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Biomedical subjects

M V Sauer

Publications and source records attributed to M V Sauer.

At least 91 records · Page 5Linked to original sources
PubMed1996

The significance of elevated early follicular-phase follicle stimulating hormone (FSH) levels: observations in unstimulated in vitro fertilization cycles.

OBJECTIVE: Our objective was to determine the effect of elevated early follicular-phase serum follicle stimulating hormone (FSH) levels on follicle growth and oocyte maturity in unstimulated in vitro fertilization (IVF) cycles. STUDY DESIGN: We compared cycles with elevated day 3 FSH levels (> 20 mIU/ml) to subsequent cycles in the same patients when day 3 FSH returned to normal and to cycles among women with normal day 3 FSH levels. PATIENTS: Seven cycles in seven patients had an elevated day 3 FSH (high-FSH group). These were compared to 11 subsequent cycles in which there was a return to a normal baseline FSH and to 13 cycles in 13 patients that entered the unstimulated protocol with a normal baseline day 3 FSH. RESULTS: The day of human chorionic gonadotropin (hCG) administration was similar in all groups as were the serum estradiol (E2) levels. Although the high-FSH group tended to have smaller maximum follicular diameters, the difference was not statistically significant. The highest FSH level on cycle day 3 in a completed cycle was 56.2 mIU/ml. The total number of oocytes aspirated and the number of embryos obtained was similar in all groups. Whereas there were no pregnancies in the high-FSH group, 2 of the subsequent 11 normal day 3 FSH cycles resulted in clinical pregnancies. Two of the 13 patients in the normal day 3 FSH values also achieved pregnancies. CONCLUSIONS: We conclude that cycle day 3 serum FSH levels as high as 56.2 mIU/ml may be associated with apparently normal follicular growth, oocyte fertilization, and embryo cleavage in unstimulated cycles. However, pregnancies are not observed. In addition, FSH levels vary widely from cycle to cycle and elevated levels in one cycle do not necessarily imply that pregnancy may not occur in a subsequent cycle when FSH levels return to normal.

Blastocyst↗
PubMed1996

Successful pregnancy in a familial Mediterranean fever patient following assisted reproduction.

We conclude that untreated women with FMF have up to a 30% incidence of infertility due to ovulatory dysfunction and peritoneal adhesions. Some of these women conceive during ovulation induction with or without insemination. We have described the first case of a successful and normal pregnancy in a patient with FMF following in vitro fertilization (IVF) while on prophylaxis colchicine therapy after other treatments for infertility were unsuccessful.

Adult↗
PubMed1996

Rare occurrence of ovarian hyperstimulation syndrome in oocyte donors.

OBJECTIVES: To define the incidence and severity of ovarian hyperstimulation syndrome (OHSS) occurring in oocyte donors. METHODS: Women (n = 149) aged 31.3 +/- 4.8 years (mean +/- S.D., range 21-41 years) participated as designated oocyte donors and underwent 400 consecutive cycles of controlled ovarian stimulation using human menopausal gonadotropin following pituitary downregulation with gonadotropin-releasing agonist. Patients were monitored by serial transvaginal ultrasound examinations and serum estradiol (E2) determinations. Oocytes (15.6 +/- 7.5 per aspiration; range 2-57) were harvested by ultrasound-directed transvaginal follicle aspiration 36 h following the intramuscular injection of human chorionic gonadotropin (hCG). Follow-up examination occurred 1 and 2 weeks post-aspiration. RESULTS: On the day of hCG injection E2 levels ranged from 512 to 13,502 pg/ml (mean 2902.7 +/- 1486.9 pg/ml). Over the next few weeks the degree of hyperstimulation in donors was staged: mild 65% (grade I, n = 98; grade II, n = 162); moderate 33.5% (grade III, n = 120; grade IV, n = 14); severe 1.5% (grade V, n = 6; grade VI, n = 0). Associated preaspiration E2 levels were: grade I, 1120 +/- 424 pg/ml; grade II, 2084 +/- 613 pg/ml; grade III, 3785 +/- 1713 pg/ml; grade IV, 5370 +/- 1264 pg/ml; grade V, 4286 +/- 1100 pg/ml. Worsening OHSS was associated with increasing levels of E2. There were no serious complications and hospitalization was not required. All symptoms resolved within 30 days of aspiration, disappearing by the time of the first menstrual flow in women of grade-III or lower stage. CONCLUSION: Although oocyte donors commonly experienced exaggerated levels of serum E2 they rarely (< 2%) developed severe OHSS. This may be attributable to their lack of embryo transfer which avoids exacerbating the illness.

