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Biomedical subjects

M V Sauer

Publications and source records attributed to M V Sauer.

At least 109 records · Page 6Linked to original sources
PubMed1995

Pregnancy in women 50 or more years of age: outcomes of 22 consecutively established pregnancies from oocyte donation.

OBJECTIVE: To describe the reproductive and obstetric outcomes of women > or = 50 years attempting pregnancy using donor oocytes. SETTING: The IVF program at the University of Southern California. PATIENTS: Thirty-six postmenopausal women aged 50 to 59 years, mean 52.3 +/- 2.6 years (mean +/- SD) were screened medically, reproductively, and psychologically and enrolled in a trial of oocyte donation. INTERVENTIONS: Recipients underwent hormone replacement therapy using oral micronized E2 and IM administered P. Oocytes were provided by designated gamete donors (mean age 30.5 +/- 4.4 years). Embryos (4.3 +/- 1.2) were transferred transcervically. MAIN OUTCOME MEASURES: Rates for embryo implantation, spontaneous abortion, ongoing and delivered pregnancies, as well as the gestational age at delivery, birthweights, complications, and postpartum outcomes. RESULTS: Forty-five aspirations resulted in 22 pregnancies (48.9%): 3 preclinical, 2 ending in spontaneous abortion, and 17 viable pregnancies (37.8%). The embryo implantation rate was 20.6%. Nine of 17 pregnancies (52.9%) were multiple gestations (6 twins; 1 triplet; and 2 quadruplets, selectively terminated to twins). All pregnancies delivered beyond 32 weeks: mean gestational age for singletons was 38.4 +/- 1.9 weeks (range 35 to 41 weeks); mean gestational age for twins was 36.3 +/- 1.4 weeks (range 34 to 38 weeks); the triplet pregnancy delivered at 32 weeks. Complications occurred in eight patients; gestational hypertension (n = 7), preterm labor (n = 3), gestational diabetes (n = 2), and pre-eclampsia (n = 1). One infant was trisomy-21. CONCLUSION: Patients > or = 50 years experience similar pregnancy rates after oocyte donation as younger women and are at equal risk for multiple gestation. Antenatal complications were experienced by the majority of patients, underscoring the importance of high risk obstetric surveillance and care.

Birth Rate↗
PubMed1995

Multiple implantation after oocyte donation: a frequent but inefficient event.

OBJECTIVE: To evaluate the natural history of multiple implantation in a donor oocyte program. DESIGN: Retrospective review of clinical pregnancies resulting from donor oocytes with analysis of serial vaginal ultrasound examinations beginning 21 days after embryo transfer. SETTING: University of Southern California IVF program (USC-IVF). MAIN OUTCOME MEASURES: Number of implantation sites lost during gestation, furthest development of the gestation, and clinical symptoms of those experiencing loss. RESULTS: Sixty-two of 101 patients (61%) who became pregnant had multiple implantations, 41 (41%) with two sacs, 12 (12%) with three sacs, 6 (6%) with four sacs, and 3 (3%) with five sacs. Overall 28% of implantations sites were lost spontaneously. Rates of loss were similar for multiple implantations. The majority (62%) of these nonviable sacs did not develop beyond a gestational sac. All patients with three or more implantation sites had ongoing pregnancies through the first trimester. The probability of pregnancy loss after visualization of fetal heart motion was 5.7%. Few patients who underwent a natural self reduction of sacs were symptomatic. CONCLUSIONS: There is a significant self-reduction in multiple implantation sites in a donor oocyte program. This may obviate the need for a selective reduction procedure. Patients should be followed for up to 10 weeks after ET before committing to a selective reductive procedure.

Abortion, Spontaneous↗
PubMed1995

Angiotensin-converting enzyme inhibition reverses luteal phase steroid production in oocyte donors.

