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Biomedical subjects

Paul Devroey

Publications and source records attributed to Paul Devroey.

At least 55 records · Page 3Linked to original sources
PubMed2004

Administration of gonadotropin-releasing hormone antagonist from day 1 of stimulation in in vitro fertilization.

After administration of GnRH antagonist from day 1 of stimulation for IVF, 12.1 cumulus oocyte complexes were retrieved (95% confidence interval [CI], 10.6-13.6), 1.9 embryos were transferred (95% CI, 1.7-2.0), and 2.4 embryos were cryopreserved (95% CI, 1.7-3.1). Stimulation for 8.8 days (95% CI, 8.4-9.2) with recombinant FSH resulted in an ongoing implantation rate of 26.5% (95% CI, 17.1-35.9) and an ongoing pregnancy rate of 39.7% per started cycle (95% CI, 30.1-50.8) and of 42.4% per ET (95% CI, 32.3-53.1).

Adult↗
PubMed2004

Prolongation of the follicular phase in in vitro fertilization results in a lower ongoing pregnancy rate in cycles stimulated with recombinant follicle-stimulating hormone and gonadotropin-releasing hormone antagonists.

OBJECTIVE: To assess the effect of altering the timing of hCG administration on ongoing pregnancy rates in patients stimulated with recombinant FSH (rec-FSH) and GnRH antagonists for IVF. DESIGN: Prospective, randomized, controlled trial. SETTING: Tertiary referral center. PATIENT(S): Four hundred thirteen patients undergoing IVF. INTERVENTION(S): Rec-FSH stimulation starting on day 2 of the cycle combined with daily GnRH antagonist starting on day 6 of stimulation. Patients were randomized to receive 10000 IU of hCG either as soon as at least three follicles were >or=17 mm on ultrasound (early-hCG group, 208 patients) or 2 days later after this criterion was met (late-hCG group, 205 patients). MAIN OUTCOME MEASURE(S): Ongoing pregnancy rate. RESULT(S): Fertilization rates and number and quality of embryos transferred did not differ between the two groups. However, a significantly lower ongoing pregnancy rate was present in the late-hCG as compared with the early-hCG group (25.0% vs. 35.6%, respectively). CONCLUSION(S): Prolongation of the follicular phase in patients stimulated with rec-FSH and GnRH antagonists for IVF does not affect oocyte or embryo quality but is associated with a significantly lower ongoing pregnancy rate.

Adult↗
PubMed2004

Is addressing the needs of its membership an easy task for the American Society for Reproductive Medicine?

The survey conducted by the American Society for Reproductive Medicine (ASRM) aimed to increase our understanding of the practices and opinions of ASRM members and to assist in decision making for the benefit of the society. Despite some limitations, this is the first step for ASRM to understand better its members, on whom its existence depends and whom it should serve.

Attitude of Health Personnel↗
PubMed2004

Reproductive biology and IVF: ovarian stimulation and endometrial receptivity.

The influence of ovarian stimulation on endometrium receptivity has been inadequately addressed in medical literature. Hormonal effects of ovarian stimulation on endometrial changes as compared with the natural cycle should be elucidated and correlated with the potential of the embryo to implant. It is important to distinguish between the endometrial effect of induction of ovulation in anovulatory women and those of ovarian (super)ovulation in ovulatory women. Induction of ovulation leads to in vivo conception whereas ovarian stimulation results in in vitro fertilization. The available data in the field indicate that endometrial changes have an impressive negative influence on the potential of embryonic implantation. The aim of this review is to analyse the effects of gonadotropin, GnRH-agonist and GnRH-antagonist administration on endometrial behaviour, to highlight the gaps in current knowledge and to propose areas in which research is needed.

Clomiphene↗
PubMed2004

Cumulative live birth rates after transfer of cryopreserved ICSI embryos.

A cohort follow-up study was designed to assess the efficacy of an intracytoplasmic sperm injection cryopreservation programme through analysis of cumulative live birth rates in successive frozen-thawed cycles in a tertiary referral centre. There were 2013 patients and they underwent 2680 frozen-thawed embryo transfer cycles. The follow-up period was between 1992 and 2001. Only frozen-thawed embryo transfer cycles up to the fourth trial were included. Crude cumulative live birth rates were calculated in five age subgroups, i.e. <30, 30-34, 35-37, 38-39 and >/=40 years old and in surgically or non-surgically retrieved sperm subgroups. Expected cumulative live birth rates were calculated only for the total number of patients. Outcome measure was a live birth occurring after 25 weeks of gestation. Overall, the expected cumulative live birth rate was as high as 26.7% after four cycles while the crude cumulative delivery rate was 10.5%. Multiple cryopreserved embryo transfer cycles increase the chance of a couple to achieve a live birth.

