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Biomedical subjects

P Devroey

Publications and source records attributed to P Devroey.

At least 235 records · Page 13Linked to original sources
PubMed1993

First established pregnancy and birth after ovarian stimulation with recombinant human follicle stimulating hormone (Org 32489).

This case report describes the first established pregnancy and birth after ovarian stimulation with Org 32489, pure recombinant human follicle stimulating hormone (recFSH, Organon International). A patient with tubal infertility participated in an open efficacy study of recFSH evaluating the efficacy of combined gonadotrophin-releasing hormone (GnRH)-agonist/recFSH treatment in women undergoing in-vitro fertilization (IVF) and embryo transfer. Ovarian stimulation was induced by recFSH in association with buserelin (Suprecur, 4 x 150 micrograms/day) using a short protocol. After 9 days of recFSH treatment (75 IU/day), six pre-ovulatory follicles (> or = 15 mm) were observed and 10,000 IU human chorionic gonadotrophin were administered. Nine mature oocytes were retrieved by oocyte puncture and after IVF, three embryos were replaced in the uterus. A viable singleton intra-uterine pregnancy was revealed at a gestational age of 7 weeks. The pregnancy progressed normally and ended with a vaginal delivery at a gestational age of 39.5 weeks. A healthy girl was born and paediatric examination did not demonstrate any abnormality.

Adult↗
PubMed1993

Higher success rate by intracytoplasmic sperm injection than by subzonal insemination. Report of a second series of 300 consecutive treatment cycles.

Subzonal insemination (SUZI) and intracytoplasmic sperm injection (ICSI) were carried out in 300 treatment cycles in couples unable to be helped by conventional in-vitro fertilization treatment. More oocytes were damaged by ICSI (13.5%) than by SUZI (7.1%). The normal fertilization rate was substantially higher after ICSI (51.0%) than after SUZI (14.3%) and was related to the semen characteristics. The cleavage rate was similar for both procedures (77%). After 217 embryo transfers (72.3% of the treatment cycles) 66 pregnancies were established, i.e. pregnancy rates of 22.0% per started cycle and 30.4% per embryo transfer. So far, pregnancy loss has occurred in 27.3% of the pregnancies, nine healthy children have been born after eight deliveries and 41 clinical pregnancies are progressing uneventfully. Chorionic villus sampling or amniocentesis have been performed in 35 pregnancies and 39 normal fetal karyotypes have been obtained after cytogenetic analysis.

Female↗
PubMed1993

High fertilization and implantation rates after intracytoplasmic sperm injection.

Previously reported better fertilization rate after intracytoplasmic single sperm injection (ICSI) than after subzonal insemination of several spermatozoa was confirmed in a controlled comparison of the two procedures in 11 patients. Intracytoplasmic sperm injection was carried out in 150 consecutive treatment cycles of 150 infertile couples, who had failed to have fertilized oocytes after standard in-vitro fertilization (IVF) procedures or who were not accepted for IVF because not enough motile spermatozoa were present in the ejaculate. A single spermatozoon was injected into the ooplasm of 1409 metaphase II oocytes. Only 117 oocytes (8.3%) were damaged by the procedure and 830 oocytes (64.2% of the successfully injected oocytes) had two distinct pronuclei the morning after the injection procedure. The fertilization rate was not influenced by semen characteristics. After 24 h of further in-vitro culture, 71.2% of these oocytes developed into embryos, which were transferred or cryopreserved. Only 15 patients did not have embryos replaced. Three-quarters of the transfers were triple-embryo transfers. High pregnancy rates were noticed since 67 pregnancies were achieved, of which 53 were clinical, i.e. a total and clinical pregnancy rate of 44.7% and 35.3% per started cycle and 49.6% and 39.2% per embryo transfer. A total of 237 supernumerary embryos were cryopreserved in 71 treatment cycles.

Cytoplasm↗
PubMed1993

Comparison of two local anaesthetics in transvaginal ultrasound-guided oocyte retrieval.