OBJECTIVE: To determine whether angiotensin-converting enzyme (ACE) inhibition would affect ovarian steroid synthesis in the oocyte donors undergoing controlled ovarian hyperstimulation (COH). SETTING: The IVF program of the University of Southern California. DESIGN: Prospective matched clinical trial. PATIENTS: Twelve oocyte donors were studied in 28 hyperstimulation cycles. INTERVENTIONS: Donors underwent a standard COH protocol. Follicle aspiration was performed 34 hours after administration of hCG. After the procedure, seven donors were administered the ACE inhibitor, captopril, 6.25 mg orally twice daily for 4 days. The remaining patients served as controls. MAIN OUTCOME MEASURES: Serum E2, P, plasma prorenin, active renin, and angiotensin II (Ang II). RESULTS: Angiotensin II increased after aspiration in both groups but was significantly lower in those receiving captopril. Peak P in the captopril group was significantly lower than controls (81.8 +/- 27.8 versus 208.5 +/- 23.9 ng/mL [conversion factor to SI unit, 3.180]). Peak E2 was significantly higher (2,222.4 +/- 875.3 versus 425.6 +/- 490.4 pg/mL [conversion factor to SI unit, 3.671]). Active renin and Ang II correlated with P. CONCLUSIONS: In stimulated cycles, inhibition of Ang II production appears to raise serum E2 and lower P levels. Angiotensin II, therefore, may have a role in the regulation of ovarian steroid synthesis.

Adolescent↗
PubMed1995

Spontaneous pregnancy in women awaiting oocyte donation.

OBJECTIVE: To evaluate the rate of spontaneous pregnancy in women awaiting oocyte donation. STUDY DESIGN: Two hundred women with histories of hypergonadotropic hypogonadism (follicle-stimulating hormone > 60 mIU/mL, estradiol < 20 pg/mL) were evaluated for oocyte donation. RESULTS: While awaiting gamete donation, five women (2.5% of patients monitored) spontaneously conceived. Their ages ranged from 32 to 42 years (mean, 37.0 +/- 5.0) (mean +/- SD). Conceptions occurred 5.0 +/- 2.6 years (range, two to eight) from their original diagnosis, while they were using hormone replacement therapy. Four of the five pregnancies continued uneventfully, and one patient spontaneously aborted. Subsequently all women demonstrated elevated serum gonadotropins and amenorrhea. CONCLUSION: Patients with hypergonadotropic hypogonadism may spontaneously conceive while awaiting oocyte donation.

Adult↗
PubMed1995

Association of early beta-human chorionic gonadotrophin values with pregnancy wastage and multiple implantation in a donor oocyte programme.

An early marker predictive of a viable pregnancy would ease the anxiety associated with positive pregnancy tests after the use of donor oocytes. We examined the predictive value of an early serum quantitative human chorionic gonadotrophin (Q-HCG) concentration on pregnancy outcome following oocyte donation. Embryo transfers after oocyte donation resulting in a positive serum beta-HCG were examined beginning 9 days after embryo transfer from those samples assayed in our laboratory (n = 77). Q-HCG concentrations were measured in our laboratory by an immunoradiometric assay utilizing the first International Reference Preparation. Implantations were defined as the number of gestational sacs visualized by transvaginal ultrasound 21 days after embryo transfer. Biochemical pregnancies were those with transient elevations in beta-HCG concentration but without implantation sites. Spontaneous abortions were characterized by an implantation site with the eventual arrest of development. Ongoing/delivered pregnancies developed appropriately and proceeded beyond the first trimester. Day 9 Q-HCG concentrations did not differentiate between biochemical pregnancies/spontaneous abortions and ongoing/delivered pregnancies, although mean +/- SD concentrations for biochemical pregnancies were significantly lower than those for the other groups (P < 0.0001): biochemical pregnancies, n = 18, 5.8 +/- 8.9 mIU/ml, range 0-35; spontaneous abortions, n = 2, 46.0 +/- 10.0 mIU/ml, range 39-53; ongoing/delivered pregnancies, n = 57, 41.5 +/- 35.4 mIU/ml, range 0-214. In addition, day 9 Q-HCG concentrations did not differentiate between multiple implantations, although the implantation of four sacs had a significantly higher mean Q-HCG concentration compared with the implantation of fewer sacs (P < 0.0001): one sac, n = 22, 32.2 +/- 21.5 mIU/ml, range 3-78; two sacs, n = 25, 35.8 +/- 21.3, range 0-81; three sacs, n = 7, 47.1 +/- 37.1 mIU/ml, range 22-126; four sacs, n = 4, 122.3 +/- 62.4 mIU/ml, range 76-214. The positive predictive value of a Q-HCG > 10 mIU/ml was 0.91 (sensitivity 91%, specificity 75%). These initial data suggest that early day 9 serum Q-HCG determinations do not accurately identify viable pregnancies or multiple implantations. Even an early negative pregnancy test should be repeated because it can be associated with a normal pregnancy.

