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Biomedical subjects

R Frydman

Publications and source records attributed to R Frydman.

At least 181 records · Page 10Linked to original sources
PubMed1996

[Anomalies of umbilical vein in the fetus. A case report and review of the literature].

Abnormal connexion of the umbilical vein in the inferior vena cava was diagnosed in a fetus at 18 weeks' gestation. Associated anomalies included nuchal and axillary lymphangiectasia, hypertrophic cardiomyopathy and hepatomegaly. Neonatal death occurred after spontaneous vaginal delivery at 25 weeks. A review of the literature summarizes the diagnostic criteria and associated anomalies.

Abnormalities, Multiple↗
PubMed1996

[Ovarian stimulation using a protocol of low dose agonist in patients with an elevated basal FSH].

This study compare the ovarian response of patients with high day 3 FSH (> 6.5 UI/L), treated with two protocols; a protocol with a low dose of GnRH agonist and a so called "long protocol" with GnRH agonist in a depot formula. The ovarian response with the agonist low dose was better with less ampules (37.1 vs 46.6) and a shorter duration of stimulation (10.5 vs 12.4 days). The number of mature oocyte was higher (5.9 vs 4.5) as well as the number of good quality embryo (3.2 versus 2.3). The E2 levels on day 8 was higher (1065 vs 460 pg/ml). The cancellation rate was lower (14% vs 26%). The use of the low dose protocol gave a better ovarian response for patients with high 3 FSH. Large randomized studies are needed to confirm these data.

Adult↗
PubMed1995

[Congenital toxoplasmosis: transmission to the fetus of a pre-pregnancy maternal infection].

It has been established that maternal immunity developing before conception protects the fetus from congenital toxoplasmosis. We observed a case of congenital toxoplasmosis consecutive to a maternal toxoplasma infection that had preceded pregnancy. A woman with normal immune system developed toxoplasmosis 2 months before conceiving. No treatment was given to this prepregnancy seroconverted patient. At 25 weeks of amenorrhoea, the ultrasound examination showed a fetal cerebral ventricular dilatation. Amniocentesis and cordocentesis showed fetal toxoplasmosis infection. Fetopathologic examination confirmed the diagnosis of cerebral toxoplasmosis. The pathophysiology of maternal-fetal toxoplasma transmission and the role played by maternal immunodeficiency are discussed. This exceptional case-report showed the difficulties of the management in patients with 3-month pre-pregnancy toxoplasmosis and its practical implications.

Abortion, Therapeutic↗
PubMed1995

Chromosome 18 analysis by fluorescence in situ hybridization (FISH) in human blastomeres of abnormal embryos after in vitro fertilization (IVF) attempt.

We performed fluorescence in situ hybridization (FISH) with a chromosome 18-specific probe on human abnormal cleaved embryos, fertilized either by two spermatozoa and exhibiting three pronuclei (3 PN) or normally fertilized and exhibiting two pronuclei (2 PN) with subsequent severe fragmentation and/or blocking. The aim of the study was to evaluate the incidence of chromosome 18 anomalies among these embryos in order to evaluate the FISH efficiency on such material and to obtain more precise and complete data than those obtained with classical cytogenetic analysis. For the 3 PN cleaved embryos, FISH confirmed the frequent regulation towards diploidy (25 per cent) and the high frequency of mosaics (53 per cent). For the 2 PN blocked or damaged embryos, FISH permitted chromosome evaluation, which was otherwise impossible with classical cytogenetic techniques: we also found a high mosaic frequency (45 per cent) with these embryos. If this frequency were the same for normally developing embryos, it would be a major obstacle to the reliability of either chromosomal or genetic preimplantation diagnosis.

Blastomeres↗
PubMed1995

Is median thoracic artery a target organ artery for estradiol and progesterone? A comparison with uterine artery.

PURPOSE: The aim of this study was to show the parallel evolution of the pulsatility index of the uterine artery and the one of the median thoracic artery. STUDY DESIGN: The study involved seven volunteer women, below 38, suffering from premature ovarian failure, who received E2 and progesterone replacement therapy. Plasma levels of E2, progesterone, follicle stimulating hormone and luteinizing hormone were measured and PI were studied and compared before treatment and on Days 13, 27 and 41. RESULTS: Before treatment, a high-resistance vascular for both arteries is uniformly found. The curves show with the increasing of the E2 plasma levels, a decrease in the PI of UA and MTA with a fall at Day 13. We compared the mean values in MTA and UA PI. No statistical difference between the three mean values in PI obtained at Day -1, Day 13 and Day 41 was demonstrated. CONCLUSION: The results suggest that median thoracic artery is a target organ artery. Such as the UA, the MTA vascular resistance is according to the variations of plasma levels of E2. In consideration of it rectilinear and superficial type, this led us to study this artery when we use different sorts of replacement therapy, and particularly in the oocyte donation program.

