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Biomedical subjects

J Mandelbaum

Publications and source records attributed to J Mandelbaum.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Multiple pregnancies prevention in in vitro fertilization: limiting the number of transferred embryos to two maximum?].

The success of an IVF-programme is mainly linked to the number and quality of embryos transferred as well as women's age, but the incidence of obstetrics complications rises significantly with the number of fetuses. Reducing the number of embryos transferred is therefore recommended in order to avoid the medical, social and financial problems associated with multiple births. Present data suggest that, when at least three embryos of good quality are available, the pregnancy rate already reaches its maximum value when two embryos are transferred. A third one merely increases the number of triple pregnancies. Further studies are needed to conclude, especially in the cases of poor quality embryos.

Adult↗
PubMed1996

[Oocyte donation -- embryo donation].

From 1993 to 1995, 82 donors have permitted the retrieval of 810 oocytes allowing to obtain 411 embryos. 95 receiving couples have been included : 30 obtained a pregnancy, 7 abandoned and 38 are waiting for a transfer. The rate of pregnancies by transfer is superior to the one observed with the transfer of frozen embryos (40.5% versus 27%).

Adult↗
PubMed1995

Monozygotic triplet pregnancy following transfer of frozen-thawed embryos.

We report a case of monozygotic triplet pregnancy after the transfer of three frozen-thawed embryos. The outcome of the pregnancy was the birth of three healthy normal boys. The pregnancy was a monochorionic triamniotic triplet pregnancy. This is the first such case of triplets, although it seems that zygote splitting is significantly more common than normal in patients undergoing in-vitro fertilization.

Adult↗
PubMed1995

[Monozygotic triplet pregnancy after transfer of frozen embryos].

We report a case of monozygotic triplet pregnancy after transfer of 3 frozen thawed embryos. The pregnancy ended by the birth of 3 healthy normal boys and all the analysis showed that it was really a monochorionic triamniotic triplet pregnancy, that as far as we know is the first reported one induced by frozen thawed technics. We shall discuss: the etiology of monozygotic pregnancies after IVF; the sonographic diagnosis of placentation; the obstetrical care which allowed the birth of 3 healthy normal boys.

Adult↗
PubMed1994

Psychological aspects in anonymous and non-anonymous oocyte donation.

A study, in which 110 patients were screened by a psychoanalyst, included 69 recipients who chose non-anonymous oocyte donation, i.e. they received oocytes from a known donor, most frequently a sister or a close relative. Another 41 recipients received anonymous oocytes, but had to bring a donor. Psychological motivations for either choice are reported, and significant topics such as attitudes towards confidentiality and links to the child are compared. No specific psychopathology is reported at this stage. An additional study on children born by these techniques is ongoing.

Adult↗
PubMed1993

Granulosa cells improve human embryo development in vitro.

A total of 17 couples with repetitive implantation failure after transfer of fresh or frozen-thawed embryos had half of their zygotes cultured in standard conditions and frozen at day 2 after insemination, and the other half cocultured with autologous granulosa cells and transferred at the morula or blastocyst stage at day 5 or 6 after oocyte retrieval. At the end of the culture period, supernatants of cocultures were recovered for steroid assays. Monolayers were stained for granulosa cell growth and morphological assessment. We observed that granulosa cells improve embryo development in vitro since 32 out of 60 (53%) reached the morula stage and 18 (30%) the blastocyst stage, leading to a total of 83% embryos available for transfer (compared with 3% without coculture). The ongoing pregnancy rate of these patients who were selected because they had at least three previous implantation failures, is only 5.9%, however, which is similar to the control group without coculture (6.3%). To conclude, granulosa cells improve embryo development but not the pregnancy rate after transfer of cocultured embryos in patients with multiple previous implantation failures.

Adult↗
PubMed1993

Co-culture with granulosa cells does not increase the fertilization rate in couples with previous fertilization failures.

