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Biomedical subjects

M V Sauer

Publications and source records attributed to M V Sauer.

At least 163 records · Page 9Linked to original sources
PubMed1990

Embryo implantation after human in vitro fertilization: importance of endometrial receptivity.

To study the effects of controlled ovarian hyperstimulation (COH) on endometrial receptivity during human in vitro fertilization (IVF), we compared embryo implantation data obtained from our nonanonymous donor oocyte program with those obtained from standard IVF. To control for embryo quality, IVF patient characteristics were matched to those of the oocyte donors with regard to age and previous gravidity. All cycles were performed in an identical manner, using standardized ovarian stimulation protocols, transvaginal follicle aspiration, fertilization and culture in vitro, and transcervical embryo transfer. A similar number of oocytes per cycle were obtained, fertilization rates were similar, and similar numbers of embryos were transferred in both groups. Transferred embryos had similar numbers of blastomeres and were morphologically judged to be of similar quality in both groups. Implantation rates per individual embryo were significantly higher in donor than in standard IVF (35% versus 10.7%) as were ongoing per embryo implantation rates (23% versus 8%). Clinical and ongoing pregnancy rates per cycle were likewise higher in the donor group than in the standard IVF group (67% versus 39%, and 61% versus 30%, respectively). We conclude that COH inhibits embryo implantation after IVF by decreasing endometrial receptivity, which is an important factor in IVF pregnancy success.

Adult↗
PubMed1990

Pregnancy after in vitro fertilization in a patient with stage I endometrial carcinoma treated with progestins.

A 35-year-old woman with chronic anovulation and bilateral tubal disease was found during infertility evaluation to have grade I endometrial carcinoma confined to an endometrial polyp. She was treated with polypectomy and endometrial curettage followed by high-dose progestagens for 6 months. Endometrial curettage at 3 and 6 months of therapy indicated regression of the lesion and the patient subsequently achieved successful pregnancy with IVF.

Adult↗
PubMed1990

Very high serum estradiol levels are not detrimental to clinical outcome of in vitro fertilization.

The use of gonadotropin-releasing hormone agonists as adjuncts to ovulation induction for in vitro fertilization (IVF) has resulted in increases in oocyte recovery rates. Along with increased oocyte number, greatly increased estradiol (E2) levels have been found. We sought to determine the clinical effect of very high E2 levels on the outcome of IVF cycles. Estradiol levels were measured in 141 patients undergoing controlled ovarian hyperstimulation with leuprolide acetate and human menopausal gonadotropin for IVF. Whereas the number of oocytes recovered and fertilized and the number of embryos available for cryopreservation were directly proportional to the E2 level, the fertilization rate and embryo cleavage rates were unrelated to the E2 level. When the patients were grouped in thirds according to E2 levels, pregnancy rate (PR) was highest in the patients with the highest E2 levels (E2 greater than 2,777 pg/mL, PR = 37%). One mild, one moderate, and one severe case of ovarian hyperstimulation syndrome occurred in patients with E2 greater than or equal to 3,000 pg/mL (n = 21), but in general, high E2 levels were attained with few complications. We conclude that high E2 levels are not detrimental to the pregnancy outcome of IVF. Our experience further suggests that cycles with E2 levels of less than or equal to 5,000 pg/mL need not be canceled and can proceed to oocyte recovery and embryo transfer.

Antineoplastic Agents↗
PubMed1990

Detection and management of pathological, non-palpable, cystic adnexal masses.

Ten patients with normal bimanual pelvic examinations were found to have small, non-palpable adnexal cysts by transvaginal ultrasound examination. After failing to respond to a course of observation and suppressive therapy with combination oral contraceptives, surgical evaluation was performed. In each case, histological examination returned a pathological diagnosis (endometrioma, serous cystadenoma, mature cystic teratoma, inflammatory cyst). This series suggests that transvaginal ultrasonography may be used to detect adnexal pathology before it is clinically apparent. A scheme for management of this clinical entity is proposed.