Transvaginal ultrasound-guided oocyte retrieval is an accepted procedure in most in-vitro fertilization programmes. In order to simplify the anaesthetic procedure into a minimally invasive one, we perform the oocyte retrieval under a modified para-cervical block combined with a standard pre-medication. In order to maximize the patient's comfort we evaluated two different local anaesthetics and their side-effects. Patients were allocated at random to receive a modified para-cervical block with mepivacaine 1% (n = 46) or with prilocaine 1% (n = 54). The patients were asked to fill in a visual analogue scale (VAS) including assessment of anxiety, pain and comfort concerning the procedure. The two local anaesthetics were both effective in reducing pain during transvaginal oocyte retrieval. The mean VAS scores were acceptable and were efficient as indicators of patient's comfort during the procedure. Mepivacaine was selected for routine use since prilocaine induced methaemoglobinaemia.

Adult↗
PubMed1993

Analysis of the risk factors with regard to the occurrence of ectopic pregnancy after medically assisted procreation.

In a retrospective study (1985-1989) based on data from the Centre for Reproductive Medicine in Brussels, a total of 23 ectopic pregnancies (2.24%) occurred after 3800 embryo, zygote or gamete transfers. This number was low compared with the data published elsewhere. Tubal damage was a major risk factor towards developing an ectopic pregnancy after in-vitro fertilization and embryo transfer. The number of ectopic pregnancies after the association of clomiphene citrate and human menopausal gonadotrophin (HMG) was significantly higher in patients with tubal (7.8%) and non-tubal indications (2.1%) compared with those stimulated with gonadotrophin-releasing hormone (GnRH) and HMG (2.18% and 0.84%, respectively). The number of replaced embryos was not associated with the rate of ectopic pregnancy and neither did transfer technique (intra-uterine or intra-Fallopian transfer) influence the ectopic pregnancy rate.

Adult↗
PubMed1993

Effects of pentoxifylline on in-vitro development of preimplantation mouse embryos.

In-vitro culture of 1-cell mouse embryos was used to assess the influence of pentoxifylline or early embryonic development. If cultured in concentrations of 5, 10 or 50 microM, early embryonic development was unaffected and no differences in cell numbers were noted in embryos reaching the blastocyst stage. However, at 3.6 and 7.2 mM, pentoxifylline inhibited cleavage from the 2-cell stage onwards. If 1-cell mouse embryos were exposed for only 30 min to these concentrations, blastocyst formation was found to be morphologically normal. However, cell numbers of such blastocysts were significantly decreased after exposure to pentoxifylline. These results may indicate that exposure of gametes or zygotes to pentoxifylline should be avoided as much as possible when this drug is used in human assisted reproduction. If administered at regular therapeutic doses, it is probable that no adverse effect on early embryonic development in vivo will occur. Further research is needed to confirm and elucidate the above findings.

Animals↗
PubMed1993

Children from anonymous donors: an inquiry into homosexual and heterosexual parents' attitudes.

This study compared two groups of homosexual and heterosexual parents with respect to their attitudes towards the donor-origin of their children. All couples had applied at the Fertility Clinic for artificial insemination with anonymous donor sperm (AID). Both groups had used anonymous donors in order to conceive. However, the sexual orientation of the parents and the presence or absence of a social father was different in the two groups. By comparing such different families it was hoped to obtain insight into those factors which influence parents' attitudes concerning donor insemination. Twenty-five lesbian and 25 heterosexual parents were interviewed. The open-ended questionnaires solicited information on the following issues: attitudes towards secrecy/disclosure of the use of a donor, views on anonymity/identity registration of the donor, parents' cognitive and emotional representation of the donor. Response rates differed between the groups: all homosexual parents consented to the interview and 44% of the heterosexual parents did so. Parents' attitudes depended on several variables. The different family structures were related to different motivations for AID treatment. For heterosexual couples, the use of a donor offered them the opportunity to become a 'normal family'. For homosexual couples, creating a two-mother family unit meant going one step further in 'being different'. Attitudes towards the use of a donor were consequently different: heterosexual couples chose secrecy and donor anonymity. Homosexual parents intended to inform their children. Of these homosexual parents, 40% would prefer the identity of the donor to be registered. This evolution towards removal of the anonymity seemed to be encouraged by the openness surrounding the use of a donor itself. In both groups it remained difficult to reduce the donor to an anonymous sperm cell, fantasies and questions about the donor continued to exist over the years.

