Biomedical subjects

P Devroey

Publications and source records attributed to P Devroey.

At least 253 records · Page 14Linked to original sources

PubMed1992

Comparison of in-vitro fertilization in male and tubal infertility: a 3 year survey.

The in-vitro fertilization and embryo transfer (IVF-ET) procedure was compared in 175 couples with male infertility and 480 couples with tubal infertility. In cases of male infertility, more oocytes were recovered but fewer oocytes were fertilized. Although the cleavage rate was decreased, no difference in embryo quality was found. In male infertility, fewer transfers were performed and the average number of embryos per transfer was lower. The total pregnancy rate was also lower per cycle (12.8 versus 22.9%), but not per transfer (25.4 versus 25.7%). The further obstetrical outcome was similar in both groups. We conclude that male infertility can be treated by IVF-ET but results are still disappointing when compared to a control group with normal spermatozoa.

Data Collection↗

PubMed1992

Induction of acrosome reaction in human spermatozoa used for subzonal insemination.

Human spermatozoa were injected into the perivitelline space of oocytes from 43 couples (44 cycles) in whom fertilization had failed in conventional in-vitro fertilization (IVF). The spermatozoa were treated to enhance the percentage of acrosome-free spermatozoa either by incubation for 24 h in T6 medium with 50% follicular fluid (v/v) or by incubation for 24 h in T6 medium followed by electroporation and incubation for a few hours in T6 medium with 3.5 mM pentoxifylline. After these two procedures, the mean percentage of acrosome-free spermatozoa increased to 35.5 and 53.9% respectively. Up to three spermatozoa were injected into the perivitelline space of metaphase II oocytes; few oocytes were damaged during the injection procedure. The overall fertilization rate was 30.9% of the 433 oocytes that were intact after subzonal insemination. Only 3% of the injected oocytes had more than two pronuclei. The cleavage rate of the fertilized oocytes was 80%. There was no difference in the fertilization and cleavage rates between the two sperm treatment procedures. One, two or three embryos were replaced in 34 cycles and seven patients became pregnant. In three of the four ongoing pregnancies, prenatal diagnosis by amniocentesis indicated a normal karyotype.

Acrosome↗

PubMed1992

The effect of gonadotrophin-releasing hormone (GnRH) agonist in the follicular phase on in-vitro fertilization outcome in normo-ovulatory women.

Sixty-three normo-ovulatory infertile women were randomly divided into two groups. All women were first desensitized with the gonadotrophin-releasing hormone agonist (GnRHa), buserelin. Thereafter, ovarian stimulation with human menopausal gonadotrophins (HMG) was started in both groups but in group A the GnRHa was stopped on the same day. In group B, the GnRHa was continued during HMG treatment until the ovulatory human chorionic gonadotrophin stimulus was given. Premature luteinization was not observed in either group, although the preovulatory basal luteinizing hormone (LH) secretion was significantly higher in group A. An equal number of embryos of comparable quality was transferred in both groups and the pregnancy outcome was similar. However, the supernumerary embryos of group A were of a lower morphological quality and survived the cryopreservation process less well. We concluded that the continuous administration of a GnRH agonist during HMG treatment resulted in better quality of supernumerary embryos.

Adult↗

PubMed1992

Oocyte and embryo donation: evaluation of 412 consecutive trials.

A total of 199 patients (412 consecutive cycles) were treated by oocyte-embryo donation in 336 replacement cycles. Of these, 296 involved intra-uterine embryo transfers, 38 zygote intra-Fallopian transfers (ZIFT) and two gamete intra-Fallopian transfers (GIFT). Of the 336 replacements, 244 (73%) constituted transfers of fresh concepti and 92 (27%) of frozen-thawed ones. A total of 85 pregnancies were achieved of which 16 ended in preclinical abortions, giving a clinical pregnancy rate of 34.7% per patient, 20.5% per transfer and a take-home baby rate of 29.1% per patient. The pregnancy rate was significantly higher (P less than 0.05) following fresh gamete or embryo replacement (23%; 56/244) than following that of frozen-thawed embryos (14.1%; 13/92). No significant difference was observed when intra-Fallopian replacement was applied (27.5%; 11/40) as opposed to intra-uterine (19.6%; 58/296). Ovarian function was not found to be of significant importance to the achievement of pregnancies after oocyte donation since comparable pregnancy rates per replacement and per started cycle were obtained in patients with ovarian failure and in those with functional ovaries (19% and 15.4%; 24.2% and 20.2% respectively). Comparison of the implantation and abortion rates between these two groups did not reveal any significant difference (11.1% and 11.1% versus 14.8% and 16.6%). The highest pregnancy rate among patients with ovarian failure was observed in those with primary ovarian failure (26.4%; 14/53), while the lowest was among women who had received chemotherapy and/or radiotherapy (9%; 1/11).(ABSTRACT TRUNCATED AT 250 WORDS)

Embryo Transfer↗

PubMed1992

Laparoscopic application of interceed (TC7).