Ten couples included in our in-vitro fertilization programme, selected because of one of more previous total fertilization failures or a low fertilization rate (< 20%), were entered in an experimental protocol of egg insemination on autologous granulosa cells. Half the oocytes from each patient were randomly assigned to either a control or a co-culture group. We observed no difference in the fertilization rate between the control (16.2%) and co-culture groups (12.1%). Only two couples benefited from this technique since fertilization was obtained only in co-culture. The poor efficiency of this protocol led us to propose the use of sperm micro-injection if all classical attempts to improve fertilization were unsuccessful.

Cells, Cultured↗
PubMed1993

[Hyperstimulation for in vitro fertilization with the "step-down" technique. Preliminary results from a prospective randomized study with and without LHRH agonists].

Twenty six normo-ovulatory patients < 38 years with tubal or idiopathic infertility and normal sperm were treated for IVF by FSH +/- hMG and randomized into four groups: with and without LHRH agonist, "step-up" or "step-down" stimulation. In the step down protocol, after 4 days with 4 amps plasmatic FSH reached its top level, then decreased. Despite reduction to only two amps, estradiol continued to increase in all the 5 women without agonist, whereas 3/7 with the long protocol were considered as low responders and stopped. The fertilization/cleavage rate was 69.2% in step-down and 45.7% in step-up (p < 0.04) with the short protocol, and respectively 65.6% and 41.9% (p < 0.03) with the long one. The pregnancy rate was equivalent in all groups.

Adult↗
PubMed1992

Hormonal secretions in singleton pregnancies arising from the implantation of fresh or frozen embryos after oocyte donation in women with ovarian failure.

OBJECTIVE: To determine whether levels of human chorionic gonadotropin (hCG), 17 beta-estradiol (E2), and progesterone (P) are different in the peri-implantation phase of fresh versus frozen embryos. DESIGN: Hormonal secretions were measured on days 9 and 11 after implantation and at 4, 5, and 6 weeks gestation. PATIENTS: Thirty-one pregnancies were achieved in 65 patients with ovarian failure. Seventeen singleton pregnancies developed after implantation of 4 frozen and 13 fresh embryos. RESULTS: Human chorionic gonadotropin and E2, contrary to P, were higher in cases of fresh embryos from the 9th day after transfer to the 5th week at which time they become statistically significant (respectively, for hCG and E2, 5,800.3 +/- 332.3 versus 2,027.3 +/- 916.3 [mean +/- SD] mIU/mL for hCG and 562.3 +/- 215 versus 291 +/- 152 pg/mL for E2). CONCLUSIONS: This difference might be explained by either the higher number of fresh embryo replaced or by the fact that the number of blastomeres and also their metabolic activity could be reduced after freezing and thawing.

Adult↗
PubMed1992

Is there an indication for embryo reduction?

The selective reduction of embryos in multiple pregnancies poses numerous medical, technical, ethical and psycho-social problems. In a retrospective study, we analysed nine hundred and twenty-two pregnancies obtained using medically assisted procreation between May 1982 and May 1990. Among 922 successful pregnancies, 372 were singleton, 102 were twin and 13 were triplet. Data from this analysis and from a French multicentre study of 262 embryo reduction procedures demonstrated the value of an embryo quality score for minimizing the risk of multiple pregnancy and the existence of extremely infrequent, ethically acceptable indications for embryo reduction. These indications included ultrasound-proven malformations of one fetus, multiple pregnancies in patients with extensive uterine scarring, and multiple pregnancy despite the appropriate use of preventative measures which can be expected to make this technique unnecessary in the future.

Abortion, Therapeutic↗
PubMed1992

Obstetric evolution of pregnancies obtained from donated oocytes.

Of 44 pregnancies obtained at the Tenon Maternity Hospital by in vitro fertilization (IVF) using donated oocytes, 25 have already been completed by spontaneous delivery or cesarean section: 22 (88%) single; 2 (8%) twins, and 1 (4%) triple. The most frequently seen complications of pregnancy were hypertension (16%) and preterm labor in the last 3 months (12%). However, as compared to a control group of 275 pregnancies resulting from classical IVF, the only difference was a very high percentage of cesarean sections (72%). No fetal deaths or neonatal malformations were reported.