Adult↗
PubMed1995

Cytogenetic analysis of uncleaved oocytes after intracytoplasmic sperm injection.

PURPOSE: This work analyzes the causes of cleavage failure after intracytoplasmic sperm injection (ICSI) and the effect of the procedure on the chromosomes of the oocytes. METHODS: Ninety-seven uncleaved oocytes from 39 patients with severe male infertility or repeated IVF failure were fixed; 79 were analyzable. We checked the decondensation stage of spermatozoa nucleus and the chromosomal abnormalities of the oocytes. RESULTS: Among the fixed oocytes, the spermatozoa nucleus was present in 97% of the cases, and it was undecondensed in 89% of the cases, showing no evolution at all. A low rate (2.6%) of premature chromosome condensation (PCC) of the spermatozoa and a low rate (2.5%) of female diploïdy were observed. Among the oocytes that could be karyotyped, we observed a high rate (45%) of chromosome breakage. CONCLUSION: ICSI fertilization failure was due mostly to the complete lack of evolution of the spermatozoa nucleus. Oocyte selection before ICSI seemed to lower the PCC rate. The high rate of oocyte chromosomal breakage rate has to be confirmed.

Chromosome Aberrations↗
PubMed1995

Urinary cGMP levels during pregnancy with and without uterine contractions.

OBJECTIVE: The purpose of this study was to investigate the nitric oxide-cGMP (NO-cGMP) system by urinary cGMP level determinations in pregnant women with and without uterine contractions. DESIGN AND SUBJECTS: cGMP expressed in nmol/mmol of creatinine was performed by radio immuno-assay (Amersham UK) in urine samples obtained from 94 pregnant women with non-complicated pregnancies. Population A without contractions (n = 62) was divided into three groups according to the gestational age (group I, < or = 15 weeks; group II, 16-33 weeks; group III, > 33 weeks). The group III from A population was compared to B population (of the same gestational age) presenting uterine contractions (n = 32). RESULTS: In A population, no significant urinary cGMP level differences were observed whatever the gestational age. Nevertheless, the comparison between patients with or without uterine contractions (A III and B populations) showed a significant difference by a variance analysis (P < 0.05). Lower levels of cGMP were seen when uterine contractions occurred. CONCLUSION: Urinary cGMP levels are significantly decreased in pregnant women with uterine contractions, without any difference from early to late pregnancy. These results, completed by more precise investigations, could suggest that the NO-cGMP system might be implicated in uterine quiescence.

Cyclic GMP↗
PubMed1995

Endometrium preparation with exogenous estradiol and progesterone for the transfer of cryopreserved blastocysts.

OBJECTIVE: To determine the implantation rates of cryopreserved blastocysts using controlled E2 and P replacement cycles in women with functioning ovaries. DESIGN: Retrospective clinical study. SETTING: University teaching hospital. PATIENTS: Infertile women with cryopreserved blastocysts obtained from previous IVF attempts. INTERVENTIONS: Exogenous E2 was administered orally from cycle day 1 and P was started transvaginally from day 15. Blastocysts were transferred on the 5th day of endometrial exposure to P (day 19). MAIN OUTCOME MEASURES: Blastocyst implantation rate and pregnancy rate (PR). RESULTS: Ninety-eight percent of blastocysts survived thawing: 67 were transferred in 42 women. Eight pregnancies occurred giving a PR of 19% per ET and 11.9% per blastocyst. CONCLUSION: The high PR observed after transferring blastocysts on the 5th day of endometrial exposure to P in controlled E2 and P replacement cycles speaks for a forward slide of the window of transfer in case of blastocysts.

Adult↗
PubMed1995

A new system for fallopian tube sperm perfusion leads to pregnancy rates twice as high as standard intrauterine insemination.

