The value of day 3 follicle-stimulating hormone levels.
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Female↗
Biomedical subjects
R F Harrison
Publications and source records attributed to R F Harrison.
Spontaneous conception after a successful attempt at in vitro fertilization/intracytoplasmic sperm injection.
OBJECTIVE: To determine the incidence of spontaneous pregnancy in women who were not actively undergoing therapy after a successful attempt at IVF/intracytoplasmic sperm injection and to characterize its pattern of occurrence. DESIGN: Retrospective postal questionnaire. SETTING: An assisted reproduction unit at a university-based teaching hospital. PATIENT(S): Five hundred thirteen replies were received from 530 questionnaires mailed. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Spontaneous pregnancy. Women who did and did not conceive spontaneously after successful IVF treatment were compared in terms of their age, duration of infertility, previous reproductive history, and indication for treatment at the time of assisted reproduction. RESULT(S): The rate of spontaneous conception among the survey respondents was 20.7%. Younger women (</=34 years of age) had a higher rate of spontaneous conception, as did those with a shorter duration of infertility. Women with unexplained infertility and endometriosis also were more likely to conceive. Few of those who had undergone intracytoplasmic sperm injection conceived, whereas 21.6% of those whose partners had had sperm quality sufficient for IVF later conceived spontaneously. CONCLUSION(S): The chances of spontaneous conception after successful ART therapy are significant in some groups of patients. This has implications for the practice of assisted reproduction and the obstetric care of patients who conceive with treatment. Contraceptive advice may need to be provided to couples who undergo IVF/intracytoplasmic sperm injection.
Adult↗
Fertility after abdominal myomectomy.
This study aimed to evaluate the morbidity and pregnancy outcome of myomectomy in infertile women with uterine fibroids. This was a cross-sectional study. Records were reviewed for 100 consecutive women in the Rotunda Hospital who underwent myomectomy in the years 1995-1996. A questionnaire regarding subsequent fertility was sent. The study was carried out in the infertility unit at the Rotunda Hospital, Dublin, Ireland. Seventy-five women responded. Multiple myomectomy was performed in 52 (70%). Mean fibroid size was 6.8 cm (range 2-14.5 cm). Nine women (12%) developed complications; five had menstrual problems, two had wound discomfort and two had abdominal discomfort. Twenty-five women (33%) became pregnant. Seven (28%) were IVF pregnancies. Overall six (24%) miscarried. In 19 of 25, pregnancy occurred where fibroids were the only identifiable cause of infertility. We conclude that abdominal myomectomy is associated with a favourable outcome in infertile women particularly if no other confounding variable is present.
Journal Article↗
Evaluating practice at an Irish tertiary level fertility clinic 1995/98.
This paper audits patients patterns and the diagnostic activities of the Rotunda Hospital, Infertility Clinic by following 186 new patients first attending between 1st March 1995 and 28th February 1996 and their progress in the clinic through to 28th February 1998. Sixty-four percent of patients came from the Eastern Health Board. Sixty-nine per cent had been previously investigated elsewhere. The non-notified drop-out rate was 23%. Of the 158 patients fully investigated, the male partner was the major factor in 27% of couples. Tubal problems accounted for 20% and endometriosis 13%. An ovulation factor was found in 13%. Twenty-seven percent of couples were given the label of unexplained infertility. In 8% more than one factor was present. Fifty-five percent were referred on for IVF/ICSI. Many at this tertiary referral centre had already attended elsewhere. A very high proportion of these had repeat investigations to complete the fertility profile. This policy is questioned as it is not cost effective. The incidence of cause of infertility in the main has little changed in 15 years.
Adult↗
Visualisation of biomedical datasets by use of growing cell structure networks: a novel diagnostic classification technique.