Adult↗
PubMed1993

Transvaginal removal of gallbladders with large stones after laparoscopic cholecystectomy.

Very large gallstones sometimes render laparoscopic cholecystectomy time consuming and difficult. In addition, several advantages of laparoscopy, namely decreased postoperative pain and minimal abdominal scarring, could be compromised by the need to enlarge the umbilical incision. Besides the solution of the mechanical or electrohydraulic fragmentation of such large gallstones, as described by several authors, we propose a posterior colpotomy as a simple technique for removing very large gallbladders in women.

Cholecystectomy, Laparoscopic↗
PubMed1992

Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte.

Intracytoplasmic sperm injection (ICSI) is a promising assisted-fertilisation technique that may benefit women who have not become pregnant by in-vitro fertilisation (IVF) or subzonal insemination (SUZI) of oocytes. We have used ICSI to treat couples with infertility because of severely impaired sperm characteristics, and in whom IVF and SUZI had failed. Direct injection of a single spermatozoon into the ooplasm was done in 47 metaphase-II oocytes: 38 oocytes remained intact after injection, 31 became fertilised, and 15 embryos were replaced in utero. Four pregnancies occurred after eight treatment cycles--two singleton and one twin pregnancy, and a preclinical abortion. Two healthy boys have been delivered from the singleton pregnancies and a healthy boy and girl from the twin pregnancy.

Adult↗
PubMed1992

Efficiency and accuracy of polymerase-chain-reaction assay for cystic fibrosis allele delta F508 in single cell.

Diagnosis of genetic disorders in the embryo before implantation, though possible by removal of one or two blastomeres at the eight-cell stage, is still experimental because the procedures of gene analysis of DNA from a single cell are not yet reliable enough for clinical application. We have evaluated the efficiency and accuracy of polymerase-chain-reaction (PCR) amplification of a single-copy gene, wild-type or cystic fibrosis delta F508 allele, on single sperm cells from a donor known to be a heterozygous carrier of the delta F508 mutation. DNA from single spermatozoa was decontaminated by restriction-enzyme treatment, then the region around the delta F508 site was amplified by nested PCR. The distribution of the wild-type and mutant alleles (59 [55%] and 48 [45%, respectively]) in the 107 single spermatozoa did not differ from that expected (50% each). 1 sample did not provide an amplified signal. To check that the two alleles would be amplified with equal efficiency when they were both present within a cell, we did PCR for 51 two-sperm samples. Again the distribution did not deviate from that expected (17 [33%] both wild-type; 21 [41%] one wild-type, one delta F508; 13 [26%] both delta F508 vs 25%; 50%; 25% expected). None of the 74 blanks in these experiments was contaminated. We conclude that our delta F508 single-cell assay is efficient and accurate and can be used for analysis of blastomere DNA to diagnose cystic fibrosis before embryo implantation.

Alleles↗
PubMed1992

Zygote intrafallopian transfer or in vitro fertilization and embryo transfer for the treatment of male-factor infertility: a prospective randomized trial.

