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Biomedical subjects

M V Sauer

Publications and source records attributed to M V Sauer.

At least 55 records · Page 3Linked to original sources
PubMed1999

Use of progesterone in assisted reproduction.

Progesterone, supplied in a variety of formulations, is commonly used in assisted reproduction. However, even the commonly accepted uses of progesterone in fertility care are believed to be largely empirical, as are the current available treatment options. While a critical balance of estrogen and progesterone is necessary for successful embryo implantation, achieving that balance is subject to differences in prescribing practice. In evaluating recommendations for the use of progesterone, discussion of its role in assisted-reproduction procedures must distinguish between known therapeutic benefits and empirical benefits.

Adult↗
PubMed1998

The impact of age on reproductive potential: lessons learned from oocyte donation.

OBJECTIVE: Oocyte donation allows a unique opportunity to separately study the effect of aging on uterine receptivity and oocyte quality. The purpose of this report is to review the published experience on reproductive aging in both laboratory animals and humans as it pertains to oocyte and embryo donation. METHODS: A review of the published medical literature. RESULTS: Natural fertility rates decline in most animals with age, becoming dramatically apparent in women as they enter the fifth decade of life. By the time of the perimenopause, pregnancy rarely occurs, whether or not assisted reproductive techniques are initiated. However, if oocytes are donated by young women to older women, both embryo implantation and pregnancy rates are restored to normal levels in recipients. CONCLUSIONS: These results strongly suggest the pregnancy wastage experienced by older women is largely a result of degenerative changes within the aging oocyte, rather than senescent changes in the uterus. The poor prognosis for fertility in older women can be reversed through oocyte donation from younger individuals.

Age Distribution↗
PubMed1998

Expectations of recipient couples awaiting an anonymous oocyte donor match.

PURPOSE: Our purpose was to survey recipients in an ovum donation program and report on their expectations while waiting for their potential donor recipient match. METHODS: Accepted or rejected anonymous ovum donor matches (n = 80) from January 1996 to May 1997 were evaluated. Patients generated a "wish list" of desired traits and physical characteristics. From an approved donor pool of medically and psychologically screened women, candidates were drawn upon as potential matches and presented to the potential recipient, who decided whether to accept the donor. Reasons for accepting or rejecting the donor were tallied and were compared to the patient's wish list. RESULTS: Medical history and race were ranked by 33 and 23% of recipient couples as the two most important characteristics, while 74 and 54% stated that these were among the three most important factors in a potential donor compared with other traits. Fifty-seven (71%) recipients accepted, while 23 (29%) rejected, the first donor presented to them. Eleven were subsequently given a second choice within 6 months, with 10 (91%) accepting the next presented match. Recipients waiting for a donor were just as likely to accept or reject a potential candidate whether waiting < 3 months (33%; 15/46), 3-6 months (25%; 4/16), or > 6 months (22%; 4/18) (P > 0.05; NS). In all but five recipients, the reason for rejection was consistent with their top three priorities reported in their wish list. CONCLUSIONS: Phenotypic, ethnic, educational, and other interests are important in the selection of an ovum donor. Recipients are proactive in their decision process, making educated and well considered decisions in spite of the limited pool and the extended time frame in waiting for an appropriate ovum donor.

Attitude↗
PubMed1998

Measuring human chorionic gonadotropin in the absence of implantation with use of highly sensitive urinary assays for intact beta-core and free beta epitopes.

OBJECTIVE: To determine if human chorionic gonadotropin (hCG) can be absorbed from the uterine cavity in the absence of an embryo. DESIGN: Prospective study. SETTING: University-based assisted reproduction program. PATIENT(S): Eight functionally agonadal patients (age range, 33-46 years) who were taking hormone replacement therapy so that they could receive donated oocytes. INTERVENTION(S): Intrauterine instillation of 50 microL of hCG (10,000 IU) during a mock cycle before an attempt at oocyte donation. MAIN OUTCOME MEASURE(S): Spot urine measurements of different hCG epitopes (intact beta, beta-core, and free beta) at timed intervals (12, 20, 44, and 68 hours after instillation). RESULT(S): All hCG epitopes were detected in the urine at the first sampling interval, and levels decreased in subsequent sampling intervals. Measurement of the serum hCG level confirmed that systemic absorption had occurred and that the urine measurements were not a result of specimen contamination through the cervix. CONCLUSION(S): hCG may be systemically absorbed into the blood through the uterine cavity, even in the absence of implantation, and its metabolites may be measured with use of highly sensitive urinary assays.

