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Biomedical subjects

J H Check

Publications and source records attributed to J H Check.

At least 163 records · Page 9Linked to original sources
PubMed1994

The use of the donor oocyte program to evaluate embryo implantation.

Pregnancy rates (PRs) are generally higher in most IVF programs when embryos derived from donor oocytes are transferred compared to the PRs of women undergoing IVF-ET. DeZiegler et al., using the transfer of frozen embryos (either patient or donor derived) in natural cycles, found a higher PR following donor oocyte derived ET and thus concluded that the lower PR in the non-donor cycles was not related to the controlled ovarian hyperstimulation (COH) regimen. Their data thus suggested the improved PR with donor embryos may be related to better quality oocytes used for recipients; however, a more receptive endometrium in the oocyte recipients could also explain the data. The studies presented herein further evaluated the latter hypothesis of improved endometrial environment for recipients by comparing PRs in donors vs recipients in a shared oocyte program. Also the study would determine if endometrial echo patterns (EP) and/or thickness (ET) help predict better PRs as they do in stimulated cycles. Finally studies would be performed to compare PRs in older vs younger oocyte recipients to see if there may be a uterine senescence in humans as in other animals and to see if age has an adverse effect on the endometrium as evidenced by sonographic studies. Study 1 compared the clinical PRs in donors vs recipients in a shared program from 1/1/92 to 12/31/92. PR for donors was 23.6% (17 pregnant in 72 transfers) compared to 34.6% for recipients (26/75). Mean age of the donors was 32 compared to 39.8 for recipients. If recipients > 40 were eliminated the PR for recipients was 44.1% (15/34). Study 2 evaluated PRs according to ET and EP in 58 transfers using donor oocytes (44 patients). There were only 2 clinical pregnancies of 22 transfers (9%/cycle) when ET was < 10 mm at the time of the donor's hCG injection compared to 14 pregnant of 36 transfers (38.7%) when ET was > or = 10 mm (p < 0.01). However, there were no differences in PR when the endometrium compared to myometrium was hypoechogenic, isoechogenic, or hyperechogenic. The respective PRs were 16.7% (1/6), 31% (9/39) and 26.1% (6/23). Study 3 evaluated PRs in donor oocyte recipients according to age (< 40 vs > or = 40 years). After evaluating PRs after the first 58 ETs to recipients of shared oocytes we found a much lower PR in women > or = 40 (2/23, 8.6%/cycle) vs 14/55 (25.4%) in those < 40.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1994

The use of a shared donor oocyte program to evaluate the effect of uterine senescence.

OBJECTIVE: To determine if there is reduced uterine receptivity after age 40 by the comparison of pregnancy rates (PRs) of donor oocyte recipients > or = 40 years to those under age 40. SETTING: In vitro fertilization-ET facility of a university-based practice, Cooper Institute for In Vitro Fertilization. PATIENTS: All patients registering for the shared donor oocyte program from November 1990 to September 1992. Most recipients were in ovarian failure. INTERVENTIONS: Donors were treated with luteal phase leuprolide acetate (LA) and gonadotropins; recipients were treated with oral E2 in graduated doses and 50 mg IM daily P. Endometrial thickness was considered in the decision to continue with transfer or to freeze all embryos. MAIN OUTCOME MEASURES: Pregnancy rates per transfer in recipients and live birth rates according to age > or = 40 or < 40. RESULTS: The clinical PR per transfer was 29.2% for the younger women and 25.4% for the older recipients. The live birth rate was 29.2% for the younger women and 22.4% for the older recipients. CONCLUSIONS: These data support the conclusion that, if there is a decline in uterine receptivity for embryo implantation with advancing age, it is at least remediable with hormonal adjustments.

Adult↗
PubMed1994

Comparison of the cumulative probability of pregnancy after in vitro fertilization-embryo transfer by infertility factor and age.