OBJECTIVE: To compare zygote intrafallopian transfer (ZIFT) and in vitro fertilization and embryo transfer (IVF-ET) as treatments of male-factor infertility. DESIGN: Patients were prospectively randomized to ZIFT or IVF-ET. SETTING: In vitro fertilization program of the Centre for Reproductive Medicine of the Dutch-speaking Brussels Free University, Belgium, which is a tertiary referral institution. PATIENTS: One hundred fifty-seven couples were enrolled in the study. Inclusion criteria allowed only first trials of couples with long-standing infertility caused by a male factor. Female factors were excluded. INTERVENTIONS: In ZIFT, up to three fertilized oocytes were transferred into one single patient fallopian tube by means of laparoscopy 18 hours after insemination. In IVF-ET, cleaving embryos were replaced into the uterine cavity about 48 hours after insemination. MAIN OUTCOME MEASURES: Fertilization and transfer rates, implantation and pregnancy rates, pregnancy outcome, and cost per procedure were evaluated. RESULTS: Implantation rates of 12.3% and 10% per replaced conceptus were achieved for ZIFT and IVF-ET, respectively. CONCLUSIONS: This study demonstrates no therapeutic advantage of ZIFT over IVF-ET in male-factor infertility in terms of reproductive outcome or economic benefit.

Adult↗
PubMed1992

Cryopreservation of human embryos.

This chapter describes general cryobiological principles and the different methods for cryopreservation of supernumerary human embryos obtained after several procedures for medically assisted procreation. Different factors that influence the performance of freezing and thawing of human embryos are reviewed: the data from international and national surveys of results, the cryopreservation procedures, the stages of embryonic development, the morphological appearance of the cryopreserved embryos, the numbers of embryos transferred, the storage times of embryos in liquid nitrogen, the ovarian stimulation protocols in the IVF cycle and the replacement cycles of cryopreserved embryos. Cryopreservation of embryos circumvents the difficult problem of synchrony between the ovarian cycles of donor and acceptor patients in an oocyte donation programme.

Blastocyst↗
PubMed1992

Preimplantation diagnosis.

Although healthy babies have been born after preimplantation diagnosis for sex determination, this technique is still in an experimental phase. To date, removal by micromanipulation of one or two blastomeres from an eight-cell embryo seems an acceptable procedure. Since a reasonable number of biopsied embryos will implant and develop in utero, the methodology for the analysis of the blastomeres at the chromosomal, gene product or DNA level, needs to be improved before further clinical application. In the meanwhile, more information about early embryo development will become available.

Animals↗
PubMed1992

Laparoscopic removal of benign mature teratoma.

Laparoscopic removal of benign mature teratoma is safe and effective in pre-menopausal patients. Fourteen patients underwent laparoscopic removal of such tumours. There were no operative complications. Post-operative hospitalization was short (average: 2 days). All patients undergoing a second-look laparoscopy had mild adhesions around the operated ovary. Two spontaneous and one in-vitro fertilization pregnancy occurred. If a teratoma is diagnosed during laparoscopy or oocyte retrieval, it should be promptly removed as malignant transformation is not excluded. In this case, the embryos should be frozen for later transfer.

Adult↗
PubMed1992

A prospective randomized comparison of intramuscular or intravaginal natural progesterone as a luteal phase and early pregnancy supplement.

A luteal phase defect has been demonstrated in cycles stimulated using a protocol including a gonadotrophin releasing hormone agonist (GnRHa). We have conducted a randomized prospective study of luteal and early pregnancy supplementation in 262 women selected for in-vitro fertilization (IVF), gamete intra-Fallopian transfer (GIFT) or zygote intra-Fallopian transfer (ZIFT). Either intramuscular progesterone in oil (50 mg/day) or intravaginal micronized progesterone (600 mg/day) was used as luteal supplement. In association with oestradiol valerate, progesterone administration was initiated from the day before oocyte retrieval until the 12th week of pregnancy. The implantation rate just failed to reach statistical significance (P = 0.07) in favour of the group receiving intravaginal progesterone. In the latter group, we observed a higher clinical pregnancy rate (33.6 versus 26.7%, not significant). Despite lower plasma progesterone levels, a lower first trimester abortion rate (P less than 0.05) was found in the intravaginally treated group. Intravaginal micronized progesterone was well tolerated by all patients and appeared more effective than intramuscular progesterone in improving the implantation rate, and in decreasing the incidence of abortions in stimulated cycles including GnRHa.

Administration, Intravaginal↗