Adnexal Diseases↗
PubMed1990

Random urinary pregnanediol glucuronide measurements in pregnancy: lack of utility for evaluation of first-trimester vaginal bleeding.

Progesterone and its urinary metabolite pregnanediol-3 alpha-glucuronide (PDG) are generally lower in women with abnormal pregnancies compared to those with normal intrauterine gestations. We evaluated the ability of random urinary PDG measurements determined by enzyme immunoassay (EIA) to differentiate normal from abnormal pregnancies. Patients with first-trimester vaginal bleeding (n = 104) were evaluated. Eventual outcomes indicated 39 women had viable intrauterine pregnancies (IUPs), 54 had spontaneous abortions (SABs) and 11 had ectopic pregnancies (EPs). Urinary PDG was significantly lower in SAB and EP compared to IUP patients. However, a wide range of values in IUP patients was noted (3.2-93.3 micrograms/ml), due to varying degrees of patient hydration at presentation. Hence, random measures of urinary PDG demonstrated poor specificity (32.8%) in correctly differentiating normal from abnormal gestations, thus limiting its clinical usefulness.

Female↗
PubMed1990

In vitro fertilization in unstimulated cycles: a clinical trial using hCG for timing of follicle aspiration.

In vitro fertilization (IVF) was performed in normally ovulatory women after the follicular phase of an unstimulated cycle. Twenty patients initiated 36 cycles of unstimulated IVF, with serial ultrasound examinations and hCG 10,000 IU given when the follicle was mature. Thirty aspirations were carried out under intravenous sedation with transvaginal ultrasound guidance. One or more oocytes were obtained in 29 aspirations (97%) for a total of 52 oocytes (average 1.7); 37 fertilized (71%), two were polyspermic, and 35 cleaved (67%). Seventeen aspirations (57%) yielded multiple oocytes. All 25 oocytes obtained from dominant follicles fertilized (100%), and 12 of 27 oocytes from secondary follicles fertilized (44%) (P less than .05 versus dominant follicles), with one polyspermic fertilization in each group. Sixteen cycles resulted in a single embryo transfer (ET), eight had two embryos, and one had three embryos transferred (36% multiple ET). Five clinical pregnancies (20% per ET, 17% per retrieval) resulted in four ongoing pregnancies (16% per ET, 13% per retrieval), all singletons. Our results suggest that in selected cases, IVF in unstimulated cycles may be a clinically viable alternative to stimulated cycles, with preliminary success rates in the range of national averages for stimulated cycles.

Adult↗
PubMed1990

Effect of hydration on random levels of urinary pregnanediol glucuronide.

To determine the effect hydration has upon the relationship between serum progesterone and its urinary metabolite pregnanediol-3 alpha-glucuronide (PDG) we measured spot samples from patients (n = 207) presenting in the 1st trimester of pregnancy. Serum and urine specimens were obtained simultaneously and measured for progesterone and PDG by radioimmunoassay (RIA). Urine specific gravity was also measured at the time of sample collection. Results demonstrated that in samples where the urine specific gravity was greater than or equal to 1.015 there was a strong positive correlation between serum progesterone and PDG (r greater than 0.60, p less than 0.001). However, when urine samples were below a specific gravity of 1.015, serum and urinary steroid values correlated poorly or not at all. We conclude that the measurement of specific gravity should be routinely performed when determining random values of urinary PDG, since only samples in which the urine is adequately concentrated accurately reflect corresponding serum progesterone concentrations.

Adolescent↗
PubMed1990

Diagnosis and modern surgical management of ovarian pregnancy.

Ovarian pregnancy represents 1 per cent of all ectopic gestations. It is an infrequent finding, with an incidence of one in 7,000 deliveries. We reviewed our experience during a recent four year period at the Los Angeles County-University of Southern California Women's Hospital. Ten patients so affected were identified. Preoperative diagnosis was rarely correct and the majority of ectopic pregnancies ruptured before surgical treatment, often necessitating blood transfusion. Oophorectomy was generally avoided; cystectomy and wedge resection were preferred because this group of patients is fertile and usually free of coexisting tubal disease.