Adult↗
PubMed1996

Oocyte donation to women of advanced reproductive age: pregnancy results and obstetrical outcomes in patients 45 years and older.

We analysed the results of oocyte donation to women of advanced reproductive age (> or = 45 years old) and followed their pregnancies through to delivery in order to assess obstetrical outcomes. Patients (n = 162) aged 45-59 years (mean +/- SD; 47.3 +/- 3.4 years) underwent 218 consecutive attempts to achieve pregnancy. Oocytes (16.2 +/- 7.2 per retrieval) were provided by donors < or = 35 years old. Cleaving embryos (8.2 +/- 4.8 zygotes/couple) were transferred transcervically (4.5 +/- 1.1 per embryo transfer) to recipients prescribed oral micronized oestradiol and intramuscular progesterone. Following oocyte aspiration there were six instances of non-fertilization (2.8%) and 212 embryo transfers. A total of 103 pregnancies was established for an overall pregnancy rate (PR) of 48.6%, which included 17 preclinical pregnancies, 12 spontaneous abortions, and 74 delivered pregnancies (clinical PR 40.6%; delivered PR 34.9%). Multiple gestations were frequent (n = 29; 39.2% of pregnancies) and included 20 twins, seven triplets, and two quadruplets. Two of the triplet and both of the quadruplet pregnancies underwent selective reduction to twins. Antenatal complications occurred in 28 women (37.8% of deliveries) and included preterm labour (n = 9), gestational hypertension (n = 8), gestational diabetes (n = 6), carpel tunnel syndrome (n = 2), pre-eclampsia (n = 2), HELLP syndrome (n = 2), and fetal growth retardation (n = 2). 48 (64.8%) deliveries were by Caesarean section. The gestational age at delivery for singletons was 38.3 +/- 1.3 weeks (range 35-41 weeks), with birth weight 3218 +/- 513 g (range 1870-4775 g); twins 35.9 +/- 2.0 weeks (range 32-39 weeks), birth weight 2558 +/- 497 g (range 1700-3450 g); and triplets 33.5 +/- 0.7 weeks (range 32-34 weeks), birth weight 1775 +/- 190 g (range 1550-2100 g). Neonatal complications (4.6% of babies born) included growth retardation (n = 2), trisomy 21 (n = 1), ventricular septal defect (n = 1), and small bowel obstruction (n = 1). There were no maternal or neonatal deaths. We conclude that oocyte donation to women of advanced reproductive age is highly successful in establishing pregnancy. However, despite careful antenatal screening, obstetrical complications are common, often secondary to multiple gestation.

Abortion, Spontaneous↗
PubMed1996

Efficacy of oocytes donated by older women in an oocyte donation programme.

Population and insemination studies indicate that women experience declining fertility with ageing. The question therefore arises whether older women are suitable oocyte donors. This study addresses this issue by examining the relationship between oocyte donor age and clinical outcome in a large oocyte donation programme. We retrospectively reviewed data from 458 consecutive oocyte donation cycles completed by 164 different designated oocyte donors. Data were divided into two groups: group A, cycles with donors aged 21-30 years at the time of follicular aspiration (193 cycles, 88 donors); and group B, cycles with donors aged 31-40 years at the time of follicular aspiration (265 cycles, 86 donors). Five donors, because of ageing during repetitive donations, contributed data to groups A and B. In a given cycle, all oocytes for a recipient came from only one designated donor. Comparing the two donor groups, there was no difference in the amount of gonadotrophin used to achieve optimal stimulation; however, more oocytes were obtained from group A than group B donors (16.8 +/- 6.9 and 15.1 +/- 8.1 respectively, P < 0.05). Similar percentages of oocytes were fertilized in each group, resulting in the transfer of comparable numbers of embryos (4.5 +/- 1.1 and 4.4 +/- 1.3 respectively). Comparable clinical pregnancy rates were achieved (group A, 36%; group B, 37%). The spontaneous abortion rates were also similar (group A, 20%; group B, 12%), resulting in comparable ongoing and delivered pregnancy rates per cycle (group A, 29%; group B, 32%) and per embryo transferred (group A, 6.4%; group B, 7.3%). In conclusion, women of proven fertility should not be excluded from donating oocytes simply because of their age. There exists a cohort of fertile women who resist the decreasing fecundity and increasing spontaneous abortion rates associated with ageing. With careful screening, many women of proven fertility can donate oocytes until the age of 40 years with an efficacy equal to that of younger women. Given the relative shortage of suitable oocyte donors, and increasing requests from recipients with previous donor oocyte babies to obtain oocytes from the same, now older, donor, the findings of this study are of practical clinical importance.

