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Biomedical subjects

M V Sauer

Publications and source records attributed to M V Sauer.

At least 127 records · Page 7Linked to original sources
PubMed1993

Evaluating the effect of age on endometrial responsiveness to hormone replacement therapy: a histologic ultrasonographic, and tissue receptor analysis.

OBJECTIVE: Our objective was to characterize the endometria of women of various ages placed on similar estrogen/progesterone replacement regimens prior to attempted donor embryo transfer using histologic, ultrasonographic, and steroid receptor markers in order to determine if advancing age has a detrimental effect on uterine responsiveness to pharmacologic sex steroid replacement therapy. STUDY DESIGN: This was a prospective open clinical trial. Functionally agonadal women aged 25 to 60 years receiving hormone replacement therapy underwent transvaginal ultrasound examination of the uterus followed by a timed endometrial biopsy on artificial cycle day 21. Endometrial histology and estrogen and progesterone receptors were analyzed from biopsy material. Subjects were assigned to three groups according to age: Group I, aged 25 to 39 years (n = 48); Group II, aged 40 to 49 years (n = 61); and Group III, aged 50 to 60 years (n = 13). Endometrial preparation was accomplished in all patients using the same sequential regimen consisting of oral micronized estradiol and intramuscular progesterone. RESULTS: Similar histologic, ultrasonographic, and steroid receptor characteristics were noted in all groups of patients regardless of age. A normal appearing midluteal secretory endometrium was demonstrated histologically in 85% of biopsies. However, 15% of biopsies exhibited intraluminal papillary excrescences within the glands and/or increase in the normal gland-to-stroma ratio. Three patients, one from each group, did not initially respond to replacement therapy and required further treatment. CONCLUSION: Functionally agonadal women exhibit normal or near-normal endometrial responses to sex steroid replacement therapy designed to imitate the natural cycle through the sixth decade of life.

Adult↗
PubMed1993

Repeat trials of oocyte donation to women with previous donor oocyte success.

Oocyte donation has proven to be highly successful in establishing pregnancy in functionally agonadal women. Both implantation and ongoing pregnancy rates in women using this method have surpassed those normally seen in standard in-vitro fertilization (IVF) patients. Over a 5 year period, seven women who had previously conceived using oocyte donation elected to attempt pregnancy and deliver a second child using the same donor. In each case the paramount consideration was to provide a sibling of the same genetic make-up as the child or children previously borne. Of the seven women studied, whose ages ranged from 24 to 44 years, five became pregnant on subsequent cycles. The time to conception varied from one to a maximum of three attempts with three of the five women becoming pregnant on the first cycle and two requiring three cycles to establish the subsequent pregnancy. The overall rate of success in this group was 12 pregnancies in 20 cycles of embryo transfer (60%). An exaggerated implantation rate (25.6%) was also noted (23 individual embryo implantations from 90 embryos transferred). Of the 12 pregnancies established in these seven women, four (33%) were multiple gestations (three triplets, one twin). We conclude that women who have previously experienced pregnancy following oocyte donation are highly likely to conceive in a subsequent trial at a rate that may be higher than that normally seen in the general population of women undergoing oocyte donation.

Adult↗
PubMed1993

Quadruplet pregnancy in a 51-year-old menopausal woman following oocyte donation.

A quadruplet pregnancy occurred in a woman 51 years of age following oocyte donation and embryo transfer. Successful pregnancy occurred following two previously unsuccessful attempts. The patient underwent a selective reduction of her pregnancy to two fetuses at approximately 13 weeks gestational age. Her pregnancy continued uneventfully and she underwent the delivery of two viable infants at 38 weeks gestational age by Caesarean section. This case represents the first quadruplet pregnancy to be established in a woman of 50 years of age or older. It illustrates both the benefits and risks of oocyte donation to women of advanced reproductive age.

Embryo Transfer↗
PubMed1993

Premature luteinization as detected by elevated serum progesterone is associated with a higher pregnancy rate in donor oocyte in-vitro fertilization.