Adult↗
PubMed1998

Upper genital-tract screening with hysterosonography in patients receiving donated oocytes.

OBJECTIVE: To compare the results of sonohysterography (SHG) for imaging of the uterine cavity to hysterosalpingogram (HSG) and hysterscopy (HSC) in order to assess its clinical utility for recipients of donated oocyte. METHOD: From January 1996 to December 1996, we evaluated all patients (n = 50) referred for ovum donation using SHG and compared the results with HSG obtained within 6 months of SHG. Patients having either an abnormal SHG of HSG underwent HSC for confirmation and treatment. SHG was routinely performed during the early follicular phase using 10 cc saline instilled through an intracervical H-S catheter with concurrent vaginal sonography. RESULT: Pathology was observed and confirmed in 19 cases (38%) including polyps (n = 10, 52.6%), submucosal myomas (n = 7, 36.8%), intrauterine adhesions (n = 1, 5.3%) and bicornuate uterus (n = 1, 5.3%). SHG and HSG were concordant in 46 cases (95.8%) of which in 29 (60.4%) a normal cavity was observed, while four studies (8%) did not agree. Two polyps were missed on HSG, while two SHGs incorrectly diagnosed a calcified myoma and an endometrial fold. Using HSC for definitive identification, the accuracy of SHG was 90%, and similar to HSG. CONCLUSION: SHG appears both sensitive and highly predictive for evaluating pathology of the endometrial cavity and appears to be as effective as HSG. Advantages of SHG include improved imaging or uterine pathology, cost, greater patient comfort and the avoidance of radiation. Routine SHG of recipients uncovered a high incidence of abnormalities in older women and underscores the need to evaluate the uterine cavity prior to ovum donation.

Adult↗
PubMed1998

Follicular fluid insulin-like growth factor-I and insulin-like growth factor-binding protein-1 and -3 vary as a function of ovarian reserve and ovarian stimulation.

PURPOSE: Follicular fluid concentrations of insulin-like growth factor (IGF)-I, IGF-II, IGF-binding protein (BP)-1, and IGFBP-3 in 57 women undergoing in vitro fertilization and embryo transfer were examined to determine whether levels reflected differences in patients' exposure to gonadotropin stimulation and a diminished ovarian reserve. METHODS: Preovulatory follicular fluid was obtained from both gonadotropin-stimulated and unstimulated cycles. Subjects were grouped according to normal or decreased ovarian reserve and whether or not they received gonadotropin stimulation. RESULTS: The mean follicular fluid concentrations of IGF-I and IGFBP-1 were significantly lower in the "decreased" ovarian reserve group compared with the "normal" ovarian reserve group, with no change in estradiol or IGF-II levels. This resulted in a decreased molar IGF-I: BP ratio and an increased molar IGF-II:IGFBP-1 ratio. In unstimulated cycles, mean follicular fluid concentrations of IGFs did not differ significantly compared with those in stimulated cycles, whereas concentrations of IGFBP-1 and IGFBP-3 were significantly lower, leading to higher molar ratios of the IGFs to the binding proteins. CONCLUSIONS: Follicular fluid IGF and binding proteins vary as a function of ovarian reserve and gonadotropin stimulation. This may reflect either differences in oocyte quality or a suboptimal follicular fluid environment.

Adult↗
PubMed1998

The utility of serum progesterone and inhibin A for monitoring natural-cycle IVF-ET.