Adult↗
PubMed2004

Live delivery rates in subfertile women with Asherman's syndrome after hysteroscopic adhesiolysis using the resectoscope or the Versapoint system.

The purpose of this study was to report on a 10-year experience in the treatment of subfertile women with intrauterine adhesions using the resectoscope or the Versapoint system. Forty-six subfertile women with stage I (n = 6), stage II (n = 25) and stage III (n = 15) intrauterine adhesions underwent adhesiolysis with the use of the resectoscope (n = 21) or the Versapoint system (n = 26). Synechiolysis was successful in 43 women (93.5%) after the first attempt. In 13 out of 14 women (92.9%) with oligo/amenorrhoea at presentation, restoration of menses was reported after adhesiolysis (Versapoint: 9/9, resectoscope: 4/5). Overall live delivery rates according to stage of intrauterine adhesions were 33.3, 44.4 and 46.7% for stages I, II and III respectively. Similar cumulative delivery rates were achieved in patients with no additional infertility factors who attempted to conceive naturally after adhesiolysis using the Versapoint (71.7%) or the resectoscope (60%). Ten gestations ended in preterm delivery (50%), while in two of the women who delivered, a hysterectomy was performed due to placenta accreta. In conclusion, hysteroscopic adhesiolysis offers a real chance of parenthood in a substantial proportion of infertile couples either by using the Versapoint system or the resectoscope.

Adult↗
PubMed2004

Quintuplet pregnancy following transfer of two blastocysts: Case report.

A 36-year-old single woman presented at the out-patient clinic in March 2000 requesting donor insemination. Between May 2000 and May 2001 she underwent six cycles of intrauterine insemination with donor sperm after clomiphene citrate stimulation without achieving a pregnancy. In January 2002, ICSI was performed; two embryos were transferred on day 3 and a dizygotic bichorionic pregnancy was achieved, which ended in a miscarriage at 21 weeks of gestation. After a second unsuccessful ICSI attempt in which a single embryo transfer was performed, she embarked upon her third attempt in March 2003 at 39 years of age. Two blastocysts were transferred after ICSI, resulting in a quintuplet gestation consisting of a monochorionic biamniotic pregnancy and a monochorionic triamniotic pregnancy. The current case report indicates that monozygotic pregnancies consisting of both twins and triplets are possible after treatment by assisted reproductive technologies. An association between extended culture, manipulation of the zona pellucida, ovarian stimulation and occurrence of monozygotic pregnancies has been suggested by retrospective studies. However, in order to identify more reliably predictive factors for the occurrence of monozygotic pregnancies, it is necessary to perform prospective trials.

Abortion, Spontaneous↗
PubMed2004

Ovarian stimulation for in vitro fertilization in patients with endometriosis.

The use of gonadotropin-releasing hormone (GnRH) agonists in a long protocol appears to enhance the probability of conception in the presence of endometriosis. In addition, there is evidence to suggest that the use of prolonged downregulation with GnRH agonists prior to ovarian stimulation for in vitro fertilization (IVF) is beneficial for achieving pregnancy. Until now, GnRH antagonists have not been used in patients with endometriosis. The management of endometriomas prior to stimulation for IVF and its impact on reproductive outcome are still subject to debate.

Adult↗
PubMed2004

Impact of ovarian hyperstimulation on thyroid function in women with and without thyroid autoimmunity.

Pregnancy is accompanied by changes in thyroid function, but limited data are available on these changes in the very first weeks of pregnancy. Yet, T(4) plays a major role in implantation and early fetal development. We sought to determine thyroid function during this period and during the first trimester, in pregnancies achieved by assisted reproductive technology. Furthermore, the thyroid hormone profile was compared between euthyroid women with (TAI+) and without (TAI-) thyroid autoimmunity. We prospectively analyzed data from 35 women who received ovarian hyperstimulation (OH) and presented clinical pregnancies. The mean age of the women was 32 +/- 5 yr. Thyroid function tests [serum TSH and free T(4) (FT(4))] and thyroid antibody status were determined before OH (baseline values) and every 20 d after ovulation induction during the first trimester of pregnancy. Serum TSH and FT(4) increased significantly at d 20, compared with baseline values (3.3 +/- 2.4 vs. 1.8 +/- 0.9 mU/liter; P < 0.0001 and 13.2 +/- 1.7 vs. 12.4 +/- 1.9 ng/liter; P = 0.005). During the first trimester of pregnancy, there was a significant change over time for TSH and FT(4) (P < 0.001 and P = 0.005, respectively). Nine women (27%) were TAI+. The TSH curve among these TAI+ women was significantly higher compared with TAI- women (P = 0.010). The opposite was observed for the FT(4) curve (P = 0.020). In conclusion, the present study showed a significant increase of serum TSH and FT(4) levels after OH in the very first period of pregnancy compared with pre-OH levels and a significant impact of TAI on the thyroid hormone profile during the first trimester. This provides evidence for an altered thyroid function in euthyroid TAI+ patients.