Adult↗
PubMed1996

A combination of norethindrone acetate and leuprolide acetate blocks the gonadotrophin-releasing hormone agonistic response and minimizes cyst formation during ovarian stimulation.

A protocol utilizing both leuprolide acetate (LA) and norethindrone acetate (NETA) in subjects undergoing ovarian suppression prior to follicle aspiration proved more effective than LA alone in reducing the incidence of ovarian cyst formation without affecting clinical outcome. Patients (n = 105) undergoing ovarian stimulation followed by follicle aspiration and in-vitro fertilization (IVF) were prospectively randomized and studied. Study measures included ovarian suppression days, days of human menopausal gonadotrophin (HMG) stimulation, serum oestradiol concentrations, number of cycles developing de novo cysts (>15 mm), number of induced flare responses (day 8 oestradiol >=50 pg/ml), number of office visits, total dose exogenous gonadotrophins, number oocytes retrieved, and clinical pregnancy and delivery rates per retrieval. Patients undergoing IVF received either LA alone (n = 58; controls) or LA and NETA (n = 47; study group) for the first 8 days of their cycle. Results comparing NETA/LA versus LA demonstrated: serum oestradiol 20.7 +/- 3.9 versus 57.3 +/- 9.4 pg/ml respectively on day 8 of ovarian suppression (P P < 0.01); and only three individuals (6.4%) using NETA/LA developed ovarian cysts >15 mm compared to 15 (25.9%) controls (P < 0.01). No differences were observed for days of stimulation, peak oestradiol attained, total dosage of exogenous gonadotrophins, or number of aspirated oocytes. Neither were there differences in the clinical pregnancy (26.8 versus 22.6%) nor in delivery rates (19.5 versus 20. 8%). We conclude that the addition of NETA to LA enhances ovarian suppression and lessens ovarian cyst formation, thereby significantly decreasing the overall cost per cycle.

Adult↗
PubMed1996

Pregnancy wastage and reproductive aging: the oocyte donation model.

Women are most successful in achieving pregnancy and delivering a healthy child when in their twenties. Natural selection against conception contributes to pregnancy wastage as women age. This phenomenon is principally a result of detrimental changes occurring within the pool of available oocytes. Oocyte donation provides a unique opportunity to study the effect of individual components of the reproductive tract by isolating the uterus from the gamete. When oocytes from young women are used to create embryos for transfer to older recipients, implantation and pregnancy rates mimic those seen in younger individuals. Furthermore, following oocyte donation, the number of miscarriages and chromosomal anomalies dramatically decreases, implying that the uterus is not responsible for the poor outcomes normally experienced by women of advanced reproductive age.

Age Factors↗
PubMed1995

A new long shelf life formulation of modified Ham's F-10 medium: biochemical and clinical evaluation.

PURPOSE: To evaluate biochemically and clinically a new formulation of modified Ham's F-10 medium made without the inclusion of hypoxanthine. The medium was formulated for long-term storage and use by separately preparing a stable liquid ("basal") portion and a freeze-dried "supplement" containing the labile medium components. RESULTS: Following 18 months of storage the basal medium was biochemically analyzed for its amino acid (aa's) and vitamin content. Cysteine and tryptophan were decreased to less than 30% of their starting theoretical concentrations (STCs). Asparagine, serine, tyrosine, histidine and lysine were present at 50% to 70% of their STC. The remaining aa's were all within 90% of their STCs except arginine which was at 77%. All of the vitamins were present at 90% or more of their STCs except inositol, riboflavin and thiamine which were present at 70% of their STCs. IVF with the new formulation resulted in 13 deliveries from 51 aspirations (25%) as compared with 10/39 (26%) in 1991, when standard medium preparation was used. Oocyte donation resulted in 30 deliveries from 84 cycles (36%) with the new formulation as compared with 21/65 (32%) in 1991. CONCLUSIONS: (1) The new basal with lyophilized supplement formulation produces similar clinical results in the IVF laboratory as medium prepared in the standard fashion, (2) certain amino acids and vitamins are not stable in the liquid basal medium, and (3) the separate formulation of a liquid basal medium with lyophilized supplement is convenient, viable alternative to modified Ham's F-10 medium prepared in the standard manner (i.e., from powder) and may decrease the need for frequent medium preparation.