BACKGROUND: Medical research produces large multivariable datasets that are difficult to visualise and interpret intuitively. We describe a novel growing cell structure (GCS) technique that compresses multidimensional datasets into two dimensional maps with colour overlays that can be visually interpreted. METHODS: The two-dimensional map is self-discovered from the training set by distribution of cases to different nodes according to similarity between the cases at each node. Nodes are added to the map until there is no further significant reduction in error. The Parzen window method is used to estimate the probability distribution of the training cases, and this probability is converted to posterior class probabilities by use of Bayes' theorem. Classification performance can be assessed by means of receiver operating characteristic (ROC) curves. Colour maps of the values of each input variable at each node are constructed, which illustrate the relation between each input variable and the overall distribution of cases in the network map. FINDINGS: From a dataset of 11 input variables from 692 fine-needle aspirate samples from breast lesions, a 32-node network produced an area under the ROC curve of 0.96, which was not significantly different from that for logistic regression (0.98, z=1.09, p>0.05). Colour maps of the input variables showed that some variables had discrete distributions over exclusively benign or malignant areas of the network, and were thus discriminant, whereas others, such as foamy macrophages, covered both benign and malignant regions. INTERPRETATION: This technique produces dimensional compression that allows multidimensional data to be displayed as two-dimensional colour images. This envisioning of information allows the highly developed visuospatial abilities of human observers to perceive subtle inter-relations in the dataset.
Artificial Intelligence↗
Combined oestrogen-progestogen replacement therapy does not inhibit low-density lipoprotein oxidation in postmenopausal women.
AIMS: The use of oestrogen containing hormone replacement therapy (HRT) is related to a significantly reduced atherosclerotic cardiovascular risk in postmenopausal women. Oestrogen is thought to be antioxidant and may inhibit low-density lipoprotein (LDL) oxidation in vitro. We investigated the effect of combined oestrogen and progestogen HRT on LDL oxidation in postmenopausal women. METHODS: Eighteen healthy women were given oestrogen/progestogen, and the susceptibility of LDL to oxidation was measured as the level of autoantibody to oxidative modified LDL and the production of conjugated dienes during copper-dependent oxidation after 3 and 6 months HRT. The levels of vitamin E, the major antioxidant in LDL, were also measured. RESULTS: After HRT, the anti-oxidatively modified LDL antibody level remained unchanged [1.58+/-0.16, 0.10 (-0.10, 0.26), and 0.08 (-0.09, 0.19), mean+/-s.d. at baseline, and mean change with 95% confidence intervals for differences at 3 and 6 months, respectively, P>0.05] as did the production of conjugated dienes when determined as lag phase [51.2+/-7.5, -0.3 (-3.9, 3.3), and 1.5 (-3.4, 6.4) min, P>0.05]. The LDL vitamin E content, measured as alpha-tocopherol, was also not altered [2.34+/-0.54, -0.07 (-0.27, 0.13), and -0.07 (-0.33, 0.16) nmol mg(-1) LDL, P>0.05] by treatment. CONCLUSIONS: Combined oestrogen and progestogen therapy for 6 months in postmenopausal women does not protect LDL against oxidation.
Cholesterol↗
Symptomatic cystic swelling at the root of the neck with left sided pleural effusion as a presentation of ovarian hyperstimulation syndrome.
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Adult↗
Evaluation of a statistically derived decision tree for the cytodiagnosis of fine needle aspirates of the breast (FNAB).