PURPOSE: Our purpose was to assess the value of monitoring serum P and inhibin A to determine how values might improve the clinical monitoring of natural cycle in vitro fertilization (IVF)-embryo transfer (ET) patients. METHODS: All patients (n = 26) who underwent natural-cycle IVF-ET (n = 35) were analyzed. Groups were evaluated according to patients who had a spontaneous luteinizing hormone (LH) surge (group I) and women receiving human chorionic gonadotropin (hCG) who underwent subsequent oocyte aspiration (group II). Group II was further evaluated according to women who did (n = 10) and did not (n = 7) have an ET. All cycles were evaluated with serial transvaginal ultrasonography and serum estradiol, progesterone, and inhibin A. When follicle maturity was achieved, hCG, 10,000 IU, was administered intramuscularly if a LH surge was not detected. Transvaginal ultrasound-guided aspiration was performed 34-36 hr after hCG administration followed by a 48-hr transcervical ET. RESULTS: No differences were seen in cycles the day prior to (d-1) and the day of a spontaneous LH surge, (n = 18) or hCG (d-0)(n = 17) in group I or group II with respect to lead follicular diameter (d-1, 15.3 +/- 0.6 vs. 14.2 +/- 0.9 mm; d-0, 17.4 +/- 0.8 vs. 17.8 +/- 0.6 mm) and serum estradiol (d-1, 148 +/- 15 vs. 150 +/- 15 pg/ml; d-0, 218 +/- 15 vs. 199 +/- 16 pg/ml), respectively. However, serum progesterone was significantly elevated in group I compared with group II on d-1 (0.82 +/- 0.6 vs. 0.48 +/- 0.04 ng/ml; P < 0.05) and d-0 (1.1 +/- 0.12 vs. 0.63 +/- 0.08 ng/ml; P < 0.05). Inhibin A was significantly greater on d-1 in group I (24 +/- 2.5 vs. 15 +/- 2.2 pg/ml; P < 0.05). In group II, cycles that resulted in an ET (n = 10) compared with group II cycles that did not (n = 7) revealed a significant difference in serum progesterone (0.51 +/- 0.05 vs. 0.7 +/- 0.07 ng/ml; P < 0.05) and inhibin A (15 +/- 2.5 vs. 37.3 +/- 5 pg/ml; P < 0.05) the day of hCG. CONCLUSIONS: The possible application of serum progesterone and inhibin A in managing natural-cycle IVF-ET is suggested. These assays may predict women who should be set up for egg retrieval, while cancelling others in spite of the absence of an LH surge.

Adult↗
PubMed1998

Operative ultrasonography for upper genital tract pathology.

PURPOSE: A procedure using transvaginal sonohysterography (SHG) to perform operative intrauterine biopsies and resections is described. METHODS: Seven women, six with intrauterine pathology noted on diagnostic SHG and one with a thickened endometrium noted on transvaginal ultrasonography, underwent attempted operative SHG. The indications were peri- and postmenopausal bleeding (n = 4) and infertility requiring assisted reproduction (n = 3). Access to the uterine cavity was accomplished with a 9-F cervical access catheter (CAC) with a 3-ml balloon (BEI Medical Systems, ZSI Gynecology Products Division, Chatsworth, CA), which was placed in the cervical canal or lower uterine segment. Depending on the position of the noted uterine pathology, a 6-F uterine ostial access catheter (UOAC) (BEI Medical Systems, ZSI Gynecology Products Division) was placed through the CAC. The uterine cavity was distended with 5-10 ml of 1% Lidocaine and a 3-F loop grasper or finger-like biopsy grasper was then passed through the UOAC or a 5-F operative instrument directly within the CAC with attempted resection under ultrasound guidance. Biopsied samples were sent to pathology for definitive diagnosis. Office hysteroscopy was then performed to confirm adequate resection. RESULTS: Three of six patients had adequate resection or biopsy of intrauterine pathology, while the seventh patient successfully had a directed biopsy of the fundal cavity under ultrasound guidance. In one case, the visualized lesion could not be grasped. In the other two cases, each patient had severe cervical stenosis and declined in-office cervical dilation precluding the procedure. Each procedure was well tolerated, with an average time from start to finish of about 25 min (range, 18-43 min) without complications. CONCLUSIONS: Operative SHG makes it possible to resect and biopsy intrauterine pathology often missed on Pipelle sampling. If found to be as effective as hysteroscopy, operative SHG would provide a cost-effective alternative. Further study is ongoing to perfect the existing instruments to allow removal of larger lesions both safe and possible.

Biopsy↗
PubMed1998

Prolonged inhibition of presynaptic catecholamine synthesis does not alter leptin secretion in normal-weight men and women.