Premature luteinization has been reported to be associated with decreased pregnancy rates in patients undergoing in-vitro fertilization. However, the detrimental effect created by a pre-aspiration rise in progesterone is difficult to assess since ovarian stimulation affects both oocyte quality and endometrial receptivity. Therefore, the relationship between premature luteinization and pregnancy rates remains uncertain. To achieve improved control for confounding variables, we studied premature luteinization in ovum donors of proven fertility. A total of 114 consecutive ovum donation cycles using pituitary suppression with a gonadotrophin-releasing hormone agonist followed by gonadotrophin stimulation were examined. Serum progesterone concentration on the day of administration of human chorionic gonadotrophin (HCG) was > 1.2 ng/ml in 29% of patients. Patients were divided into two groups based on this value. There was a significant increase in clinical pregnancy rates per embryo transfer in the group with higher progesterone concentrations (53 versus 25%, P = 0.012), as well as significantly more oocytes obtained at aspiration (19.6 +/- 10.4 versus 13.3 +/- 5.4, P < 0.001), and significantly higher peak serum oestradiol values (3903 +/- 1787 versus 2453 +/- 1232 pg/ml, P < 0.001). There were no significant differences between groups due to age, degree of stimulation or the number of embryos transferred. We conclude that premature luteinization as based on elevated serum progesterone concentration is a common occurrence in oocyte donors, reflects healthy follicular development, and is associated with increased pregnancy rates.

Adult↗
PubMed1993

New advances in the treatment of infertility in women with ovarian failure.

Ovarian failure is heterogeneous in etiology and may occur at various points in a woman's life. As such, it may interfere with fertility. Clinical presentation ranges from complete cessation of menses to oligomenorrhea to the continuation of menses with elevated gonadotropins. Various therapies have been used in an attempt to induce fertility, including sex steroids and gonadotropin-releasing hormone agonists to suppress circulating gonadotropin alone or in combination with estrogen or gonadotropin-releasing hormone agonists to induce ovulation. Corticosteroids are also used to overcome autoimmunity. Randomized therapeutic trials are rare and fail to demonstrate any significant improvement in ovulation and pregnancy rates. Donor oocytes have demonstrated high success rates and have proven to be useful in patients with both premature ovarian failure and natural menopause. Pregnancies have been initiated and maintained in women through 60 years of age. Thus, for those accepting of the technique, oocyte donation appears to be the treatment of choice for hypergonadotropic hypogonadism.

Adrenal Cortex Hormones↗
PubMed1993

Successful delivery after age 50: a report of two cases as a result of oocyte donation.

BACKGROUND: Because of donor oocyte programs, women who previously were considered too old to successfully achieve conception and delivery can now bear children. To our knowledge, there have been no previous reports of pregnancy outcome in women over age 50 who conceived using donor oocytes. This study presents the pregnancy and delivery data on two women who delivered at age 52. CASES: Case 1 was a 51-year-old woman, gravida 3, para 3, whose three children had been conceived with her first husband more than 20 years previously. She had remarried 18 years before presentation and had been actively trying to conceive for the last 7 years. She was diagnosed as being in menopause based on elevated gonadotropins, amenorrhea, and failure to have progesterone-withdrawal menses. She conceived on her first embryo transfer cycle with embryos derived from donor oocytes and fertilized by her husband's sperm (oocytes were donated by a woman who was undergoing retrieval for in vitro fertilization). During pregnancy she remained healthy, but had uterine prolapse at 20 weeks. She delivered a normal healthy male at 40.5 weeks; cesarean was performed because of a presumptive diagnosis of fetal distress after 3 hours of labor, when monitoring revealed fetal heart decelerations. Case 2 was also a 51-year-old woman, gravida 6, para 4, who wished to conceive with her second husband's sperm through the donor oocyte program. She had amenorrhea of 2 years' duration and elevated gonadotropins. Conception occurred after fertilization of a donor oocyte by her husband's sperm. She had an uneventful pregnancy, but labor was induced at 38 weeks' gestation given the supposed high-risk status of this age group. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. CONCLUSION: Theoretically, the risks of pregnancy complications in older patients are magnified given the aging maternal cardiovascular system, which may predispose these women to placental insufficiency. These first two cases of donor oocyte pregnancies in women over age 50 found no maternal or fetal age-related complications. We hope these reports will encourage all researchers to share their findings so that prospective patients can make better, more informed decisions as to whether they want to participate in donor oocyte programs.