A decision tree for the diagnosis of FNAB was derived from defined human observations using a rule induction method, C4.5 (a derivative of the ID3 algorithm). This algorithm is an implementation of the top-down induction method where the tree is determined iteratively by adding those nodes and branches which maximize the information gain at each step. The tree was derived from a training set of 200 FNAB with known outcome using 10 defined features (from one observer) and patient age. The tree contained a total of seven nodes (six observable features and patient age) with eight endpoints (four benign, four malignant). The tree was applied to a test set of 400 further FNAB with observations from the training observer and produced a sensitivity of 95%, specificity of 93% and a positive predictive value (PPV) of a malignant result of 89%. Four trainee pathologists were given a training session on the observable features and then used the tree to determine outcome in a further 50 FNAB. The observers were blind to clinical details apart from age and the endpoints were coded with letters and not labelled benign or malignant. The results from these observers produced ranges of sensitivity 80-96%, specificity 64-92%, PPV 73-92% and kappa statistics (with known outcome) 0.6-0.8. Reported difficulties in using the tree included estimation of nuclear size. These results were worse than the performance of the observers on a further 50 cases without using the decision tree (sensitivity 80-100%, specificity 72-100%, PPV 78-100%, kappa 0.72-0.92). The original 50 case test set was rerandomized and the four trainee observers made all 10 defined observations on each specimen without using the decision tree; these observations were then used to derive decisions from the tree. The performance from this method was similar to that using selected features from the tree, suggesting that observation of all features together does not improve the reliability of each specific observation. The poor performance of this tree suggests that this methodology may be unsuitable for producing decision support aids for diagnostic or training purposes in this domain.
Biopsy, Needle↗
Outcome from consecutive in-vitro fertilization/intracytoplasmic sperm injection attempts in the final group treated with urinary gonadotrophins and the first group treated with recombinant follicle stimulating hormone.
In the absence of specific dose equivalency data, the aim of this study was to compare the clinical results during the cross-over from menopausal urinary products (human menopausal gonadotrophin; HMG) to recombinant follicle stimulating hormone (FSH) follitrophin beta (FSHr) in order to determine whether the manufacturer's recommendation for equivalence of ampoule to ampoule (50 IU FSHr:75 IU HMG) would prove clinically correct. A total of 353 consecutive in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment cycles was studied between 1st September 1996 and mid-February 1997. This included cycles in the last 191 women receiving HMG and the first 162 taking FSHr. All were down-regulated using a gonadotrophin releasing hormone (GnRH) agonist long protocol method from day 1 of the cycle. Greater efficacy was seen in the HMG group in terms of days of stimulation required, need to increase dosage, cycle discontinuation, number of follicles punctured, the numbers of oocytes retrieved and their quality. The hormonal response to stimulation assessed by oestradiol concentrations on days 5, 8 and day of human chorionic gonadotrophin (HCG) was significantly lower in the FSHr group. The ratio of oestradiol per follicle and per oocyte was significantly lower in the FSHr group. There was a highly significant increase in cost with FSHr therapy. Clinical pregnancy rates were 14% per cycle with FSHr and 20% per cycle with HMG.
Drug Costs↗
No show is a major problem in planning appointments for infertility patients.
We examined the pattern of bookings for and actual visits undertaken by patients attending the Infertility Clinics at the Rotunda Hospital Dublin as well as the accuracy of systems in place for recording such events. The data provided by the Hospital Patient Administration System (PAS), clinic worksheets and clinic record chart of first visit couples attending initially over a 12 month period 1995/1996 and their subsequent records to February 1998 was analysed. Comparable figures were provided from the corresponding private clinic over the same time frame. Sixty-nine percent had already had investigations and treatment elsewhere. Discrepancies were noted between the PAS and manual systems as confirmed by the patient records. The manual proved more accurate. We found 32% (88 of 276) patients failed to turn up for a first appointment compared with 17% of private patients. Un-notified no-show provides great logistic difficulties in planning clinic management. Waiting lists grow, staff and patients alike are greatly inconvenienced. This apparent recklessness makes the Charter of Rights for Hospital Patients difficult to comply with. A possible answer is to demand reconfirmation near to the clinic date and in it's absence reassign the appointment to another. Population education is clearly needed.
Appointments and Schedules↗
Processing of semen in an antibiotic-rich culture medium to minimize microbial presence during in vitro fertilization.
