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Biomedical subjects

J Kerin

Publications and source records attributed to J Kerin.

At least 19 recordsLinked to original sources
PubMed2000

Human chorionic gonadotropin as a predictor of outcome in assisted reproductive technology pregnancies.

OBJECTIVE: To determine whether serum hCG and progesterone levels obtained 16 days after ovulation are reliable predictors of pregnancy outcome. DESIGN: A retrospective study. SETTING: The data were obtained from two integrated Adelaide-based clinics: the Queen Elizabeth Hospital and Wakefield Clinic. PATIENT(S): Women who have achieved a pregnancy through ART treatment. MAIN OUTCOME MEASURE(S): Analysis of data using logistic regression (STATA v.5.0) to predict a binary outcome: ongoing pregnancy or miscarriage. Ongoing pregnancy was defined as progression to >20 weeks' gestation. Miscarriage included spontaneous abortion, biochemical and ectopic pregnancies, and blighted ovum. RESULT(S): Human chorionic gonadotropin was found to be the main determinant of ongoing pregnancy. Age and progesterone had minor effects, whereas stimulation, luteal support, and treatment types were nonpredictive. Low hCG levels between 25 and 50 IU/L are associated with a low probability of ongoing pregnancy (<35%), whereas levels of >500 IU/L predict a >95% chance of ongoing pregnancy. CONCLUSION(S): A single serum hCG level 16 days after ovulation provides a useful predictor of pregnancy outcome.

Abortion, Spontaneous↗
PubMed1999

A laparoscopic surgical training and accreditation program up and running.

Beginning in March 1997, a training and accreditation program in laparoscopic surgery was established at our hospital according to the training guidelines provided by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) (1, 2). Registrars were accredited upon satisfactory completion of supervised surgery at each training level. Consultants seeking clinical privileges in advanced laparoscopic surgery were asked to submit a formal application. By August 1998, 143 minor laparoscopic procedures had been formally assessed resulting in 8 of 9 registrars successfully completing training to level 2 laparoscopy. Thirty-three of 83 (39.8%) advanced laparoscopic procedures were directly supervised and an experienced laparoscopic surgeon was available, if required, for a further 15 procedures. Two consultants undertook additional supervised training before being granted full accreditation for level 3 laparoscopic procedures. Another 2 consultants have been given provisional accreditation for level 3 procedures. Although challenging, implementation of the RANZCOG guidelines on training and accreditation in laparoscopic surgery is quite possible. Greater efforts should be undertaken to establish these guidelines as the 'gold standard' for hospital accreditation committees.

Accreditation↗
PubMed1997

Reduced pregnancy rates following the transfer of human embryos frozen or thawed in culture media supplemented with normal serum albumin.

Over a 26 month period 17% of couples having treatment in our clinical programmes selected a commercially available protein (normal serum albumin, NSA) prepared from pooled human sera instead of using their own serum as a supplement for their embryo culture media. In a retrospective analysis of >2000 gonadotrophin-stimulated cycles and 1000 cycles where frozen/thawed embryos were transferred, fertilization, embryo quality and pregnancy rates following in-vitro fertilization (IVF), gamete intra-Fallopian transfer (GIFT) or intracytoplasmic sperm injection (ICSI) were unaffected by the type of protein used to supplement the culture medium. When embryos were thawed in medium containing NSA, both pregnancy (PR) and implantation rates (IR) were significantly lower (P <0.05) than if the medium was supplemented with serum (PR 8.3% and 17.5%; IR 4.6% and 10.5%). Inclusion of NSA before freezing reduced the IR of thawed embryos. To further test this observation all cycles where embryos were cultured and frozen in medium containing NSA (173 cycles) were matched to cycles where serum was used and the outcome was compared. At the end of 1995 just over half of the embryos in both groups had been thawed. No statistical difference was noted in the pregnancy rates (NSA, 5.6% versus serum, 11.3%) but the IR per embryo was significantly lower when embryos were cultured and frozen in medium supplemented with NSA (2.2%) than when serum was used as the supplement (6.6%).

Blood↗
PubMed1993

Comparison of cycle outcome for gamete intrafallopian transfer alone and in combination with intrauterine embryo transfer.