Abortion, Spontaneous↗
PubMed1994

Serum progesterone monitoring in post-molar surveillance.

Serial serum progesterone and beta human chorionic gonadotropin (beta hCG) levels were measured during surveillance of 24 women at risk for development of gestational trophoblastic neoplasia (GTN) following evacuation of complete molar gestations. Six of the 24 patients developed post-molar GTN. The initial median progesterone level of 76 ng/ml in these six patients drawn at evacuation was significantly higher than the median of 18 ng/ml in those not developing GTN (P = 0.026). Additionally, the serum progesterone decreased to < 5 ng/ml within a week of evacuation in 16/18 patients without GTN. In 5/6 GTN cases, levels of progesterone remained > 5 ng/ml for > or = 3 weeks of the surveillance period (P < 0.05). Serum beta hCG levels required 4-11 weeks of surveillance to distinguish between non-persistent cases and GTN. We conclude that serial serum progesterone levels measured during post-molar surveillance parallel beta hCG regression.

Biomarkers, Tumor↗
PubMed1994

Addition of a gonadotropin releasing hormone (GnRH) antagonist and exogenous gonadotropins to unstimulated in vitro fertilization (IVF) cycles: physiologic observations and preliminary experience.

PURPOSE: To describe our preliminary experience with the addition of a GnRH antagonist (Nal-Glu) and exogenous gonadotropins (follicle stimulating hormone; FSH) to unstimulated IVF cycles. METHOD: Seven spontaneously ovulatory women underwent eight unstimulated IVF cycles at our institution. They were treated with a single dose of Nal-Glu, 50 micrograms/kg, or with a combination of Nal-Glu, 50 micrograms/kg, and exogenous FSH, 150-300 IU, during the late follicular phase of spontaneous cycles. They then received 10,000 IU of human chorionic gonadotropin (hCG) to time accurately follicle aspiration in unstimulated IVF cycles. RESULTS: Two women underwent three cycles with Nal-Glu alone on the day of hCG administration. One pregnancy resulted. Five women underwent five cycles with 3 to 6 days of daily Nal-Glu and FSH. Four of these cycles resulted in aspiration after the FSH dose was increased to 300 IU. Nal-Glu and FSH allowed continued development of the dominant follicle without the occurrence of luteinizing hormone (LH) surge. CONCLUSIONS: (1) Nal-Glu alone given 18 hr prior to hCG did not interfere with continued follicle viability or with the attainment of pregnancy. (2) Simultaneous Nal-Glu and FSH allowed for continued growth and development of the dominant follicle without the occurrence of an LH surge. (3) This preliminary experience confirms the feasibility of this novel approach, which may ultimately enhance the efficacy of unstimulated IVF cycles by eliminating premature ovulation and maximizing control of gonadotropin delivery to the developing follicle.

Adult↗
PubMed1994

Failure to comply with hormone replacement may jeopardize pregnancies in functionally agonadal women: a series report.

In conclusion, these three functionally agonadal patients illustrate that discontinuing hormone support may have disastrous effects upon early pregnancy. Patients should be educated as to the importance of utilizing medications correctly. In cases where compliance is an issue, embryo transfer should be delayed. If compliance is questioned, a serum progesterone or estradiol measurement should confirm clinical suspicions.

Adult↗
PubMed1994

Three hundred cycles of oocyte donation at the University of Southern California: assessing the effect of age and infertility diagnosis on pregnancy and implantation rates.