OBJECTIVE: To identify and determine the prevalence of microorganisms in preprocessed and postprocessed semen in an IVF-ET program. DESIGN: Prospective study. SETTING: University Teaching Hospital. PATIENT(S): Seventy-four men undergoing preprogram evaluation, each producing two semen samples. INTERVENTION(S): Semen processing with a wash and swim-up technique in a penicillin- and streptomycin-rich medium. MAIN OUTCOME MEASURE(S): The identity and prevalence of seminal microorganisms before and after processing. RESULT(S): Sixty-three percent of individual unprocessed semen samples grew microorganisms, the majority of which were nonpathogenic. Thirty-three men (44.6%) had microbes identified in repeat samples, four had identical organisms each time. Twenty (27%) had positive cultures in one sample, negative in the other. Twenty-one (28.4%) had consistently sterile semen. After seminal processing, the recovery rate for microbes was 5%. Microbial presence after processing did not correlate with either the sperm swim-up concentration or the initial microbial concentration. CONCLUSION(S): Bacteriospermia is common. The microorganisms found rarely are replicated and most likely represent contamination. Wash and swim-up semen preparation in an antibiotic rich culture medium effectively eliminates 95% of organisms.
Anti-Bacterial Agents↗
An artificial neural network system for diagnosis of acute myocardial infarction (AMI) in the accident and emergency department: evaluation and comparison with serum myoglobin measurements.
Recent studies have confirmed that artificial neural networks (ANNs) are adept at recognising patterns in sets of clinical data. The diagnosis of acute myocardial infarction (AMI) in patients presenting with chest pain remains one of the greatest challenges in emergency medicine. The aim of this study was to evaluate the performance of an ANN trained to analyse clinical data from chest pain patients. The ANN was compared with serum myoglobin measurements--cardiac damage is associated with increased circulating myoglobin levels, and this is widely used as an early marker for evolving AMI. We used 39 items of clinical and ECG data from the time of presentation to derive 53 binary inputs to a back propagation network. On test data (200 cases), overall accuracy, sensitivity, specificity and positive predictive value (PPV) of the ANN were 91.8, 91.2, 90.2 and 84.9% respectively. Corresponding figures using linear discriminant analysis were 81.0, 77.9, 82.6 and 69.7% (P < 0.01). Using a further test set from a different centre (91 cases), the accuracy, sensitivity, specificity and PPV for the admitting physicians were 65.1, 28.5, 76.9 and 28.6% respectively compared with 73.6, 52.4, 80.0 and 44.0% for the ANN. Although myoglobin at presentation was highly specific, it was only 38.0% sensitive, compared with 85.7% at 3 h. Simple strategies to combine clinical opinion, ANN output and myoglobin at presentation could greatly improve sensitivity and specificity of AMI diagnosis. The ideal support for emergency room physicians may come from a combination of computer-aided analysis of clinical factors and biochemical markers such as myoglobin. This study demonstrates that the two approaches could be usefully combined, the major benefit of the decision support system being in the first 3 h before biochemical markers have become abnormal.
Adult↗
The effect of hormone replacement therapy on vitamin E status in postmenopausal women.
OBJECTIVES: Vitamin E (alpha-tocopherol) is the most important dietary antioxidant found in lipids and cell membranes and its intake is inversely related to the incidence of atherosclerotic cardiovascular disease. Oestrogen-containing oral contraceptives may decrease plasma vitamin E level in young women. We investigated if oestrogen-containing hormone replacement therapy (HRT) may have the same effect on vitamin E status in postmenopausal women METHODS: Eighteen healthy postmenopausal women took a combination of oestrogen/progestogen (Harmogen Provera) therapy and another ten acted as a control group. Blood samples were taken at baseline and repeated after 3 and 6 months in both groups. Vitamin E in plasma, red cells and isolated low-density lipoprotein (LDL) was measured as alpha-tocopherol by high-performance liquid chromatography. RESULTS: Vitamin E status showed no change in either group after 3 and 6 months in comparison to its baseline value. CONCLUSION: Combined oestrogen/progestogen HRT for 6 months in healthy postmenopausal women did not alter vitamin E. status in vivo.