As an alternative to embryo cryopreservation, the efficacy of intrauterine transcervical transfer of a small number of embryos resulting from fertilization of supernumerary oocytes obtained during a GIFT cycle (GIFT-ET) was assessed in this investigation. Data from 72 consecutive GIFT (N = 27) and GIFT-ET (N = 45) cycles were retrospectively reviewed. Age and infertility diagnoses were similar among the two groups. Clinical pregnancy, ongoing pregnancy, and abortion rates per retrieval were not significantly different between the two groups. We conclude that GIFT-ET offers no advantage over GIFT alone and that cryopreservation of all supernumerary embryos with intrauterine transfer in subsequent cycles would maximize pregnancy rates from a single oocyte aspiration and GIFT procedure.

Adult↗
PubMed1991

Internal jugular vein thrombosis after ovulation induction with gonadotropins.

An unusual case of ovarian hyperstimulation syndrome complicated by internal jugular vein and mediastinal thrombosis is presented. Hemoconcentration and perhaps immobilization appear to be the most probable causative factors. The patient was successfully treated with heparin anticoagulation. An uneventful twin pregnancy resulted from the stimulation cycle.

Adult↗
PubMed1990

Falloposcopy: a microendoscopic technique for visual exploration of the human fallopian tube from the uterotubal ostium to the fimbria using a transvaginal approach.

A transvaginal microendoscopic technique has been developed for safely exploring the human fallopian tube from the utero tubal ostium to the fimbria and adjacent peritoneal cavity. Falloposcopy was performed without complication or evidence of endotubal damage in 44 women, 38 of whom also underwent a concurrent laparoscopy. Eight women with normal tubes served as controls and 36 women with tubal damage underwent falloposcopy in an attempt to document endotubal defects. Previous salpingectomy in 13 women and ostial obstruction in 4 cases left 71 tubes available for falloposcopy. Technical failures, defined as an inability to negotiate the tubal lumen in the absence of obstructive disease occurred in 8 of 71 (11%) procedures. In 63 successful procedures, the tubal lumen was considered to be falloposcopically normal in 28 cases (44%) and contained defects ranging from partial to total obstruction secondary to intraluminal fibrosis within the intramural, isthmic, and ampullary segments in the remaining 35 tubes (56%). Falloposcopy provides a nonincisional modality for defining the normal and abnormal surface anatomy of the tubal epithelium.

Endothelium↗
PubMed1990

Development and application of a falloposcope for transvaginal endoscopy of the fallopian tube.

A small flexible microendoscope with an outside diameter (OD) of 0.5 mm has been developed for effective visualization of the entire length of the human fallopian tube. Using a transvaginal approach, a small flexible operating hysteroscope with an OD ranging from 3.3 to 4.5 mm, was used to visualize the uterotubal ostium (UTO) for cannulation of the tube. A coaxial technique, incorporating guidewire cannulation, placement of an "over the wire" Teflon catheter, and replacement of the guidewire with a falloposcope, for video documentation of endotubal surface anatomy has been carried out without complication in 55 women who had a total of 84 tubes available for tubal endoscopy. Characterization of normal and abnormal epithelial changes has been documented for the intramural, isthmic, ampullary, and fimbrial tube. Technical difficulties related to failure to negotiate the entire tubal lumen in the absence of obstructive disease occurred in 9 (11%) of the 84 endoscopy cases. These technical difficulties have been partly overcome by the incorporation of smaller directional guidewires, softer distortion-free Teflon catheters, improved microendoscopes, and the acquisition of new surgical skills necessary for safe and successful endoscopy of the fallopian tube. Minor difficulties were experienced in 7 (8%) of 84 endoscopies due to ostial spasm secondary to attempted guidewire cannulation. Cannulation was successful once spasm ceased. Of the 75 (89%) remaining successful tubal endoscopies, documentation of endotubal lesions ranging from accumulated debris, nonobstructive intraluminal adhesions, stenosis, polyps, to total fibrotic obstruction were observed in 43 (57%) examinations. The majority (70%) of these lesions were confined to the medial third of the tube, between the UTO and ampullary isthmic junction (AIJ). The tubal lumen was considered to be endoscopically normal in 32 (42%) examinations. Techniques of tubal aquadissection (TA), guidewire cannulation (GC), wire guide dilitation, and direct balloon tubuloplasty (DBT) under hysteroscopic-falloposcopic-laparoscopic control were devised for attempting to break down intraluminal adhesions, dilate a stenosis, or open up an obstruction in 35 of the 43 tubes containing a lesion. Combinations of these tubuloplasty techniques were effective for dislodging debris, breaking down adhesions, or dilating stenoses in 16 (58%) of 29 cases and consistently ineffective for bypassing true fibrotic obstructions in 6 (100%) of 6 cases. A detailed description of the falloposcope, its accessory instrumentation, and technique of falloposcopy is outlined. Additionally, preliminary evaluation of falloposcopically directed tuboplasty techniques and their effects on tubal lesions are described. This transvaginal endoscopic technique has been termed falloposcopy and the microendoscopic instrument, a falloposcope.