Adult↗
PubMed2003

Human oocytes reversibly arrested in prophase I by phosphodiesterase type 3 inhibitor in vitro.

This study addresses the role of cAMP hydrolytic isoenzyme phosphodiesterase type 3 (PDE 3) modulation on human oocyte maturation in vitro. Presence of phosphodiesterase type 3 A (PDE 3A) mRNA was confirmed in human germinal vesicle-stage (GV) oocytes. Making use of a selective PDE 3 inhibitor, Org 9935 (10 microM), oocytes retrieved from immature follicles were arrested in prophase I with a high efficiency for up to 72 h. Cumulus oocyte complexes (COCs) were retrieved in the follicular phase of the cycle before or after exposure to endogenous LH or hCG administration in vivo and randomly distributed into maturation medium with or without the PDE 3 inhibitor. Previous exposure of small follicles to LH activity in vivo had no influence on the arresting capacity of the PDE 3 inhibitor. Reversal from pharmacological arrest leads to a progression through meiosis in a normal time frame with formation of a well-aligned metaphase plate. Ultrastructure analysis of COC derived from follicles between 8 and 12 mm showed that the induced extension of prophase I arrest in vitro resulted in cytoplasm changes but not in apparent nuclear changes during culture.

3',5'-Cyclic-AMP Phosphodiesterases↗
PubMed2003

Endometrial integrin expression in the early luteal phase in natural and stimulated cycles for in vitro fertilization.

OBJECTIVE: To investigate the effect of ovarian stimulation on integrin expression in the early luteal phase. STUDY DESIGN: Seven endometrial biopsies were taken 2 days after the oocyte retrieval from stimulated cycles for IVF and 23 from natural cycles, 2 days after ovulation. RESULT: Endometrium was in-phase in 22/23 and 7/7 biopsies from the natural and stimulated cycles, respectively. Integrins alpha(1) and alpha(4) were simultaneously positive in 43.4% from the natural and in all (100%) the stimulated cycles (P<0.03). On the day of the endometrial biopsy, progesterone serum values were higher in the stimulated cycles (55.2+/-9.5 microg/l versus 8.5+/-3.8 microg/l) (P<0.001). HSCORE value was significantly higher in stimulated cycles for both integrins. CONCLUSION: Endometrial integrin expression is more consistently present in the early luteal phase in stimulated cycles than in natural cycles and this may be related to the higher serum progesterone concentration and/or the more advanced endometrial histological features.

Adult↗
PubMed2003

Outcome for donors and recipients in two egg-sharing policies.

OBJECTIVE: To assess the effect of two different donation policies on results of egg-sharing. DESIGN: Retrospective analysis. SETTING: Tertiary referral center. PATIENT(S): One hundred five donor-recipient pairs participating in an egg-sharing program between 1998 and 2001. INTERVENTION(S): Egg-sharing was performed according to policy A (retrieval of at least 12 oocytes, with more oocytes allocated to the donor) or policy B (retrieval of at least 8 oocytes, with equal distribution of oocytes between donors and recipients). MAIN OUTCOME MEASURE(S): Delivery rate and cycle cancellation rate. RESULT(S): Policy B resulted in a decreased cycle cancellation rate in the recipient group compared with policy A (9.7% vs. 29.7%, respectively; P<or=.01). No significant difference in delivery rate per fresh transfer was observed between policy A and policy B in donors (30.2% vs. 27.8%, respectively) or recipients (28.2% vs. 25.7%, respectively). CONCLUSION(S): Decreasing the number of oocytes required to perform egg sharing from 12 to 8 and dividing the oocytes equally between donors and recipients significantly reduces the cycle cancellation rate while it does not appear to affect adversely the probability of delivery.