Antioxidants↗
Application of autonomous neural network systems to medical pattern classification tasks.
This paper presents a study of the application of autonomously learning multiple neural network systems to medical pattern classification tasks. In our earlier work, a hybrid neural network architecture has been developed for on-line learning and probability estimation tasks. The network has been shown to be capable of asymptotically achieving the Bayes optimal classification rates, on-line, in a number of benchmark classification experiments. In the context of pattern classification, however, the concept of multiple classifier systems has been proposed to improve the performance of a single classifier. Thus, three decision combination algorithms have been implemented to produce a multiple neural network classifier system. Here the applicability of the system is assessed using patient records in two medical domains. The first task is the prognosis of patients admitted to coronary care units; whereas the second is the prediction of survival in trauma patients. The results are compared with those from logistic regression models, and implications of the system as a useful clinical diagnostic tool are discussed.
Artificial Intelligence↗
Image analysis of low magnification images of fine needle aspirates of the breast produces useful discrimination between benign and malignant cases.
Fine needle aspirates of the breast (FNAB) (n = 362; 204 malignant, 158 benign), prepared by cytocentrifuge methods and stained by the Papanicolaou technique, were analysed using a semi-automated image analysis system at a low magnification which precluded resolution of nuclear detail. The measured parameters were integrated optical density, fractal textural dimension, number of cellular objects (single cells and contiguous groups of cells), distance between cellular objects (mean, s.d., skewness and kurtosis), area of cellular objects (mean, s.d., skewness, kurtosis) and the nearest neighbour statistic. The cases were divided into a 200-case training set and a 162-case test set. Analysis was performed by logistic regression and the multi-layer Perceptron type of artificial neural network. Logistic regression and the neural network produced similar performances with a sensitivity of 82-83%, specificity 85% and a positive predictive value for a malignant result of 85%. A non-parametric analysis of all the predictor variables showed that all except the mean area of cellular objects and the s.d. of this measurement were significant discriminants (P < 0.05), but most were highly interrelated and this was reflected in the selection of only three predictor variables by forward and backward conditional logistic regression. This study shows that much diagnostic information is present in low power views of FNAB, and that image analysis could form the basis of a semi-automated decision-support aid.
Biopsy, Needle↗
Cytogenetic analysis is essential before ICSI.
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Cytoplasm↗
Neural networks and early diagnosis of myocardial infarction.
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Diagnosis, Computer-Assisted↗
A 2-year study of lipid and lipoprotein changes in postmenopausal women with tibolone and estrogen-progestin.
OBJECTIVE: To assess changes in lipid-lipoprotein profile in postmenopausal women taking tibolone and estrogen-progestin, compared with untreated controls. METHODS: Sixty-three women were randomized to take a combined estrogen-progestin preparation (n = 31) or tibolone (n = 32), and 50 other women acted as controls. Fasting lipid-lipoprotein levels were measured over 96 weeks. RESULTS: The controls, who were older and postmenopausal longer than the therapy subjects, exhibited significant decreases in total (P < .05) and low-density lipoprotein (LDL) (P < .001) cholesterol and increases in triglyceride (P < .05) and lipoprotein (a) (P < .001) over the 96-week period of study. Lipoprotein (a) also decreased significantly in both treated groups (P < .001). Total and LDL cholesterol decreased and triglyceride increased in the estrogen-progestin group, but, compared with controls, these changes were not significant. Total cholesterol decreased in the tibolone group, although decreases in low- and particularly high-density lipoprotein (HDL) (P < .001) cholesterol and parallel decreases in apolipoprotein A1 (P < .001) and B (p < .01) were also observed. There was evidence of a reversion phenomenon in apolipoproteins A1 and B in all groups, and in lipoprotein (a) with tibolone. CONCLUSION: Some changes accompanying tibolone may be favorable and may counter its adverse effect on HDL cholesterol. Lowering of lipoprotein (a) was the only significant change found with estrogen-progestin.
Animals↗