Interceed (TC7) is a surgical adjuvant which has been shown to be efficacious in reducing adhesion formation in gynaecological pelvic surgery by laparotomy. In view of the increasing number of laparoscopic interventions and the concern with reducing post-operative adhesions, we evaluated the possibility of Interceed delivery through the ancillary trocars. Twenty-four patients underwent operative laparoscopy followed by the application of Interceed. No difficulties were noticed. Material sized from 1.9 x 2.5 to 3.8 x 5 cm was successfully delivered into the peritoneal cavity, while the duration of the procedure ranged from 2.5 to 6 min for each piece. In conclusion, it is feasible to consider application of Interceed during laparoscopic interventions. This approach to delivery requires a short operative time, minimal instrumentation and enhanced ease of application.

Cellulose, Oxidized↗

PubMed1992

Pituitary gonadotrophin secretory capacity during the luteal phase in superovulation using GnRH-agonists and HMG in a desensitization or flare-up protocol.

Pituitary gonadotrophin reserve and basal gonadotrophin secretion were tested during the luteal phase in women superovulated with buserelin/human menopausal gonadotrophin (HMG) in a desensitization (n = 17) or flare-up protocol (n = 7). In the desensitization protocol the luteinizing hormone-releasing hormone (LHRH) stimulated serum LH and follicle stimulating hormone (FSH) concentrations remained impaired at least until day 14 after arrest of the agonist. In the flare-up protocol basal and stimulated LH secretion was still abnormal on days 14 and 15 after human chorionic gonadotrophin (HCG) injection. Normal basal serum FSH concentrations were measured at the end of the luteal phase in the flare-up protocol, but the response of FSH to LHRH injection was still subnormal. We conclude that gonadotrophin function remained impaired until the end of the luteal phase after desensitization and flare-up GnRH-agonist and HMG stimulation protocols. Corpus luteum stimulation with exogenous HCG or substitution therapy using natural progesterone are required to prevent the possible negative effects resulting from pituitary dysfunction after GnRH-agonist treatment.

Adult↗

PubMed1992

Pregnancy after zygote intra-fallopian transfer using spermatozoa from a patient with Kallmann's syndrome.

A successful zygote intra-Fallopian transfer has been performed using spermatozoa from a patient with Kallmann's syndrome. Spermatogenesis was induced by hormonal treatment but even so, semen quality remained slightly impaired and no pregnancy occurred over 4 years, despite ovulation induction in the patient's spouse. Finally she conceived after assisted procreation by in-vitro fertilization and delivered a healthy baby.

Adult↗

PubMed1992

Beta-N-acetylhexosaminidase activity in human oocytes and preimplantation embryos.

beta-N-acetylhexosaminidase is a lysosomal enzyme, which has two isoenzymes: beta-Hex A, a trimer consisting of one alpha-chain and two beta-chains (alpha beta 2) and beta-Hex B, a tetramer formed of four beta-chains (beta 2 beta 2). Genetic defects in the alpha-chain lead to Tay-Sachs disease, whereas mutations in the beta-chain gene lead to Sandhoff disease. In a previous study we developed a microassay for total beta-N-acetylhexosaminidase and used this for measuring activities in mouse oocytes and preimplantation embryos. In this study, to assess the feasibility of transferring this technique to the human for the purposes of preimplantation diagnosis for Tay-Sachs and Sandhoff disease, beta-Hex activity was assayed in human oocytes and embryos and in the medium in which they had been cultured. We showed that although the activity of beta-N-acetylhexosaminidase in human oocytes and embryos was > 500 times higher than in the mouse, it was not detectable in the culture medium and the activity in oocytes and embryos remained virtually constant throughout human preimplantation development, making it difficult to distinguish embryonic from maternal enzyme activity. In the absence of this distinction it would be inappropriate to use beta-N-acetylhexosaminidase activity for the purposes of preimplantation diagnosis of Sandhoff or Tay-Sachs disease. These experiments demonstrate that measuring the beta-N-acetylhexosaminidase activity in human embryos cannot be used at present for preimplantation diagnosis.

Blastocyst↗

PubMed1992

[A randomized prospective study comparing supplementation of the luteal phase and early pregnancy by natural progesterone administered by intramuscular or vaginal route].