Embryo Transfer↗
PubMed1993

Investigation of the female pelvis.

Abnormalities of the female pelvis are commonly discovered in the evaluation of infertile couples. A systematic approach to diagnosing pathology requires the careful integration of both noninvasive and invasive testing. Transvaginal ultrasound imaging provides immediate and detailed information regarding the gross anatomy of the pelvis and is both a highly sensitive and specific test when used by skilled observers. Hysterosalpingography remains a helpful adjunct in discovering more subtle abnormalities, such as endometrial polyps and salpingitis isthmica nodosa. Invasive surgical tests are hysteroscopy and laparoscopy. These methods accurately define pathology, and in many cases pelviscopic instruments may be employed as a means of delivering surgical treatment. A systematic approach should be used for evaluating the female pelvis, taking into consideration the rationale behind utilizing various diagnostic procedures.

Female↗
PubMed1992

Reversing the natural decline in human fertility. An extended clinical trial of oocyte donation to women of advanced reproductive age.

OBJECTIVE: To evaluate the effect of age on pregnancy success rates in functionally agonadal women undergoing oocyte donation. DESIGN: A prospective study of 100 consecutive patients using oocyte donation for the treatment of infertility. PATIENTS: Women aged 40 years and above requesting oocyte donation (N = 104) were required to undergo medical, reproductive, and psychological screening. Suitable candidates (n = 65) were matched with an oocyte donor whose cycle was synchronized with that of the potential recipient, prior to the donor's undertaking ovarian hyperstimulation and transvaginal ultrasound-directed follicle aspiration. Outcomes were compared with those of two groups undergoing therapy at the same time: (1) women below 40 years of age undergoing oocyte donation for premature ovarian failure (n = 35) and (2) women 40 years of age and above undergoing standard in vitro fertilization and embryo transfer using their own oocytes (n = 57). MAIN OUTCOME MEASURES: Embryo implantation and pregnancy rates. SETTING: The in vitro fertilization program of the University of Southern California and the California Medical Center, Los Angeles. RESULTS: Improved outcomes were observed with regard to fertilization rates in vitro, number of embryos transferred, embryo implantation rate, clinical pregnancy rates, and ongoing or successfully completed pregnancy rates when women undergoing oocyte donation regardless of age were compared with women 40 years of age and above using their own oocytes. No age-related decline in fertility was demonstrable when oocyte donation was used, with a mean age of 44.3 +/- 3.1 years for those successfully conceiving (range, 40 to 52 years). Perinatal outcomes (n = 27) were generally uncomplicated, with a mean gestational age at delivery of 38.4 +/- 2.1 weeks (range, 34 to 42 weeks), although multiple births occurred in 24.1% of cases. CONCLUSIONS: The age-related decline in female fertility may be reversed in couples electing to use donated oocytes from a younger woman, and women of advanced reproductive age may conceive, carry, and give birth to infants with success rates similar to those of their younger counterparts using assisted reproductive methods.

Adult↗
PubMed1992

Embryotoxicity of three commercially available powderless surgical gloves.

The one-cell mouse embryo bioassay was utilized to test the embryotoxicity of three brands of powerless surgical gloves; Pristine, Ansell, and BioGel. The Pristine gloves demonstrated no significant embryotoxicity, while the other two brands demonstrated a consistent inhibition of blastocyst development of one-cell mouse embryos.