OBJECTIVE: To compare the cumulative probability of pregnancy after multiple IVF cycles by age and cause of infertility. DESIGN: A prospective study was done in which patients were followed from the time they registered for their first IVF cycle until they achieved a clinical pregnancy, withdrew from treatment, or study was terminated. PATIENTS, SETTING, TREATMENTS: Infertile women undergoing IVF-ET at the Cooper Institute for In Vitro Fertilization were enrolled in this study if the luteal phase leuprolide acetate (LA) and hMG controlled ovarian hyperstimulation (COH) regimen was used. MAIN OUTCOME MEASURES: Clinical pregnancy, as determined by a positive beta-hCG level and ultrasonographic confirmation of a gestational sac, and delivery rates based on number of women with live births were compared by infertility factor and age. RESULTS: The 3-month cumulative probability of pregnancy based on life table analysis was 33% in women with tubal factor who were < or = 35 years of age, 25% in women with tubal factor who were > 35 years of age, 30% for women with multiple factors who were < or = 35 years of age, and 14% for women with multiple factors who were > 35 years of age. The rate for the older women with multiple factors was significantly lower than that for the other groups. The delivery rates were lower for the women with multiple factors than for women under 35 with tubal factor only. CONCLUSIONS: There is a significant effect of age and infertility factor on pregnancy and delivery rates. Physicians should consider these factors in evaluating their patients' prospects for success in IVF-ET.

Adult↗
PubMed1994

Pregnancy rates in donors versus recipients according to the serum progesterone level at the time of human chorionic gonadotropin in a shared oocyte program.

Previous data suggested a subtle increase in serum P at the time of hCG injection without LH surge reduces the PR of women having oocyte retrievals for IVF; this study compared PRs of recipients in a shared oocyte program according to the donors' pre-hCG P level. There was no difference in viable PRs between recipients and donors when P < or = 1 ng/mL. The PR was similar for recipients when donors' P was > 1 ng/mL (12.7%). Donors with P > 1 ng/mL had the lowest PR: 7.2%. The data suggest that the adverse effect of higher serum P without LH surge may be on the endometrium rather than the oocyte.

Chorionic Gonadotropin↗
PubMed1994

The use of chymotrypsin/galactose to treat spermatozoa bound with anti-sperm antibodies prior to intra-uterine insemination.

Anti-sperm antibodies in semen have been associated with a decrease in fertility potential. The question arises as to whether intra-uterine insemination (IUI) can improve pregnancy rates by merely allowing earlier capacitation and close timing to ovulation, or whether certain treatments of the spermatozoa add extra benefit. The study presented herein was designed to compare IUI using Percoll density separation with an albumin treatment versus chymotrypsin/galactose treatment. Sixteen patients were evaluated where IUI was randomized between both sperm treatments. Pregnancy rates/cycle were 25% (eight of 32) with chymotrypsin/galactose-treated spermatozoa compared to only 3% (one of 33) cycles with albumin-treated spermatozoa (P < 0.01). Since it has been reported that the proportions of spermatozoa showing immunobead binding for specific antibodies after chymotrypsin/galactose treatment remain unchanged, the exact mechanism for improvement is unknown; possibly chymotrypsin/galactose interferes with the function of the antibodies.

Autoantibodies↗
PubMed1994

The frequency of antisperm antibodies in the cervical mucus of women with poor postcoital tests and their effect on pregnancy rates.

PROBLEM: To determine the impact of the presence of antisperm antibodies (ASAs) in the cervical mucus of female partners in couples with unexplained poor postcoital tests (PCT). Furthermore, the efficacy of intrauterine insemination (IUI) in these same patients was determined by pregnancy rates (PRs). METHOD: Pregnancy rates following IUI in patients with infertility and poor postcoital tests, whether the cervical mucus was positive or negative for ASAs, were evaluated. RESULTS: The 6-month PRs were similar in the ASA negative (40.5%) versus the positive (42.4%) group. CONCLUSIONS: It appears that the antifertility effect of ASA may be mainly the immobilization of sperm in the cervical mucus, and thus, performing IUI may effectively correct the problem.

