonist protocol.

Serum concentrations of androstenedione, testosterone and dehypdroepiandrosterone sulfate (DHEAS) as well as estradiol and progesterone were measured throughout the in vitro fertilization (IVF) cycle and compared by conception outcome to try to determine if differing levels of androgens could help elucidate the endocrine environment conducive to successful IVF cycles. The luteal phase gonadotropin-releasing hormone agonist (GnRH-a) protocol was used for ovarian stimulation. of the 46 women enrolled in the study, 11 conceived and 35 did not conceive. Throughout the follicular phase, levels of androstenedione and DHEAS were found to rise but the same pattern of increase was found in both conception and non-conception cycles. The pattern of testosterone increase in non-conception cycles was faster than that in conception cycles. Differences in mean levels of androstenedione, testosterone, estradiol and progesterone by conception outcome in the late luteal phase can be attributed to secretion by the corpus luteum. It is possible that those women having multiple failed cycles with rapidly rising serum testosterone levels should be considered for longer use of the GnRH-a. Differences in the pattern of testosterone rise should be monitored.

Adult↗