Adult↗
PubMed1992

[Prognostic value of preovulatory elevations of plasma progesterone during in vitro fertilization using LHRH agonists in a long protocol].

We retrospectively analyzed the prevalence and prognostic significance of plasma progesterone rises during in vitro fertilization (IVF) protocols including pituitary down-regulation by LHRH agonists in a long protocol and stimulation by hMG (n = 1,116: Group A) or pure FSH (n = 178: Group B). On the day of hCG injection, plasma progesterone level was in the 0.60-0.99 ng/ml range in 7.1% of group A patients and 6.2% of group B patients (NS) and above 1 ng/ml in respectively 4.0% and 3.4% of the cases (NS). On the same day, plasma progesterone was strongly correlated with plasma estradiol (r = 0.26 - p < 0.001 in group A; r = 0.21 - p < 0.01 in group B). However, increased progesterone levels were not associated with changes in plasma LH levels, falls in plasma estradiol levels after hCG injection, or significant modifications in biological and clinical results of IVF. The cause of this pattern of progesterone rise remains to be elucidated.

Buserelin↗
PubMed1991

Cryopreservation of oocytes and embryos.

In humans, embryo cryopreservation is now a widespread routine procedure, both reliable and flexible. It can successfully be applied to excess embryos, arising from in vitro fertilization, at any developmental stage. The role of gonadotropin-releasing hormone analogues in embryo freezing has given rise to much controversy, whereas in oocyte donation, systematic embryo cryopreservation reduces the efficacy of the whole procedure. New ultrarapid techniques led for the first time to viable pregnancies. Whereas technical goals are being achieved, social and legal problems arise that cannot be neglected, concerning the fate of embryos in storage in case of conflicting situations. Oocyte cryopreservation is rather disappointing at present, and many studies highlight the risks of cryoinjury to the zona pellucida, the meiotic spindle, and other cytoskeletal cell structures. New insights into freezing isolated primordial mouse follicles provide alternate research prospects to store the female gamete.

Cryopreservation↗
PubMed1990

Oocyte maturation, fertilization and embryonic growth in vitro.

As the oocyte develops into an embryo, cytological and metabolic events follow one another in an accurate and successive sequence. Meiosis resumes in the ovarian follicle, parallel to cytoplasmic and membrane maturation, from the onset of the ovulatory LH discharge. Only a fully mature oocyte will be recognized and penetrated by a fertilizing sperm, to ensure rapid and synchronous male and female pronuclear growth and early embryonic development. In vitro, the resumption meiosis is easily obtained once the oocyte is withdrawn from the inhibitory influence of the follicle. Cytoplasmic and membrane maturation may however be impaired, leading to fertilization failures or anomalies such as triploidy and even impaired embryo viability. Human in vitro fertilization is nowadays routinely carried out with a high success rate, but in vitro embryonic growth to the blastocyst is still unsatisfactory even with oocytes matured in the ovary, and major improvements are needed to reach optimal viability. Many studies have now been published on human oocyte maturation, fertilization and the growth of embryos in vitro. We give only a brief account of them, due to limited space, and have therefore included topics of most relevance to assisted conception as opposed to those more involved with academic research.

Embryo, Mammalian↗
PubMed1990

Treatment of hyperstimulation during in-vitro fertilization.

In 33 patients treated with a combination of an LHRH agonist (LHRH-A) and gonadotrophin in a long protocol, a biological hyperstimulation occurred (E2 greater than 2500 pg/ml on the day of HCG administration and 4722 +/- 1190 pg/ml the day after, with greater than 10 follicles greater than 12 mm on each ovary). The replacement of fresh embryos were deferred and LHRH-A was continued, and an endometrial biopsy was performed on the theoretical day of replacement (2 days after oocyte recovery). With this technique, we obtained a mean number of 17.9 +/- 7 oocytes, a fertilization rate of 49% and a replacement rate of 87% in a deferred cycles. The overall pregnancy rate of frozen-thawed embryos was 27% in the seven spontaneous cycles, 12 induced cycles and 10 artificial cycles. Only one severe hyperstimulation occurred and this case emphasizes that caution remains necessary even with this technique.

Embryo Transfer↗