Antibodies↗
PubMed1994

Evaluation of whether using hCG to stimulate oocyte release helps or decreases pregnancy rates following intrauterine insemination.

The study's objective was to determine if using human chorionic gonadotropin (hCG) as a timing method for intrauterine insemination (IUI) in patients who make mature follicles but have cervical factor problems has a negative effect on pregnancy rates (PRs) (possibly by releasing an immature oocyte), or increases the rate of luteinized unruptured follicles (LUF). Patients were offered hCG or natural release after an explanation of the theoretical advantages and disadvantages. Intrauterine insemination was performed 36-40 h after hCG; timing of IUI with hCG was based on day of luteinizing hormone (LH) surge modified by serum progesterone (P). Incidence of LUF in those taking hCG-5/116 (4.3%); 0/33 without hCG. Pregnancies-24/116 (20%) with hCG; 3/30 (10%) without hCG. No statistical differences in these rates were found. Thus, using hCG for more convenient timing for IUI in nonsuperovulated cycles does not decrease the PR or cause a high incidence of LUF.

Chorionic Gonadotropin↗
PubMed1993

The range of subtle rise in serum progesterone levels following controlled ovarian hyperstimulation associated with lower in vitro fertilization pregnancy rates is determined by the source of manufacturer.

Two previous studies found a correlation of higher pregnancy rates (PRs) with lower serum progesterone (P) levels at the time of human chorionic gonadotropin (hCG) injection in in vitro fertilization (IVF) cycles when luteal phase leuprolide acetate (LA)-human menopausal gonadotropin (hMG) was used for the controlled ovarian hyperstimulation (COH) regimen. In these two studies the radioimmunoassay (RIA) by Diagnostic Products Corporation (DPC) was used to measure P levels. This study attempted to corroborate these findings using a different RIA for P (Amersham) when the same COH regime was administered. The PR was significantly higher in the group where P was < or = 1 ng/ml at the time of hCG (43.2%) versus the groups where the P level ranged from 1.1 to 2 ng/ml (15.8%). Viable PRs were also significantly higher in the lower P group. In contrast to the previous data with the DPC assay, no differences were seen with P < 0.5 ng/ml (36.4%) versus 0.5-1 ng/ml (44.6%). Nevertheless, using the Amersham RIA, the data does suggest decreasing PRs with higher serum P levels at time of hCG when using luteal phase LA-hMG COH regimen.

Chorionic Gonadotropin↗
PubMed1993

The effect of the age of the recipients on pregnancy rates following donor-oocyte replacement.

PURPOSE: Besides waning ovarian function with advancing age, the question of a uterine senescence factor has been proposed as a cause of decreased fecundity. The replacement of oocytes from younger donors into older recipients allows further investigation into the aging endometrium. RESULTS: The pregnancy rate was considerably lower, 8.5% in recipients in ovarian failure who were > or = 40 years old (n = 23) compared to younger recipients, < 40 years of age (n = 55), who were also in ovarian failure, which would support the uterine senescence theory. CONCLUSION: The endometrial factor may be manifested by failure to generate a critical endometrial thickness of 10 mm by sonography in 61% of the older group, compared to only 29% of the younger group. Future studies should address methods of improving the endometrial thickness in the older group, to determine if improved pregnancy rates will occur and to evaluate whether increasing luteal support with extra progesterone may also improve pregnancy rates.

Adult↗
PubMed1993

The effect of endometrial thickness and echo pattern on in vitro fertilization outcome in donor oocyte-embryo transfer cycle.