Adult↗
PubMed1990

Falloposcopy. A microendoscopic transvaginal technique for diagnosing and treating endotubal disease incorporating guide wire cannulation and direct balloon tuboplasty.

Direct visualization of the entire length of the fallopian tube lumen, from the uterotubal ostium to the fimbria, using a transvaginal approach, has been achieved. Small, flexible hysteroscopes with outside diameters (ODs) ranging from 3.3 to 4.5 mm and operating channel diameters of 1.5 to 1.8 mm were used to pass guide wires, over-the-wire catheters and a falloposcope with an OD of 0.5 mm safely along the fallopian tube lumen. Forty-three falloscopy procedures were performed. The normal falloposcopic appearance of the fimbrial, ampullary, isthmic and intramural tubal epithelium was characterized in eight cases. In 35 falloposcopies, endotubal lesions were found and characterized. They included 5 cases of intramural stenosis; 10 of isthmic stenosis; 5 of isthmic obstruction; 2 of salpingitis isthmica nodosa; 10 of nonobstructive endotubal disease from intraluminal adhesions, associated devascularization and epithelial atrophy in the intramural, isthmic and ampullary segments; 2 of hydrosalpinx; and 1 of an intratubal polyp. A technique of guide wire cannulation and balloon tuboplasty under hysteroscopic-falloposcopic-laparoscopic control was developed for attempting to dilate a stenotic tube, open up an obstruction or break down intraluminal adhesions. A combination of 32 guide wire cannulation and direct balloon tuboplasty (DBT) procedures was performed. Guide wire cannulation and DBT were effective in breaking down non-obstructive intraluminal adhesions in 6/10 cases (60%), dilating intramural or isthmic stenoses in 6/15 cases (40%) and negotiating an isthmic stricture secondary to salpingitis isthmica nodosa in 1/2 cases (50%). Those procedures failed to bypass complete fibrotic obstructions in 5/5 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Catheterization↗
PubMed1989

Psychologic aspects of providing infertility services.

Psychologic issues enter into all aspects of providing infertility services. At the onset the infertile are faced with decisions regarding treatment options. Treatment involves uncertainty and lack of control and exposes the couple to the possibility of failure. The introduction of in vitro fertilization and gamete intrafallopian transfer exposes a proportion of couples to successive experiences of failure. These treatments have implications for emotional processing; some factors can increase the likelihood of impaired coping. Specific ways of dealing with the psychologic needs of infertile couples at all stages of their treatment can be helpful.

Adaptation, Psychological↗
PubMed1988

Occurrence of a spontaneous luteinizing hormone surge in superovulated cycles--predictive value of serum progesterone.

A preovulatory increase in serum progesterone (P) precedes the occurrence of an endogenous luteinizing hormone (LH) surge in a majority of women. This study evaluates whether a single daily measurement of serum P could reliably identify a spontaneous LH surge in women undergoing controlled ovarian hyperstimulation. Eighty-four infertile women received either clomiphene citrate and human menopausal gonadotropin (hMG), or hMG alone. Serum P levels were increased significantly the morning of the day of an endogenous LH surge (P less than 0.01). A 2-fold rise in the serum P levels was associated with a predictability of 64.4% of a LH surge; however, a 4-fold increase in serum P could accurately predict a spontaneous endogenous LH discharge in 93.3% (P less than 0.001) of cases.

