Biomedical subjects

Michael M Alper

Publications and source records attributed to Michael M Alper.

6 recordsLinked to original sources

PubMed2005

One last chance for pregnancy: a review of 2,705 in vitro fertilization cycles initiated in women age 40 years and above.

OBJECTIVE: To describe live birth rates and predictors of success in 1-year age increments for women > or =40 years when initiating assisted reproductive technologies (ART). DESIGN: Retrospective database analysis. SETTING: A large university-affiliated infertility center. PATIENT(S): One thousand two hundred sixty-three women undergoing 2,705 ART cycles at age 40 or above. INTERVENTION(S): Couples undergoing ART. MAIN OUTCOME MEASURE(S): Pregnancy and live birth rates per cycle start were determined based on 1-year increments in women aged > or =40. Predictors of success, including number of embryos transferred, number of fetal heartbeats, availability of embryos for cryopreservation, and cycle day 3 FSH levels, were analyzed. RESULT(S): The overall live birth rate per cycle start was 9.7%. Cumulative live birth rates in women ranged from 28.4% if starting ART at age 40 to 0 by age 46. The overall spontaneous abortion rate was 32.6% (range, 23.9%-66.7%). Higher pregnancy rates were predicted by the greater number of embryos available for transfer, by the availability of excess embryos for cryopreservation, and by the presence of two fetal heartbeats on ultrasound. The outcome of the first IVF cycle did not predict the outcome of subsequent cycles. CONCLUSION(S): Assisted reproductive technology has a reasonable chance for success (>5%) up until the end of the forty-third year. Twins on initial ultrasound, large numbers of embryos available for transfer, and the presence of excess embryos for cryopreservation predict higher live birth rates.

Adult↗

PubMed2004

Initiation of the gonadotropin-releasing hormone antagonist ganirelix for in vitro fertilization cycles in which the lead follicle is >14 mm.

The initiation of GnRH antagonists when the lead follicle is >14 mm does not adversely affect IVF success rates and leads to a shortened duration of GnRH antagonist administration.

Adult↗

PubMed2004

In vitro fertilization outcomes: why doesn't anyone get it?

It is not only patients who frequently do not understand the implications of multiple pregnancies and IVF outcomes in general. Physicians, insurers, and governments must share the responsibility for failing to properly address both overall and multiple pregnancy rates after IVF.

Embryo Transfer↗

PubMed2004

A mesothelial cyst of the round ligament presenting as an inguinal hernia after gonadotropin stimulation for in vitro fertilization.

OBJECTIVE: To report the case of a round ligament cyst which, as the result of gonadotropin stimulation for IVF, simulated an incarcerated inguinal hernia. DESIGN: Case report. SETTING: A private infertility center and a university hospital. PATIENT(S): A 31-year-old woman who developed left lower quadrant pain after gonadotropin stimulation for IUI and a tender left inguinal mass after increasing ovarian stimulation for IVF/intracytoplasmic sperm injection. INTERVENTION(S): Surgical excision of a mesothelial cyst of the left round ligament and exploration of the left inguinal canal. MAIN OUTCOME MEASURE(S): Successful surgical excision of left inguinal mass. RESULT(S): Resolution of symptoms. CONCLUSION(S): Mesothelial cysts of the round ligament should be included in the differential diagnosis of inguinal masses in women. Gonadotropin stimulation might cause previously unrecognized cysts to simulate an incarcerated inguinal hernia, necessitating surgical repair.

Adult↗

PubMed2002

Is your IVF programme good?

Few standards exist today to assess the quality of an IVF centre. Although much focus is placed upon pregnancy rates, emphasis on this outcome alone is inadequate. The purpose of this report is to examine those factors that should be considered in assessing the overall quality of an IVF centre. Current methods to assess quality are reviewed. Many governing bodies throughout the world currently focus solely on pregnancy rates, which can be misguided if factors such as multiple pregnancies, ovarian hyperstimulation, patient satisfaction, and the proper evaluation of laboratory and clinical protocols are not taken into account. Measurements of quality and methods to improve it are critical in all business models, including IVF. We propose an international standard such as the ISO 9001 for IVF centres to properly evaluate and improve the delivery of their care.

Female↗

PubMedDate not supplied

Luteal support with vaginal micronized progesterone gel in assisted reproduction.

The purpose of this study was to review the rationale for vaginal progesterone treatment as luteal support in IVF, and the clinical experience with vaginal micronized progesterone gel. It was found that luteal support with exogenous progesterone significantly improves implantation and pregnancy rates after IVF. Vaginal administration offers a number of potential advantages over intramuscular injection in terms of tolerability and convenience. The clinical experience with Crinone 8%, a vaginal gel containing 90 mg micronized progesterone in a polycarbophil base, indicates that the use of this preparation is associated with pregnancy rates comparable with those achieved after intramuscular administration of progesterone. Moreover, in studies in which patient preferences have been assessed, significantly higher preferences for vaginal micronized progesterone gel have been reported, compared with intramuscular administration or vaginal suppositories. In conclusion, the vaginal micronized progesterone gel used in this study provided effective and well-tolerated luteal support in women undergoing IVF.

Administration, Intravaginal↗