There have been some conflicting data concerning the importance of endometrial thickness and echo patterns before transfer in different IVF-ET situations under different COH regimens. We previously found in women undergoing IVF-ET after luteal phase LA-hMG a significantly higher PR in those patients attaining at least a 10-mm endometrial thickness and a lower rate in those women with an entirely homogeneous hyperechogenic endometrium (pattern C). The present study evaluated the relationship of endometrial thickness and echo pattern to PRs in donor oocyte recipient immediately before transfer. There were 16 pregnancies in 58 cycles (27.5%). Conclusions similar to the previous COH study were reached concerning the > or = 10-mm thickness levels correlating with improved PRs (9% versus 38.7%, P < 0.01). In contrast, no correlation with echo pattern was found.

Adult↗
PubMed1993

Effect of xenobiotics on quinone reductase activity in first trimester explants.

The placental protective enzyme quinone reductase (QR) has recently been reported to be induced by exposure to mercury, which is a toxic metal in vitro at term. In the present study we have examined the effect of three groups of xenobiotics-carcinogens, chemoprotectors and a natural antioxidant, ascorbic acid (vitamin C) on this enzyme activity in the first trimester placenta in vitro. Incubations with the carcinogen benzo[a]pyrene (BP) at 10-50 microM doses increased the enzyme activity at 6 h. At 24 h the effect of 10 microM BP was significant while that of 50 microM BP was not consistent. On the other hand the effect of 50 microM 3-methylcholanthrene at both time points was not significant. Ascorbic acid (5-25 microM) added for 24 h caused a 2- and 4-fold increase in the enzyme activity, respectively (P < 0.005). Exposure to a 25 microM concentration of different classes of chemoprotectors 2(3)-tert-butyl-4-hydroxyl-anisole (BHA), dicoumarol and Sudan I caused a 2.5- to 3.6-fold significant increase in the enzyme activity after 24 h (P < 0.01). Present data suggest that QR activity in the early placenta is responsive to a wide variety of xenobiotics in vitro. Vitamin C in concentrations usually consumed, exerted a potent effect on local QR activity in vitro which may protect pregnant women and their conceptus in an adverse environment.

Ascorbic Acid↗
PubMed1993

Effect of 1-34 human parathyroid hormone upon first trimester placental human chorionic gonadotrophin secretion in vitro: potentiation by epidermal growth factor.

Human chorionic gonadotrophin (HCG) secretion by the early placenta is under multifactorial control. Epidermal growth factor (EGF) has been reported to be involved in regulating the formation and secretion of HCG by first trimester placental explants in culture. The effect of the amino-terminal fragment of parathyroid hormone (1-34 PTH), a calciotrophic factor upon HCG secretion, and its possible interaction with EGF were examined in this study, both in static cultures and in superfusion, where it has previously been demonstrated that HCG secretion is spontaneously pulsatile. Gestational age-dependent effects of 1-34 PTH were noted in both models. In static cultures, 1-34 PTH stimulated HCG secretion in 7-9 week placenta, in a biphasic fashion, the maximal effect being noted at 10-25 ng/ml concentrations (250-270%), while at 1 and 100 ng/ml, the effect was mild. In superfusion, the effect of 1-34 PTH added overnight was also stimulatory, as shown by the significantly increased pulse amplitude and area under the curve. Effects of 1-34 PTH at 11-14 weeks were inhibitory. In static cultures at 7-9 weeks, the stimulatory effect of 25 ng 1-34 PTH was increased by 70% when EGF (100 ng/ml) was added. However at 11-14 weeks, this combined effect was inhibitory. We conclude that 1-34 PTH has an endocrine effect on secretion of HCG by the first trimester placental tissue, and this effect is potentiated by the addition of EGF.

Chorionic Gonadotropin↗
PubMed1993

A prospective study to evaluate the efficacy of modified swim-up preparation for male sex selection.