PURPOSE: Our purpose was to evaluate the effect of age on endometrial receptivity and to compare success rates for oocyte donation among groups with differing primary diagnoses. DESIGN: This was a retrospective analysis of 300 consecutively attempted oocyte donation cycles. SETTING: The setting was the in vitro fertilization program at the University of Southern California. METHODS: Recipients were divided into groups according to age: Group I, < 30 years (n = 8); Group II, 30-39 years (n = 59); Group III, 40-49 years (n = 107); and Group IV, 50-59 years (n = 18). Additionally, indications for treatment were divided into Classes A-G according to a primary diagnosis given to each patient and included premature ovarian failure (n = 44), surgical castration (n = 9), genetic disease carrier (n = 12), transitional menopause (n = 27), natural menopause (n = 30), multiple IVF failures (n = 62), and postchemotherapy (n = 8). Recipients received oral micronized estradiol and intramuscular progesterone. Oocytes were donated by fertile young women utilizing ovarian hyperstimulation with menopausal gonadotropins. RESULTS: There were no significant differences among groups or classes related to either the number of oocytes received or the number of embryos transferred per cycle. Rates for embryo implantation and resorption and the clinical and ongoing or delivered pregnancy rates were similarly not different among patients except for women who previously received chemotherapy, where a significantly elevated rate of spontaneous abortion was noted P < 0.05). CONCLUSIONS: The establishment of pregnancy utilizing oocyte donation is not adversely affected by the chronological age of the recipient, inferring that the age-related decline in fertility is due primarily to oocyte aging, and not to loss of endometrial receptivity. Also, prior exposure to chemotherapy may alter endometrial integrity and lead to greater pregnancy wastage in women receiving donated embryos.

Abortion, Spontaneous↗
PubMed1994

The demographic characterization of women participating in oocyte donation: a review of 300 consecutively performed cycles.

OBJECTIVES: To define the demographic characteristics of women participating as oocyte donors and recipients in a gamete donation program. The study took place in the in vitro fertilization program of the University of Southern California (USC-IVF) and all women who underwent controlled ovarian hyperstimulation for the sole purpose of gamete donation (n = 110), and the recipients of the donated gametes (n = 192) were included. METHODS: Demographic characteristics were tallied for each of the above mentioned groups and reported as means +/- S.D. or as percentages as appropriate. Comparisons between recipients were made according to age groups defined by 10-year age intervals. RESULTS: Oocyte donors were most commonly married mothers in their late twenties who were fully employed. The majority (74%) proffered services anonymously. Recipients differed significantly by age group, with younger patients (< 30 years) being more likely to have been married only once, never to have been pregnant and unlikely to have had previous infertility care. This contrasted with women > 40 years old who were often remarried, likely to have undergone an elective termination of pregnancy, and usually a recipient of extensive infertility care prior to attempts at oocyte donation. CONCLUSIONS: In cases where solicitation of services has not occurred, women donating oocytes may best be described as married, employed, middle class mothers whose primary motivation for participation appears to be altruistic. Significant demographic differences exist between recipients of donated oocytes, which appeared to be age related.

Adult↗
PubMed1994

Mishaps and misfortunes: complications that occur in oocyte donation.

Despite careful screening and the adherence to strict protocol, approximately 2% of initiated cycles of oocyte donation were found to be complicated by difficulties incurred by oocyte donors. The risk of these adverse events appeared to be limited to the initial trial of donation with experienced donors being more reliable. Thus, surveillance of the cycle's progress should be maximal during this time. Both donors and recipients need to be aware of the unique problems posed by oocyte donation to provide full informed consent. This includes the possibility for unplanned pregnancies when discontinuing the donors' usual method of contraception. These mishaps underscore the importance of reminding patients that cycle success cannot be guaranteed, and unexpected complications cannot be entirely avoided.

Female↗
PubMed1994

Pharmacokinetics and endometrial tissue levels of progesterone after administration by intramuscular and vaginal routes: a comparative study.