Animals↗
PubMed1992

Demographic differences between younger and older recipients seeking oocyte donation.

An older population of women is now increasingly seeking infertility care. The number of these patients may in fact eclipse those of younger patients for whom the method of oocyte donation was initially designed and previously offered. As a group, these older individuals appear to be energetic and demanding, with high expectations regarding the performance and the effectiveness of their fertility care. Physicians need to exercise vigilance in order to emphasize that eggs are not being bought and sold as a commodity and that guarantees of pregnancies cannot be made. Nevertheless, whereas oocyte donation requires all parties, donor, recipient, and doctor, to work together toward a common goal, it still offers women of advanced reproductive age perhaps their best chance at conception, pregnancy, and parenthood.

Abortion, Induced↗
PubMed1992

Pelvic abscess complicating transcervical embryo transfer.

A severe pelvic infection resulting in a tuboovarian abscess after transcervical embryo transfer is reported. The case is unique in that the recipient was an agonadal woman who had not undergone prior transvaginal aspiration. Although rare, pelvic infection after embryo transfer may occur in spite of normal precautions.

Abscess↗
PubMed1992

A prospective controlled evaluation of TEST-yolk buffer in the preparation of sperm for human in vitro fertilization in suspected cases of male infertility.

OBJECTIVE: To evaluate sperm preincubation in tes and tris (TEST)-yolk buffer as a potential enhancing agent of fertilizing capacity of sperm during human in vitro fertilization (IVF). DESIGN: Oocytes obtained during IVF were divided into two groups: one group fertilized with TEST-yolk buffer-treated sperm and the other group with standard-prepared sperm. SETTING: The University of Southern California IVF Program. PATIENTS: Thirty-nine couples with suspected male factor infertility undergoing IVF. INTERVENTIONS: Preinsemination incubation of sperm in TEST-yolk buffer for 24 hours. MAIN OUTCOME MEASURES: Fertilization rates in vitro. RESULTS: TEST-yolk buffer-treated sperm fertilized 140 of 241 oocytes (58%), whereas control sperm fertilized 108 of 251 oocytes (43%). Of four couples who had previously failed to fertilize during IVF, one fertilized with both specimens and three fertilized with TEST-yolk buffer-treated sperm only. CONCLUSIONS: TEST-yolk buffer pretreatment of sperm for 24 hours results in higher fertilization rates during IVF among suspected male factor patients.

Egg Yolk↗
PubMed1992

The synergistic effects of clomiphene citrate and human menopausal gonadotrophin in the folliculogenesis of stimulated cycles as assessed by the gonadotrophin-releasing hormone antagonist Nal-Glu.

Clomiphene citrate (CC), alone or in combination with exogenous gonadotrophins, has been widely used in ovulation induction. CC promotes endogenous release of gonadotrophins, yet when used in combination with exogenous gonadotrophins, its contribution to folliculogenesis is difficult to assess. In order to determine the contribution of CC-induced endogenous gonadotrophin production to the overall ovarian stimulation in cycles treated with CC/human menopausal gonadotrophin (HMG), Nal-Glu, a gonadotrophin-releasing hormone (GnRH) antagonist was administered. Fertile women (n = 10) undergoing ovarian stimulation and oocyte aspiration for the sole purpose of gamete donation were studied. Five women received CC (100 mg daily for 5 days) in conjunction with pure follicle stimulating hormone (FSH) 150 IU daily. Five women received HMG alone. Nal-Glu (50 micrograms/kg/day) was administered intramuscularly to both groups when the leading follicles reached a mean diameter of 16 mm. Human chorionic gonadotrophin (HCG) 10,000 IU was given when the largest follicles reached a mean diameter of 20-22 mm. A significant fall in serum oestradiol levels was observed in women given CC/FSH (37.9 +/- 7.3%) within the first 24 h of Nal-Glu administration. Serum luteinizing hormone (LH) decreased greater than 20% within 24 h of Nal-Glu administration and remained low throughout the rest of the treatment. No decrease in oestradiol levels was noted in cycles receiving HMG alone. With supplemental FSH, falling oestradiol levels in CC/FSH cycles rebounded and continued to rise until the day after HCG administration. Despite a drop in oestradiol in CC/FSH cycles, the aspirated oocytes exhibited no untoward effects. The fertilization and cleavage rates were similar, and pregnancies occurred in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Clomiphene↗
PubMed1992

Oocyte donors: a demographic analysis of women at the University of Southern California.