Amino Acids↗
PubMed1995

Triplet pregnancy in a 51-year-old woman after oocyte donation.

A triplet pregnancy occurred in a 51-year-old menopausal women after oocyte donation. Three of the four transferred embryos implanted, and the patient elected to carry the pregnancy. She delivered three viable infants weighing between 1500 and 2100 gm at 33 weeks' gestation by cesarean section.

Female↗
PubMed1995

Recipient's age does not adversely affect pregnancy outcome after oocyte donation.

OBJECTIVE: Our purpose was to examine the effect of the recipient's age on pregnancy and miscarriage rates after oocyte donation. STUDY DESIGN: A retrospective analysis of 307 consecutively performed donor oocyte cycles was undertaken. Recipients were divided into two groups: younger group < or = 42 years old (165 cycles) versus older group > 42 years old (145 cycles). Pregnancy outcomes between groups were compared. Confounding variables such as donor and cycle characteristics, recipient characteristics, and male parameters were also examined. RESULTS: Both groups had the same incidence (6%) of failed fertilization cycles. At least one embryo was transferred in the remaining 286 cycles. Ongoing or delivered pregnancy rates per embryo transfer were similar for younger and older groups (30.2% vs 30.6%). Differences in miscarriage rates were not statistically significant (9.8% vs 16.3%). There were no differences in the cycle parameters related to donor age, number of oocytes aspirated, number of oocytes fertilized, and number of embryos transferred. Donor sperm was more frequently utilized in the older group (19 vs 4 cycles, p = 0.0002). In the remaining cycles male partners of older recipients were significantly older (37.9 +/- 0.5 years vs 43.9 +/- 0.6 years, p < 0.0001), but there were no differences in semen parameters or fertilization rates. Older recipients were more likely to be parous but also to have experienced a previous miscarriage. CONCLUSION: Recipient age does not adversely affect cycle outcome with donor oocytes. This implies that aging of the uterus is not of clinical significance to patients electing this method of infertility treatment.

Abortion, Spontaneous↗
PubMed1995

Preimplantation adoption: establishing pregnancy using donated oocytes and spermatozoa.

The experience of transferring embryos produced through in-vitro fertilization (IVF) utilizing donated oocytes and spermatozoa is described. Recipients (n = 28; aged 38-59 years) received oral micronized oestradiol and i.m. progesterone and were synchronized to donors undergoing ovarian stimulation. Reasons for selecting therapy included advanced reproductive age (> 42 years; n = 21) or hypergonadotrophic hypogonadism (n = 7), combined with severe male factor infertility in 23 couples. Five women were single and without partners. Oocytes were fertilized by cryopreserved spermatozoa designated for use by the recipient. Up to five embryos were transferred transcervically. Supernumerary embryos were cryopreserved. A total of 36 aspirations produced 15.6 +/- 7.3 oocytes per retrieval. In 10/36 cycles (27.8%), embryos were available for cryopreservation. Using fresh embryos, the overall pregnancy rate was 38.9% (14/36), clinical pregnancy rate 33.3% (12/36), and ongoing/delivered pregnancy rate 30.6% (11/36). Three ongoing pregnancies were later established by transferring cryopreserved embryos. Adjusting for these events, the per aspiration overall pregnancy rate per retrieval was 47.2%, clinical pregnancy rate 41.7%, and ongoing/delivered pregnancy rate 38.9%. Implantation rates per individual embryo transferred were 16.6% following fresh embryo transfer. A viable pregnancy was achieved by 14 of 28 women (50% cumulative pregnancy rate). We conclude that using donor oocytes and donor spermatozoa is efficacious and allows couples of whom both members suffer from severe gamete abnormalities and single functionally agonadal women an effective means of achieving pregnancy.

Adoption↗
PubMed1995

Altered responses to stress in women undergoing in-vitro fertilization and recipients of oocyte donation.