Adult↗
PubMed2003

Influence of individual sperm morphology on fertilization, embryo morphology, and pregnancy outcome of intracytoplasmic sperm injection.

OBJECTIVE: To evaluate the influence of morphology of individual spermatozoa on fertilization and pregnancy outcome. DESIGN: Retrospective analysis. SETTING: An IVF center in an institutional research environment. PATIENT(S): Fertilization and embryo quality according to individual sperm morphology were analyzed in 662 consecutive ICSI cycles. Pregnancy outcome was evaluated for these cycles and an additional 1005 consecutive ICSI cycles. INTERVENTION(S): ICSI was performed using sperm cells of ejaculated, epididymal, or testicular origin. Observation through an inverted microscope was used to prospectively classify injected sperm cells as normal or morphologically abnormal. MAIN OUTCOME MEASURE(S): Oocyte fertilization, embryo morphology, and pregnancy outcome of unmixed embryo transfers. RESULT(S): Injection of morphologically abnormal spermatozoa (irrespective of origin) resulted in a lower fertilization rate (60.7%) than did injection of morphologically normal spermatozoa (71.7%). Embryo cleavage quality did not differ between groups. Higher pregnancy and implantation rates were obtained in patients with normal sperm morphology (36.7% and 18.7%, respectively) than in those with abnormal sperm morphology (20.2% and 9.6%). CONCLUSION(S): Individual sperm morphology assessed at the moment of ICSI correlated well with fertilization outcome but did not affect embryo development. The implantation rate was lower when only embryos resulting from injection of an abnormal spermatozoon were available.

Ejaculation↗
PubMed2003

Prenatal genetic testing by amniocentesis appears to result in a lower risk of fetal loss than chorionic villus sampling in singleton pregnancies achieved by intracytoplasmic sperm injection.

OBJECTIVE: To compare pregnancy outcome after prenatal genetic testing by chorionic villus sampling (CVS) or amniocentesis in singleton pregnancies achieved by intracytoplasmic sperm injection (ICSI). DESIGN: Retrospective analysis. SETTING: Tertiary referral center. PATIENT(S): Eight hundred twenty-eight patients with singleton gestations achieved by ICSI. INTERVENTION(S): Midtrimester amniocentesis (685 patients) and first-trimester CVS (143 patients). MAIN OUTCOME MEASURE(S): Fetal loss rate, preterm delivery rate, and proportion of babies born with low or very low birth weight. RESULT(S): A significant difference was observed in fetal loss rate between CVS and amniocentesis (3.7% vs. 0.9%, respectively). On the other hand, a similar preterm delivery rate was present between the two methods (11.2% vs. 12.4%, respectively). No significant difference was observed between amniocentesis and CVS in the proportion of babies with birth weight of either <1,500 g (1.8% vs. 3.8%, respectively) or between 1,500 and 2,500 g (8.2% vs. 4.6%, respectively). CONCLUSION(S): Amniocentesis appears to result in a lower risk of fetal loss as compared with CVS in patients with a singleton pregnancy achieved by ICSI.

Abortion, Spontaneous↗
PubMed2003

First live birth after ovarian stimulation using a chimeric long-acting human recombinant follicle-stimulating hormone (FSH) agonist (recFSH-CTP) for in vitro fertilization.

OBJECTIVE: To report the first pregnancy and live birth after ovarian stimulation using a chimeric long-acting human recombinant FSH agonist (recFSH-CTP) for IVF. DESIGN: Case report. SETTING: Tertiary fertility center. PATIENT(S): A 32-year-old woman with a 7-year history of primary infertility. INTERVENTION(S): Ovarian stimulation with a single SC injection of 180 microg recFSH-CTP on cycle day 3, followed by daily injections of 150 IU recFSH from cycle day 10 onward, combined with daily GnRH antagonist 0.25 mg SC to prevent a premature LH rise. Final oocyte maturation was induced by 10,000 IU hCG. MAIN OUTCOME MEASURE(S): First ongoing pregnancy obtained with recFSH-CTP. RESULT(S): Twelve oocytes were retrieved. Ten oocytes were fertilized in vitro by intracytoplasmic sperm injection, and from these 10 oocytes, two embryos were subsequently transferred after 3 days of culture. A pregnancy test 2 weeks after ET was positive, and ultrasound investigation revealed an intact, intrauterine, singleton pregnancy after 12 weeks. CONCLUSION(S): The first pregnancy and live birth was achieved after ovarian stimulation using recFSH-CTP for IVF.

Adult↗