OBJECTIVE: To evaluate the relative efficacy of a new system for fallopian tube sperm perfusion in comparison with standard IUI in controlled ovarian hyperstimulation (COH) cycles. DESIGN: Prospective randomized trial. SETTING: Ovulation induction program of a tertiary outpatient care center, Hôpital Antoine Béclère, Clamart, France. PATIENTS: We studied 74 infertile women aged 20 to 38 years undergoing 100 cycles of COH from December 1993 to May 1994 only excluding cases of age > 38 years, obstructed or severely damaged fallopian tubes, E2 levels per mature follicle < 250 pg/mL (conversion factor to SI unit, 3.671) on the day of hCG administration, spontaneous LH surge, and cases of marked sperm abnormalities. INTERVENTIONS: Controlled ovarian hyperstimulation was achieved using three types of ovarian stimulation protocols: clomiphene citrate (CC) and hMG (n = 35). hMG alone (n = 35) or GnRH agonist and FSH and hMG (n = 30). Thirty-six hours after hCG administration, patients were assigned randomly to either IUI (group A, n = 50) or fallopian tube sperm perfusion (group B, n = 50). Intrauterine insemination was performed with 0.2 mL of sperm suspension according to a standard technique. Fallopian tube sperm perfusion was performed using a simple and reliable system that ensures a good cervical seal and allows to a pressurized injection of 4 mL of sperm suspension. MAIN OUTCOME MEASURES: Feasibility of the fallopian tube sperm perfusion method, clinical pregnancy (presence of gestational sac with heart beats at 6 weeks of amenorrhea), and ongoing pregnancy rates (PRs) (> 12 weeks of amenorrhea), incidence of complications (multiple pregnancies and ovarian hyperstimulation syndrome [OHSS]). RESULTS: Overall, the new fallopian tube sperm perfusion system was simple to handle and well tolerated by patients. In group A, we observed 10 clinical pregnancies (20% per cycle) of which 7 were ongoing (14%). In group B, 20 clinical pregnancies (40% per cycle) of which 17 ongoing pregnancies (34%) were obtained. These differences were statistically significant. The prevalence of twin and three or more sac pregnancies was similar in the two groups (3/10 and 0/10, respectively, in group A, and 5/20 and 2/20, respectively, in group B). No case of moderate or severe OHSS was observed in this series. CONCLUSIONS: Our results indicate that the new system for fallopian tube sperm perfusion is not only simple and reliable but also may lead to PRs twice as high as standard IUI in COH cycles.

Adult↗
PubMed1995

Physiopathology of premature progesterone elevation.

OBJECTIVE: To determine the effects of the last hMG administration on plasma P and androgen profiles during controlled ovarian hyperstimulation (COH) for IVF-ET. DESIGN: Controlled clinical study. SETTING: The IVF-ET program of a tertiary outpatient care center, Hôpital A. Béclère, Clamart, France. PATIENTS: Nine IVF-ET candidates aged 25 to 36 years having presented normal responses to COH in previous IVF-ET cycles. INTERVENTIONS: Controlled ovarian hyperstimulation was induced for IVF-ET using hMG after endogenous gonadotropins were suppressed with a time-release GnRH agonist. Just before the last hMG administration (225 IU), the participants were hospitalized for 24 hours for serial blood sampling. These occurred before (baseline) and after hMG administration, every 30 minutes for 1 hour, hourly for 4 hours, and every 3 hours for the remaining part of a 24-hour post-hMG observation period. MAIN OUTCOME MEASURE: Measurement of P, T, androstenedione (A), E2, FSH, and LH. RESULTS: Plasma P and androgens (T and A) increased significantly, reaching peak values 12 to 15 hours after hMG administration and decreased progressively thereafter, to reach values not significantly different from baseline 24 hours after hMG administration. Plasma E2 levels increased progressively and steadily during the 24-hour observation period. Plasma FSH levels remained constant after hMG administration while LH stayed undetectable. CONCLUSION: In COH cycles induced for IVF-ET, the hormonal profile after the last hMG injection suggests that hMG triggers an increase in plasma P and androgens that culminates 12 to 15 hours after hMG administration. This elevation in plasma P and androgens observed after hMG administration is likely to reflect a direct action of the LH and/or FSH components of hMG on granulosa cells. In some women these hormonal consequences of hMG treatment may impair endometrial receptivity in IVF-ET cycles.

Adult↗
PubMed1995

Development of a training model for ultrasound-guided invasive procedures in fetal medicine.

Training in ultrasound-guided procedures in fetal medicine is currently available in a few major fetal medicine units. Unlike elective surgical procedures, cordocentesis is usually performed without sedation as an outpatient procedure and active supervision of the trainee intensifies the anxiety already felt by the patient. In addition, the complication rate is higher in the initial few procedures or when the procedure is not regularly practiced. We have developed a comprehensive method of training for transabdominal invasive procedures using a medical model that simulates the in vivo situation.

Cordocentesis↗
PubMed1995

Ultrasound evaluation of the length of the fetal nasal bones throughout gestation.