A summary is presented of 3 years' experience with donors in an oocyte donation programme. During this interval, 50 women participated as gamete donors. All proffered their services without solicitation from the programme. Most were college-educated, working mothers. The majority stated that the primary motivation for participation was concern for others' infertility. Oocytes donors generally found the required use of parenteral medication taxing but tolerable. In most cases, injections were administered to the donor by her husband or by the female recipient. The majority of donations were performed without anonymity (66%). Cycles were performed at approximately 3-month intervals. This approach as well tolerated by donors and allowed predictable scheduling of cases. All women felt their participation was of great significance and each was willing to donate oocytes again if asked.

Adult↗
PubMed1992

In vitro fertilization in unstimulated cycles: the University of Southern California experience.

OBJECTIVE: To describe the clinical experience of our center with in vitro fertilization (IVF) in unstimulated cycles and to provide a comparison to stimulated cycles. DESIGN: Spontaneous ovulatory cycles were triggered with human chorionic gonadotropin in the midcycle, and 78 aspirations for IVF were performed, with the remainder of the IVF cycle proceeding in a standard manner. SETTING: The IVF program of the University of Southern California and the California Medical Center, Los Angeles, California. PATIENTS: Spontaneously ovulatory women (n = 46) with predominantly pelvic factor as their principal cause of infertility, under the age of 40, and no male factor. INTERVENTIONS: Human chorionic gonadotropin administration in midcycle, follicle aspiration, IVF, and embryo transfer. MAIN OUTCOME MEASURES: Embryo implantation and pregnancy. RESULTS: Seventy-eight follicle aspirations resulted in 11 clinical (14%) and 9 ongoing (12%) pregnancies. The per embryo implantation rate was 13% clinical and 11% ongoing. There was no decrease in per cycle pregnancy rates (PRs) for up to three unstimulated cycles. CONCLUSIONS: Unstimulated IVF is a viable alternative to stimulated cycles with PRs approximately one half those of stimulated cycles. It is reasonable to offer patients up to three cycles of unstimulated IVF without expecting a decrease in PRs.

Chorionic Gonadotropin↗
PubMed1991

The effect of leuprolide acetate on steroidogenesis by granulosa and theca cells in vitro.

Enhancement of follicular response to controlled ovarian hyperstimulation for human in vitro fertilization (IVF) has been suggested following pretreatment with leuprolide acetate (LA). However, additional human menopausal gonadotropin (hMG) is required to achieve follicle maturity in the presence of LA. We studied the effect of LA on steroidogenesis of granulosa and theca cells in vitro. Human granulosa cells obtained from IVF follicular fluid aspirations were cultured for 14 days in the presence and absence of human chorionic gonadotropin (hCG). hCG significantly enhanced progesterone (P) and estradiol (E2) production by the cells, however, the addition of LA in concentrations of 10, 100, and 1000 ng/ml had no effect. Porcine granulosa cells were cultured for 48 hr in the presence and absence of follicle stimulating hormone (FSH) with the addition of LA at the same doses. LA did not affect the FSH-induced increase in P production. Porcine theca cells were cultured for 48 hr in the presence and absence of hCG. The addition of LA did not affect androstenedione (A) production by these cells. We conclude that in this dynamic model in vitro, LA does not inhibit or stimulate P or E2 production by granulosa or A production by theca cells.

Androstenedione↗