Leptin has been called a hormone of reproduction, and seems to link fat and fertility. It has been speculated that the neurotransmitter norepinephrine (NE) (noradrenaline), possibly via the sympathetic nervous system, may represent the afferent signal which modulates leptin release from adipocytes. The purpose of this study was to produce a state of decreased sympathetic output by using the catecholamine synthesis inhibitor alpha-methyl-para-tyrosine (AMPT), in order to study the effect of this compound on the secretion of leptin from fat cells. Ten subjects (five women and five men) received a total of 5 x 1 g doses of AMPT or 5 x 50 mg promethazine (active placebo) over a 26 h period, separated by 4-6 weeks using a randomized, double-blind, placebo-controlled, cross-over design. Blood samples for hormone measurements were obtained over 24 h (18 time points) on day 2 of each experiment. Urinary measurement of the NE metabolite 3-methoxy-4-hydroxyphenylglycol (MHPG) on study day 2 served as a marker of the effectiveness of AMPT as an inhibitor of NE synthesis. The daily excretion of this metabolite decreased from 1.56 +/- 0.22 mg in the placebo experiment to 0.53 +/- 0.1 mg in the active experiment (P < 0.05). Plasma leptin concentrations measured in the control group in women and men were similar to those reported previously in lean subjects with a body mass index < 27.5 kg/m2. Leptin concentrations in women were 3-fold higher than in men. Leptin is secreted in a circadian rhythm in both sexes with an increase of nocturnal concentrations by approximately 50%. Two-way analysis of variance reveals no significant difference in leptin secretion between the control and active groups in women and men. In summary, preliminary results do not support the hypothesis that NE represents the afferent signal from the central nervous system which modulates leptin release from adipocytes in the human. Further studies are needed to define the role of the sympathetic nervous system as well as NE in the regulation of leptin secretion and its involvement in obesity and reproduction.

Adult↗
PubMed1998

Recruitment and screening policies and procedures used to establish a paid donor oocyte registry.

We have reviewed the demographic characteristics of, and report abnormalities noted in, the de-novo growth and development of a paid oocyte donation programme. The personal profiles of all prospective oocyte donors were reviewed. Acceptance or rejection of candidates was based upon screening the results of medical, genetic and psychological testing. A total of 603 candidates initially responded to our advertisement. From this pool, 313 individuals were considered suitable and contacted by telephone. Following further conversation, 176 women were scheduled an entry interview. On completion of the formal screening process, 17.6% (n = 31) of those actually interviewed were denied entry. Thus, from the initial interested parties, only 23% of women wishing to participate in oocyte donation were considered suitable candidates. Given the high attrition rate, we concluded that the need for rigorous and thorough medical, psychological and genetic testing is mandatory for the establishment of a donor registry. Furthermore, professional counselling of prospective donors with respect to the results of tests and the implications of test results with respect to their future medical and reproductive health, are important parts of providing comprehensive care.

Adult↗
PubMed1997

The addition of norethindrone acetate to leuprolide acetate for ovarian suppression has no adverse effect on ovarian stimulation.

PURPOSE: Our goal was to determine if the addition of norethindrone acetate (NETA) to leuprolide acetate (LA) has an adverse effect on controlled ovarian stimulation (COH) during in vitro fertilization (IVF). METHODS: Forty-one consecutive patients undergoing COH and IVF were divided into two groups and evaluated. Group 1 consisted of 18 patients who did not become pregnant following two cycles (one of each protocol). Group 2 consisted of 23 patients who became clinically pregnant following one cycle from either protocol. The standard protocol consisted of LA (1 mg) injected subcutaneously from the first day of menses until day 8 or when ovarian suppression was evident, at which time the dose was halved and COH was initiated. The study protocol was identical except 10 mg of NETA was given orally with LA for the first 8 days. Ovarian stimulation was similar in each protocol. RESULTS: No adverse effect on ovarian stimulation was evident on the addition of NETA to LA. No differences were noted in days of stimulation, peak estradiol (E2) level attained, peak E2-to-oocyte ratio, dosage of exogenous gonadotropins, number of aspirated oocytes, fertilization rate, or oocyte and preembryo quality. CONCLUSIONS: The addition of NETA does not attenuate COH in women undergoing IVF.

Adult↗