Deficiency in the luteal phase has been shown during stimulated cycles using a protocol involving a GnRH agonist. The authors undertook a randomised prospective trial of supplementation by progesterone of the luteal phase and of early pregnancy in two hundred and seventy two patients requiring fertilisation in vitro (FIV), gamete inter-fallopian transfer (GIFT) or zygote inter-fallopian transfer (ZIFT). Either progesterone in solution in oil (50 mg/day) administered by intramuscular injection or micronized progesterone administered intra-vaginally (600 mg/d) were used as support for the luteal phase. Administration of progesterone in association with estradiol valerate was started on the day prior to oocyte puncture and was continued until the 12th week of pregnancy. The implantation rate was very close to the threshold of significance (P = 0.07) in favour of the patients given vaginal progesterone. There was a higher rate of clinical pregnancies (33.6 versus 26.7 p. cent) in the latter group, though this was not significant. While plasma progesterone (Pg) levels were lower in patients using vaginal progesterone, the abortion rate during the first three months was lower in this group (P < 0.05). Micronized progesterone administered vaginally was well tolerated by all patients. During stimulated cycles, notably by GnRHa, it thus proved to be more effective than Pg administered by intramuscular injection with regard to implantation and abortion rates.

Administration, Intravaginal↗

PubMed1992

Adhesions.

Although several decades have passed since the first theories concerning normal healing and adhesion formation processes were proposed, the possible role of some factors is still under investigation. The availability of recombinant murine interleukin-1 allowed the assumption that interleukin-1 may be an important short-term mediator of adhesion formation. The definite effect of prostaglandin E2 on adhesion formation was also further elucidated, whereas prostaglandin F2 alpha was found to play a minimal role in the inflammatory process, which is the initial step in the pathogenesis of adhesions. The development of recombinant tissue plasminogen activator offers a unique alternative to augment the depressed endogenous fibrinolytic system. Intraperitoneal application of recombinant tissue plasminogen activator to injured animal models showed significant reduction in both de novo and reformation of adhesions. The presumption that operative laparoscopy is more beneficial than laparotomy with regard to postoperative adhesion development is demonstrated by the latest studies on this topic. Recently developed barrier methods, including natural or synthetic materials, have been tested in animal models and appear promising in reducing both formation and reformation of adhesions. Until these are introduced in clinical practice, the immediate future will certainly involve the further expansion of absorbable barriers.

Female↗

PubMed1992

The relationship between embryo quality and the occurrence of multiple pregnancies.

OBJECTIVE: To study the relationship between the quality of the transferred embryos and the occurrence of multiple pregnancies. Embryo quality was defined by the cleavage rate and by morphological parameters such as blastomere size and the presence or absence of anucleate fragments. DESIGN: A retrospective analysis of 1,915 consecutive transfers of fresh embryos between January 1986 and December 1989. SETTING: All the embryo transfers (ETs) were performed in patients from the in vitro fertilization program of the Center for Reproductive Medicine, Vrije Universiteit Brussel, Brussels, Belgium. RESULTS: We confirmed the relationship between the number of embryos transferred and the pregnancy rate (PR): 11.9% of the single, 19.0% of the double, and 34.1% of the triple ETs were successful. Thirty-one percent of these triple embryo replacements resulted in a multiple gestation. At the time of transfer (44 to 48 hours after insemination), we observed that embryos that had undergone at least two mitotic divisions implanted better than two-cell embryos of comparable morphological appearance (implantation rate per transferred embryo: 21.3% versus 12.3%, P less than 0.001) and that heavily fragmented embryos did not implant as well as embryos without or with fewer anucleate fragments (1.5% versus 14.1%, P less than 0.001). The PR, implantation rate, and the incidence of multiple pregnancies increased significantly with the number of good quality embryos that were transferred. CONCLUSIONS: Our study indicated that embryo quality based on morphological observations could predict the occurrence of multiple pregnancies.

Blastocyst↗

PubMed1991

The incidence of multiple pregnancy after in vitro fertilization and embryo transfer, gamete, or zygote intrafallopian transfer.

This retrospective study concerns the incidence of multiple pregnancy after the replacement of three conceptus using different techniques of assisted reproduction. During a 2-year period, 713 in vitro fertilization-embryo transfers (IVF-ETs) with three embryos, 190 gamete intrafallopian transfers (GIFT) with three oocytes, and 161 zygote intrafallopian transfers (ZIFT) with three zygotes were performed. Although we observed significant differences in implantation and pregnancy rates (PRs), the three techniques resulted in high multiple PR. At 20 weeks, 16% of GIFT pregnancies, 27% of ZIFT pregnancies, and 32% of IVF-ET pregnancies were multiple. Therefore we recommend to limit the number of conceptus transferred to a maximum of three in all cases.

Adult↗

PubMed1991

In vitro fertilization techniques with frozen-thawed sperm: a method for preserving the progenitive potential of Hodgkin patients.