Clinical impressions suggest the presence of considerable anxiety and depression in infertile couples. We utilized a psychological stress test to assess adaptations to provoked stress to improve the psychological profile of infertile women. A psychological stress test was administered to four groups: normal menstruating females (controls, n = 13); oocyte donors (n = 13); recipients of oocyte donation (n = 7); and women undergoing standard in-vitro fertilization (IVF; mean age 38.0 years; n = 8). The psychological stress test consisted of three active coping tasks: (i) serial subtraction, (ii) Stroop colour test, (iii) speech task and (iv) one passive coping task, the cold-pressor test. Haemodynamic responses (HD) were monitored before, during and after the psychological stress test, and serum samples were drawn for catecholamines and cortisol. Baseline blood pressures were similar among groups. The psychological stress test elicited different biophysical responses in controls compared with the other groups (P < 0.001). Oocyte donors had different speech task responses from baseline, although these and the other parameters of the psychological stress test were not different from either the recipient or IVF groups. Blood pressure responses from baseline were blunted in both recipients and standard IVF patients following provoked stress. Baseline cortisol and norepinephrine were similar among all groups, yet provoked stress elicited a significant increase in controls (142.0 +/- 25.2%, P < 0.001) compared with oocyte donors (17.1 +/- 19.7%), recipients and standard IVF patients (mean -15.5 +/- 17.3% respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Isolated polycystic morphology in ovum donors predicts response to ovarian stimulation.

The isolated finding of polycystic-appearing ovaries on ultrasound examination of normal women is not uncommon. The purpose of this study was to determine the clinical significance of polycystic ovaries in a population of healthy, non-hirsute, fertile women preparing to undergo ovarian stimulation. We evaluated whether the finding of polycystic ovaries in oocyte donors predicts a different response to ovarian stimulation when compared to donors with normal-appearing ovaries. Furthermore, we examined whether oocytes from polycystic ovaries had the same capacity for fertilization and development as those retrieved from normal ovaries. In all, 11 donors with polycystic-appearing ovaries were compared prospectively to 13 donors with normal-appearing ovaries who were undergoing ovarian stimulation during the same time interval. The two groups were similar in age and baseline androgen concentrations. Significantly more oocytes were produced by the polycystic group for the amount of human menopausal gonadotrophin (HMG) administered (P < 0.05). In addition, all previous cycles completed by these 24 donors were compared (polycystic group: total of 31 cycles; normal group: total of 37 cycles). The donors with polycystic ovaries required less HMG to obtain optimal stimulation (P < 0.05), attained a greater peak oestradiol concentration (P < 0.05), produced a greater number of follicles (P < 0.05) and oocytes (P < 0.01) and a higher percentage of mature oocytes (P < 0.05). Furthermore, they achieved a higher peak oestradiol/HMG (P < 0.01) and oocytes/HMG ratio (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Cysts↗
PubMed1995

Predictive value of serum oestradiol concentrations and oocyte number in severe ovarian hyperstimulation syndrome.

Ovarian hyperstimulation syndrome (OHSS) is a serious complication of gonadotrophin usage but it is difficult to accurately predict its occurrence. Previous investigators have identified the combination of high oestradiol concentrations and oocyte number as being predictive in 80% of cases. In this study we sought to identify the incidence of severe OHSS in patients with high oestradiol concentrations and large numbers of oocytes and to evaluate the importance of pregnancy in the development of OHSS. Between 1990 and 1993, we studied 139 cycles using two assisted reproductive techniques [oocyte donor, n = 72; in-vitro fertilization (IVF), n = 67] in which either oestradiol (> 4000 pg/ml), oocyte number (> 25), or both were elevated. OHSS was diagnosed by standard criteria. There were no cases of severe OHSS in the oocyte donor group and six in the IVF group. Among 10 patients with oestradiol concentration > 6000 pg/ml and > 30 oocytes, only one had OHSS (10%). The relative risk of OHSS with pregnancy was 12 (confidence interval 2.18-66.14). We conclude that the risk of OHSS even at high levels of stimulation is lower than previously believed. Secondly, donors have a very low risk of OHSS, probably because of the absence of pregnancy. As such, cryopreservation of all oocytes in IVF cycles is a reasonable alternative to cycle cancellation or use of adjunctive medication.

Cell Count↗
PubMed1995

Oocyte and embryo donation.

Oocyte and embryo donation has become increasingly common over the past 10 years. Today, it is successfully used to treat women with a variety of disorders, including ovarian failure, avoidance of genetic disease transmission, declining ovarian function, poor oocyte quality following conventional assisted reproduction, and age-related infertility. Success rates do not appear to vary with the recipient's age or diagnosis, with live birth rates in the 25-35% range. Oocyte and embryo donation represent the most efficacious method of assisted reproduction.

Adult↗