Chorionic Gonadotropin↗
PubMed1988

An alternate approach to controlled ovarian hyperstimulation in "poor responders": pretreatment with a gonadotropin-releasing hormone analog.

Pharmacologic hypophysectomy was induced with a subcutaneous injection of leuprolide acetate before the administration of exogenous gonadotropins for multiple follicle development in 27 women who had previously responded poorly to conventional controlled ovarian hyperstimulation (COH). Pituitary desensitization occurred within 6 days and concurrent COH with exogenous gonadotropins resulted in an enhanced yield of oocytes in comparison to previous COH attempts (P less than 0.05). Fertilization and pregnancy rates also were higher with gonadotropin-releasing hormone agonist (GnRHa) treatment (P less than 0.01). The administration of leuprolide acetate effectively suppressed endogenous gonadotropin secretion when initiated in the follicular or luteal phase of the menstrual cycle. GnRHa therapy can appreciably facilitate the management of gonadotropin therapy, and increase the probability of oocyte collection and pregnancy.

Chorionic Gonadotropin↗
PubMed1987

Management of unexpected ovarian dermoid cyst during laparoscopy for oocyte pickup.

In conclusion, management of unexpected SDT during OPU include the following therapeutic goals: (1) complete eradication of the tumor to eliminate the remote possibility of malignancy and recurrence; (2) performance of adequate peritoneal lavage to prevent chemical peritonitis; (3) conservation of the maximum amount of functional ovarian tissue; and (4) exclusion of the possibility of dermoid cyst in the contralateral ovary. If laparoscopic drainage of a SDT, marsupialization, and adequate fulguration of cystic wall provide a low incidence of recurrence, the risk of oophorectomy and the necessity of laparotomy will be avoided. The aspirate contents should be examined and histopathologic confirmation of the clinical diagnosis and exclusion of a malignant process should always be performed. The laparoscopic approach must be investigated further to determine its efficacy compared with the conventional approach.

Adult↗
PubMed1982

Ovulation detection in the human.

The importance of predicting human ovulation for either optimizing or avoiding conception has been considered from an endocrine, morphological and clinical view point. Of the biochemical markers in peripheral blood, a knowledge of the LH peak is the most clearly defined, with a two to four fold increase above baseline levels for a relatively short 24-30 hour preovulatory period. Ovulation is considered to occur 28-36 hours after the beginning of the LH rise or 8-20 hours after the LH peak. Daily assessment of the rise in preovular oestrogen reflects Graafian follicle development but the rise is less distinct and spread over 3-4 days with marked day to day fluctuations. LH induces a marked reduction in oestrogen production some 12 hours prior to ovulation and at the same time induces a two to three fold increase in progesterone production above baseline levels. While these changes in themselves are not great enough for day to day discrimination, a knowledge of their reciprocal relationship may be. The preovular rise in FSH is relatively small compared to LH and the radioimmunoassay technique has not generally been refined to be as rapid and reliable. Monitoring the day to day growth of the preovular follicle ultrasonically is both linear and potentially predictable but there is a wide range of its final diameter (17-26 mm) prior to ovulation making prediction inaccurate. With further refinements in ultrasonic resolution, detection of intrafollicular changes of the cumulus oophorus and granulosal cell layer configuration and thickness may give a closer prediction of the time of ovulation. At a clinical level a knowledge of menstrual cycle length in association with body messages which herald ovulation are useful and may forewarn that ovulation in terms of days is approaching. Such markers as preovulation pain, the detection of periovular cervical mucus and the change in physical character and position of the cervix are reliable signs of preovulation for many well motivated and informed women for either promoting or avoiding conception. A knowledge of the basal body temperature is not a prospective guide to ovulation, but once the thermal shift is established in association with loss of periovular mucus symptoms, the fertile period can be considered to have passed. Because we do not have a precise and simple marker of human ovulation, it is necessary that the most suitable marker of pre- or postovulation is chosen for the particular need in a given individual.

Body Temperature↗