Adult↗
PubMed1990

Conservative surgical treatment of ectopic pregnancy. Avoiding partial salpingectomy.

Salpingostomy is the preferred surgical method of managing ectopic gestation when patients desire future fertility. Problems with that technique stem principally from difficulties with hemostasis. While ligation of a single mesosalpingeal vessel has been described, blood to the site of the ectopic gestation is supplied primarily by the tubal branch of the ovarian artery. We developed a technique for ligating that vessel at both ends of the ectopic site. The technique may be combined with mesosalpingeal vessel ligation and leads to excellent hemostasis. Although blood vessels to the tube are interrupted, tubal length is preserved. Salpingostomy is thus possible, even in cases of large, actively bleeding or ruptured ectopic gestations. The need for partial salpingectomy, frequently utilized under those circumstances, is thus obviated. Salpingostomy may result in spontaneous recanalization; if anastomosis is needed subsequently, maximal tubal length is preserved.

Cautery↗
PubMed1989

Spontaneously resorbing ectopic pregnancy: preservation of human chorionic gonadotropin bioactivity despite declining steroid hormone levels.

We compared serum hormone profiles of patients with normal intrauterine pregnancies (n = 14), spontaneously resorbing ectopic pregnancies (n = 10), and viable ectopic pregnancies (n = 26). Hormone profiles were evaluated at 5 to 8 weeks' gestational age. Ectopic pregnancies were diagnosed by laparoscopy; intrauterine gestations were confirmed by ultrasonography. Immunoreactive beta-human chorionic gonadotropin, progesterone, estradiol, and 17-hydroxyprogesterone were measured by radioimmunoassay. Bioactive human chorionic gonadotropin was measured by a modified mouse Leydig cell bioassay. Diminished steroid production was noted in ectopic pregnancies; levels in serum of patients with resorbing ectopic pregnancies were lower than values expressed in viable ectopic pregnancies (p less than 0.01). Serum levels of human chorionic gonadotropin bioactivity correlated closely with immunoreactive human chorionic gonadotropin in all three groups (r = 0.81, p less than 0.01). Ratios of bioactive human chorionic gonadotropin to immunoreactive beta-human chorionic gonadotropin were similar (0.93 +/- 0.26 in resorbing ectopic pregnancies, 1.11 +/- 0.16 in viable ectopic pregnancies, and 0.90 +/- 0.10 in intrauterine pregnancies). We conclude that although reduced serum levels of steroids noted in ectopic pregnancy suggest an impairment in corpus luteum activity, diminished steroid production was not attributable to lower human chorionic gonadotropin bioactivity.

17-alpha-Hydroxyprogesterone↗
PubMed1989

Retained pregnancy complicating donor ovum transfer.

Retained pregnancy is an uncommon complication of females participating in uterine lavage for purposes of ovum donation. Reported are two subjects experiencing this complication. Unlike other ovum donors, uterine retroflexion was present in both women. This anatomic configuration was likely responsible for the retained pregnancies and such women are best excluded from participating in this method of embryo donation.

Adult↗
PubMed1989

A trial of superovulation in ovum donors undergoing uterine lavage.

In an attempt to increase the number of fertilized ova recoverable by uterine lavage, the authors superovulated ovum donors using a combination of clomiphene citrate and human menopausal gonadotropin. Six women underwent seven lavage cycles with uterine flushes performed 96, 120, 144, and 168 hours after ovulation and artificial insemination. Ova were recovered from three women between 96 and 144 hours after ovulation. However, no ova were recovered from the other three donors, two of whom were later noted to be pregnant. Retained pregnancies occurred despite postlavage administration of high-dose contraceptive pills, endometrial aspiration, and, in one case, RU 486. None of the infertile women became pregnant as a result of the trial. The authors conclude that, although superovulation may increase ovum production, without reliable contragestion, such practice is unsafe for ovum donors undergoing uterine lavage.