OBJECTIVE: To determine pharmacokinetic and endometrial effects of vaginally delivered micronized P. DESIGN: Functionally agonadal estrogen-replacement recipients received either micronized P administered vaginally or bi-daily IM injections of P. Hourly blood samples were obtained, from baseline to 6 hours after the initial dose of P and again on simulated cycle day 21 when transvaginal ultrasound (US) measurements and tissue samples of the endometrium were performed. Blood and tissue samples were assayed for P. Endometrial histology, estrogen receptor (ER) and P receptor (PR) contents were evaluated. SETTING: University of Southern California School of Medicine, Los Angeles, California. PARTICIPANTS: Twenty functionally agonadal and four normally ovulating women. MAIN OUTCOME MEASURE: Delivery differences were assessed by [1] endometrial P concentrations; [2] USs; [3] histologic datings; [4] ER and PR contents, and [5] serum P levels. RESULTS: Endometrial P concentrations were higher with vaginally administered P than endometrial concentrations observed in normal ovulatory women or women who consistently had the highest serum P after IM administration (11.50 +/- 2.60 versus 1.40 +/- 0.40 versus 0.30 +/- 0.10 ng/mg protein [36.56 +/- 8.27 versus 4.45 +/- 1.27 versus 0.95 +/- 0.32 nmol/L], respectively). After 7 days of P, no differences between either treatment regimen and control groups were detected by histologic, ultrasonographic, or immunocytochemical receptor analyses. CONCLUSION: Vaginal micronized P enhances P delivery to the uterus compared with a standard IM regimen and results in a synchronous secretory endometrial histology in agonadal women preparing for embryo donation.

Administration, Intravaginal↗
PubMed1994

Factors affecting pregnancy success of human in-vitro fertilization in unstimulated cycles.

Successful pregnancies have recently been reported in cycles of unstimulated in-vitro fertilization (IVF) which is a simplification of the standard IVF approach utilizing ovarian stimulation. The purpose of this study was to analyse retrospectively the results of the first 3 years of unstimulated IVF cycles at our institution in order to identify factors which predispose these cycles to success or failure. All patients (n = 57) underwent serial monitoring with transvaginal ultrasound and serum oestradiol determinations. Human chorionic gonadotrophin (HCG) 10,000 IU was administered when follicles were felt to be mature and aspiration undertaken (n = 98) 34-36 h later. Among nine patients aged > or = 40 years, 13 aspirations resulted in nine embryo transfers and no pregnancies. In one completed cycle in this group, the patient, who was 42 years old had a baseline follicle stimulating hormone (FSH) concentration of 35.3 mIU/ml. The cycle progressed uneventfully and follicle aspiration yielded two oocytes and two morphologically normal embryos which, however, did not implant. In six patients < 40 years with male factor, seven aspirations yielded 18 oocytes of which 15 were inseminated and did not fertilize. One of the immature oocytes was allowed to mature in vitro and was fertilized and cryopreserved. Its transfer in a subsequent cycle yielded a live birth. Among 78 cycles in 42 patients aged < 40 years without male factor, 63 resulted in embryo transfer with 14% clinical pregnancy rates per aspiration and 17% per embryo transfer. Pregnancy was associated with higher oestradiol concentrations at the time of HCG administration and multiple embryos available for embryo transfer.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Pregnancy after age 50: application of oocyte donation to women after natural menopause.

The age at which the uterus no longer provides a receptive environment for embryo implantation and development remains unknown. We assessed whether menopausal women between the ages of 50 and 59 years could be prepared for pregnancy with oocyte donation. All potential recipients underwent extensive screening to ensure that they were in excellent physical, reproductive, and psychological health before enrollment. Of 18 patients initially screened (mean [SD] age 52.2 years [2.5]), 14 couples were entered into the study. Oocytes were donated by fertile women (28.1 [2.7] years) who provided gametes after pituitary downregulation with leuprolide acetate and routine ovarian hyperstimulation by human menopausal gonadotropin. 22 donor follicle aspirations resulted in 21 embryo transfers to 14 recipients. Pregnancies were established in 9 women. 1 pregnancy ended in a preclinical loss. The ratio of clinical pregnancies per transfer attempt was 38% (8/21), with an implantation rate per transferred embryo of 19%. Of the 8 clinical pregnancies, 1 spontaneous abortion occurred at 7 weeks' gestation. 3 women have delivered, 2 at 35 weeks' by emergency caesarean section for worsening preeclampsia and 1 at 37 weeks' after a normal vaginal birth. 4 pregnancies continue to progress normally beyond the second trimester. Women may become pregnant after the age of natural menopause by means of in-vitro fertilisation of donated oocytes. However, thorough medical screening before embryo transfer is essential to reduce to a minimum obstetric risks common in this older population.

Embryo Transfer↗