A previously published study reporting the use of a modified swim-up technique for sperm preparation prior to insemination which resulted in a high percentage of male births has been criticized for its lack of controls. The present prospective study was initiated to investigate further the efficacy of modified swim-up preparation for male sex-selection when applied in a properly defined control group. Our results showed that the proportion of males born in singleton pregnancies was approximately 50% in the group inseminated following sperm preparation with Percoll and in the control group with no sperm preparation compared with 88.5% in the group treated with the modified method of swim-up sperm preparation prior to insemination. This high rate of males in the group treated with modified swim-up was also observed in singleton pregnancies of women taking ovulation inducing drugs (primarily clomiphene citrate). This contrasts with previous publications in which a higher rate of females was found in clomiphene citrate patients using the albumin separation technique. How the mechanism of the swim-up procedure may result in a high male birth rate remains unclear. A high percentage of y enriched semen was found using fluorochrome quinacrine mustard staining but this procedure may falsely stain autosomal chromosomes. If analysis using sensitive DNA probes fails to confirm the y enrichment of the spermatozoa, one must hypothesize that the modified swim-up procedure damages the x-spermatozoa.

Female↗
PubMed1993

The efficacy of short-term gonadotrophin-releasing hormone agonists versus human chorionic gonadotrophin to enable oocyte release in gonadotrophin stimulated cycles.

One of the reasons for failure to conceive following human menopausal gonadotrophin (HMG) therapy may be due to non-release of oocytes from the follicles. We hypothesized that by using a gonadotrophin-releasing hormone agonist (GnRHa) for a short duration, endogenous release of luteinizing hormone and follicle stimulating hormone may enable oocyte release to occur, similar or superior to the effect of human chorionic gonadotrophin (HCG). This study attempted to compare the efficacy of HCG versus the GnRHa leuprolide acetate to release oocytes and achieve pregnancies and to compare the effectiveness of leuprolide acetate versus a combination of HCG with HMG to release oocytes. Unfortunately due to lack of prior data, many patients preferred to reject leuprolide acetate in favour of HCG, resulting in three times as many patients being treated with HCG in cycle 1; 78.2% of oocytes were released following leuprolide acetate versus only 55.7% with HCG. Interestingly, 87.5% of those females in whom oocyte release failed in cycle 1 with HCG did indeed release with leuprolide acetate in cycle 2, but none of these previous failures released with HCG in cycle 2. Pregnancy rates were equal in those women releasing oocytes, whether treated with HCG or leuprolide acetate. These preliminary data justify a larger randomized study.

Chorionic Gonadotropin↗
PubMed1993

Adverse effect of a homogeneous hyperechogenic endometrial sonographic pattern, despite adequate endometrial thickness on pregnancy rates following in-vitro fertilization.

We have previously presented data to show that in patients who had in-vitro fertilization (IVF)-embryo transfer using ovarian stimulation involving the luteal phase leuprolide acetate--human menopausal gonadotrophin (HMG) regimen, poor pregnancy results ensued if either the endometrial thickness was < 10 mm or a homogeneous hyperechogenic sonographic pattern was present immediately prior to taking a human chorionic gonadotrophin (HCG) injection. There were only 15 cases with this hyperechogenic type endometrium (and no pregnancies). The purpose of the present study was to evaluate the influence of a hyperechogenic endometrium when the endometrial thickness was > or = 10 mm, in a more extensive series, in women having IVF-embryo transfer using the same ovarian stimulation regimen. A total of 273 consecutive cycles, where endometrial thickness was > or = 10 mm, were evaluated (not including the 85 cycles previously reported). Of 22 patients with the hyperechogenic pattern, one achieved a chemical pregnancy (beta-HCG > 500 mIU/ml) and none achieved clinical pregnancies (ultrasound confirmation). In contrast, 67 of 251 (26.7%) patients conceived with other echo patterns (chi 2 analysis = 5.9, df = 1, P = 0.01). These data thus confirm, in a larger series, the negative influence of this type of echo pattern on subsequent pregnancy rates following the luteal phase leuprolide acetate--HMG ovarian stimulation regimen.

Embryo Transfer↗