The banked sperm of 5 of 13 Hodgkin patients was thawed for assisted reproduction. The post-thaw sperm characteristics were extremely impaired. Nevertheless, in 80% of all trials fertilization in vitro was obtained and conceptus could be transferred. All spouses became pregnant and seven healthy infants were born. One could recommend every Hodgkin patient to bank his sperm before chemotherapy. In vitro fertilization techniques with this frozen-thawed sperm reveal promising results in comparison with artificial insemination to maintain the reproductive capacity of male Hodgkin patients.

Adult↗

PubMed1991

In-vitro fertilization, gamete- or zygote intra-fallopian transfer for the treatment of male infertility.

This retrospective study compares in-vitro fertilization and embryo transfer (IVF-ET), gamete intra-Fallopian (GIFT) and zygote intra-Fallopian transfer (ZIFT) for the treatment of male infertility in 266 couples (n = 318 cycles). The IVF-ET technique revealed a total pregnancy rate of 14.1% per cycle and 29.1% per transfer. The conception rate with GIFT was 17.8%; an abortion rate of 50% was noted. The ZIFT procedure scored a 20.9% total pregnancy rate per cycle and 33.3% per transfer. The cumulative take home baby rates per couple for IVF-ET, GIFT and ZIFT were 13.5, 7.0 and 20.0%, respectively.

Adult↗

PubMed1991

The influence of inadvertent intranasal buserelin administration in early pregnancy.

Buserelin was inadvertently administered during 13 early pregnancies in 12 women with long-standing infertility, who had started the GnRH-agonist for gonadotrophin desensitization prior to ovarian stimulation for IVF. Six women delivered a healthy child and one pregnancy continues uneventfully. Three patients aborted before the sixth week and three women with tubal disease had an ectopic pregnancy. Corpus luteum function was normal in 11 of the 13 pregnancies. Although no evidence of embryotoxic effects of buserelin was observed, barrier contraceptive methods should be advised during the first days of its administration.

Administration, Intranasal↗

PubMed1991

Human serum albumin versus serum: a comparative study on embryo transfer medium.

OBJECTIVE: This study has examined the efficacy of human albumin as a replacement for serum in embryo transfer (ET) medium. DESIGN: In a prospective, randomized study, 224 cycles were analyzed. Patients were randomly divided into three groups: in group A, embryos were transferred in 75% serum; in group B, in 8% serum; and in group C, 2.25% human serum albumin (HSA). SETTING: All the ETs were performed in patients from the in vitro fertilization program of the Center for Reproductive Medicine, Vrije Universiteit Brussel, Belgium. PATIENTS, PARTICIPANTS: In 194 patients, 224 ETs were performed. The patients were selected when they had at least one good-quality embryo. INTERVENTIONS: None. MAIN OUTCOME MEASURE(S): Use of albumin in culture medium resulted in higher pregnancy rates (PRs). To further simplify the procedure, albumin was also used in ET medium. RESULTS: An overall PR of 43% in group A, 27% in group B, and 36% in group C was achieved. No significant difference was observed in PRs between three different transfer media. CONCLUSIONS: We conclude that HSA is a safe and suitable replacement for serum, both in embryo culture and in the transfer medium.

Adult↗

PubMed1990

[Curreny results of GIFT and ZIFT].

This report describes the results of gamete intra-fallopian transfer (GIFT) in 102 treatment cycles for male infertility and in 202 cycles for unexplained infertility. Twenty-one pregnancies out of 102 GIFT replacements (20.6 p. 100) were obtained in male infertility and 74 pregnancies out of 202 GIFT replacement (36.6 p. 100) were established. One hundred and forty-five pregnancies were obtained out of 348 zygote intra-fallopian transfers (ZIFT) (41 p. 100).

Embryo Transfer↗

PubMed1990

Placental production of estradiol and progesterone after oocyte donation in patients with primary ovarian failure.

After oocyte donation 18 pregnancies were established in 17 patients with the absence of ovaries. Eight patients were delivered of nine healthy infants including one set of twins, six pregnancies were progressing normally, and four pregnancies were aborted. Four pregnancies were established after transfer of frozen-thawed embryos. In the simulated luteal phases, replaced with estradiol valerate and progesterone, pregnancies could be established and maintained as indicated by the profile of serum human chorionic gonadotropin concentrations. Weekly determinations of serum 17 beta-estradiol levels indicated significantly higher values at 7 weeks' gestation, as compared with week 5. This observation precludes that the luteoplacental shift occurred before 7 weeks' gestation. The weekly serum determinations of progesterone were significantly higher week 9, as compared with week 5. Two pregnancies were achieved after the vaginal administration of micronized progesterone.

Adult↗