Adult↗
PubMed1989

Triplet pregnancy following oocyte donation to a functionally agonadal woman.

Reported is the first triplet gestation following oocyte donation to an agonadal woman. The transfer of five ova resulted in implantation of all five, with continued embryonic development in three. Pregnancy support was provided by exogenously administered oral E2 and intramuscular P for 100 days, at which time placental hormone production solely maintained the gestations.

Adult↗
PubMed1989

In vitro fertilization in unstimulated cycles: a new application.

After four unsuccessful attempts at multiple follicular induction with exogenous gonadotropins, a patient underwent two attempts at IVF in spontaneous cycles triggered with hCG. The second attempt resulted in the transfer of three embryos and a successful singleton intrauterine pregnancy. We believe that unstimulated IVF is a viable option for patients with ovulatory cycles. It should be considered in cases of failed hyperstimulation, and may become a primary treatment option in the future.

Adult↗
PubMed1989

Establishment of a nonanonymous donor oocyte program: preliminary experience at the University of Southern California.

Transvaginal ultrasound-directed oocyte retrieval was performed on eight women functioning exclusively as gamete donors for 10 patients with ovarian failure. Donors included sisters, personal friends, and compensated participants selected by the recipient couple. Oocyte donors underwent controlled ovarian hyperstimulation and transvaginal oocyte aspiration. Thirteen initiated cycles resulted in 11 embryo transfers and six ongoing pregnancies. There were no complications, and all donors stated a willingness to undergo the procedure again. The use of nonanonymous oocyte donation appears both efficacious and efficient and is recommended as an option for achieving pregnancy in women with ovarian failure.

Adult↗
PubMed1989

Effects of extracellular ionized calcium, diltiazem and cAMP on motility of human spermatozoa.

In order to elucidate the effects of ionized calcium and calcium channel blockers on human sperm motility, an in vitro study was conducted looking at the effects of exogenous calcium, ethylene diamine tetraacetic acid (EDTA), diltiazem and dibutyrl cyclic adenosine monophosphate (db-cAMP) on per cent motility and mean velocity of human sperm. Washed spermatozoa from 21 fertile donors were incubated with ionized calcium (zero, five, 10 and 50 mM), EDTA (one and 10 mM), diltiazem (one, 10, 100 microM and one mM) and cAMP (five mM). Per cent motility and mean velocity determinations were made at 10 and 120 min. by computerized analysis of videomicrographs. Over a wide range of extracellular ionized calcium concentrations (50 microM to 50 mM), per cent motility and mean velocity of human sperm were not stimulated or inhibited. At ionized calcium concentration less than 1 microM, achieved by addition of EDTA (10 mM), per cent motility decreased by 68% and 79% and mean velocity decreased by 44% and 48% compared to controls at 10 and 120 min. respectively (p less than 0.001). The decrease in mean velocity was reversible by addition of calcium to the EDTA (10 mM) sample to return ionized calcium to control concentration (0.5 mM). This reversibility suggests EDTA did not have a direct toxic effect on spermatozoa and that its action was mediated by changes in ionized calcium concentration. Diltiazem (one mM) decreased sperm mean velocity by 26% and 28% compared to controls at 10 and 120 min. respectively (p less than 0.01), but had no effect at lower concentrations (one, 10 or 100 microM). Db-cAMP (five mM) increased per cent motility by 25% and 20% and mean velocity by 36% and 34% compared to controls at 10 and 120 min. respectively (p less than 0.05). These results indicate that a minimum level of extracellular ionized calcium is essential to normal sperm motility and suggest that sperm are more dependent on the intracellular translocation of calcium ions for the regulation of motility than on the extracellular ionized calcium concentration. While db-cAMP does significantly increase per cent motility and mean velocity of human sperm, its clinical usefulness for the treatment of male infertility remains to be demonstrated.

Bucladesine↗