Subtle facial abnormalities, including smallness of the nose, are common findings in trisomy 21 and numerous other genetic conditions. The aim of this study was to construct a normal range for the length of the fetal nasal bones with gestation in a Caucasian population. Ultrasound measurements were performed on a strictly mid-sagittal profile in 376 normal singleton fetuses at 14-34 (mean 24) weeks' gestation. It was found that the length of the nasal bones increased from 4 mm at 14 weeks to 12 mm at 35 weeks' gestation, and that there was a linear relationship between the length of these bones and biparietal diameter and femur length. We conclude that the length of nasal bones can easily be measured in fetuses at 14-34 weeks' gestation and that such measurements might prove useful in the evaluation of pregnancies at high risk for associated fetal abnormalities.

Embryonic and Fetal Development↗
PubMed1995

Sperm-zona binding and sperm-oocyte penetration analysed by DNA fluorescence: a test for gamete quality after in-vitro fertilization.

Sperm-zona binding, sperm-oocyte penetration and pronucleus formation in oocytes obtained after in-vitro fertilization (IVF) failure were studied by analysing DNA fluorescence. Oocytes were classified according to their maturational status, sperm-zona pellucida binding and sperm-oocyte penetration. Spermatozoa were classified as normal or abnormal according to conventional parameters. Sperm-zona binding and sperm-oocyte penetration into uncleaved oocytes were positively related to fertilization: 6.2% of those oocytes from cohorts where none of the oocytes fertilized had > 10 spermatozoa bound to the zona, and 7.7% of them were penetrated. When at least one oocyte per cohort fertilized, these rates were 37.1 and 41.1% respectively. Sperm-zona binding is related more strongly to sperm-oocyte penetration, even without pronucleus formation, than to the maturational status of the oocyte: 26.9% of the oocytes were penetrated by spermatozoa, of which 20.7% had reached the pronuclear stage. For 25 out of 78 couples with a total IVF failure, whatever the spermiogram, defective sperm-zona binding, sperm-oocyte penetration or pronucleus formation was observed. Sperm-zona binding and penetration were positively related, especially when oocytes came from patients with partial IVF failure. Clinical information concerning the fertilizing capacity of oocytes and spermatozoa after IVF failure can be obtained by the simultaneous analysis of sperm-zona binding and sperm-oocyte penetration, and whether or not the latter results in pronucleus formation.

Benzimidazoles↗
PubMed1995

Timing of pronuclear development and first cleavages in human embryos after subzonal insemination: influence of sperm phenotype.

The sequential transformations of human sperm nuclei in human eggs after subzonal insemination (SUZI; n = 104) and the influence of sperm defects on this timing were studied. This chronology was compared to that of two control series of zygotes obtained after SUZI with normal spermatozoa (n = 35) and after in-vitro fertilization (IVF) with normal donor spermatozoa (D-IVF; n = 220). Pronuclear formation took place between 4.5 and 10.5 h post-SUZI for 92.8% of the zygotes. They remained visible for 13 h and began to disappear 18.5 h post-SUZI. The timespan 3 h. Zygotes obtained after D-IVF had a similar rate of pronuclear disappearance but approximately 4 h later. The second cell cycle was more rapid for zygotes obtained by D-IVF than by SUZI, but the developmental rate of zygotes obtained by SUZI varied according to sperm phenotypes. For patients with previous unexplained IVF failures (control group with normal spermatozoa), the developmental rate was lower, suggesting the influence of oocyte quality. In conclusion, the end of the first cell cycle of zygotes obtained by insemination under the zona pellucida appears 4 h earlier compared to zygotes obtained after insemination outside the zona pellucida.

Adult↗
PubMed1995

In-vitro endometrial secretion of human interleukin for DA cells/leukaemia inhibitory factor by explant cultures from fertile and infertile women.

Human interleukin for DA cells/leukaemia inhibitory factor (HILDA/LIF) is a cytokine with pleiotropic effects involved in successful murine implantation. We evaluated human uterine HILDA/LIF production by monitoring its in-vitro secretion by endometrial explant cultures obtained from individuals in either normal or pathological conditions. The cytokine secretion was standardized using the day 5:day 1 ratio of HILDA/LIF concentration in supernatants of such cultures, hereby termed HILDA/LIF production index (HLPI). Our results confirmed that HILDA/LIF is secreted by the human endometrium as assessed by secretion at every phase of the cycle in either normal fertile women, or women bearing intrauterine devices. This was also the case for samples obtained from infertile women presenting repeated failures of embryonic implantation or unexplained primary sterility. However, the HLPI were significantly lower in those latter two groups when compared to fertile women. These results suggest an abnormal regulation of HILDA/LIF secretion in such circumstances, and the clinical implication of those data is discussed.

Adult↗