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Biomedical subjects

R Frydman

Publications and source records attributed to R Frydman.

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

Nonsurgical treatment of heterotopic pregnancy: a report of six cases.

OBJECTIVE: To evaluate nonsurgical management of heterotopic pregnancy. DESIGN: Retrospective case series. SETTING: Department of Obstetrics and Gynecology (Antoine Béclère Hospital, Clamart, France, Paris-Sud University). PATIENTS: Six women with heterotopic pregnancy who conceived in four cases after ovulation induction. INTERVENTION: Transvaginal ultrasound (US)-guided aspiration/injection of potassium chloride (KCl) was performed in three cornual pregnancies with alive embryo. Expectant management was realized in three other cases. The regression was followed by serial US examination. MAIN OUTCOME MEASURES: Early and late complications related to the procedure, outcome of intrauterine pregnancy (IUP). RESULTS: Five of six patients were treated successfully (3 with KCl and 2 after expectant management). Three of these five patients had a spontaneous vaginal delivery, and two abortions occurred in the remaining two patients. Salpingectomy had to be performed in one case 10 days after medical treatment. This twin pregnancy ended with an abortion at 23 weeks of amenorrhea. Four cornual heterotopic pregnancies were treated successfully. No complication occurred after the initial management. CONCLUSION: Ultrasound permits a reliable and early diagnosis of heterotopic pregnancy. In such cases nonsurgical management is an efficient alternative with a good IUP prognosis.

Adult↗
PubMed1993

Physiological oestradiol and progesterone replacement cycles in women with ovarian failure: a model to study endometrial maturation and sex steroid receptor regulation by exogenous hormones.

High endometrial receptivity has been achieved with physiological oestradiol and progesterone replacement cycles in women with ovarian failure. To understand whether different protocols using the oral route or the transdermal route can influence the endometrial maturation and the regulation of sex steroid receptors, we studied 33 women with ovarian failure treated by two commonly used protocols and assessed endometrial receptivity using light microscopy, scanning electron microscopy and immunohistochemistry for oestrogen and progesterone receptors on biopsies taken to include different periods of the luteal phase. The morphology in these patients was similar to that observed in women with normal ovulatory cycles, indicating that the morphological response is not dependent on the type of oestradiol, oral or transdermal, in the replacement cycles as compared to the endogenous oestradiol in the menstrual cycle. The relative distribution of steroid receptors between the epithelium and stroma varies similarly to that observed during the luteal phase of the menstrual cycle. These results confirm the role of progesterone, especially the importance of the number of days of exposure to it, in the disappearance of steroid receptors from endometrial glands. These observations give a better understanding of endometrial receptivity around the time of presumed implantation and confirm clinical results concerning the best timing of oocyte transfer.

Adult↗
PubMed1993

Mifepristone (RU 486) induces embryo expulsion in first trimester non-developing pregnancies: a prospective randomized trial.

This study was designed to investigate the use of oral mifepristone (RU 486) for the induction of natural expulsion of concepti in women with spontaneously interrupted pregnancy in the first trimester. It consisted of a double-blind placebo-controlled study of mifepristone (600 mg) against placebo. A total of 46 women consulting for interrupted pregnancy were diagnosed at ultrasound with no clinical sign of miscarriage. Measurements were made of the occurrence of natural expulsion, the frequency of complete expulsion, the need for subsequent surgical evacuation, analgesia and the need for transfusion. Natural expulsion occurred within 5 days in 82% of patients receiving mifepristone treatment versus 8% of placebo-treated patients (P < 0.001). All patients experienced bleeding after RU 486 and two needed emergency aspiration for haemorrhagic expulsion. The treatment failed in four patients, who underwent evacuation under local anaesthesia. In the control group, 19 patients underwent evacuation under local (n = 10) or general (n = 9) anaesthesia. It was concluded that a standard oral pilot dose of 600 mg of mifepristone induces natural expulsion in 82% of women with non-developing first trimester intrauterine pregnancies.

Abortion, Missed↗
PubMed1993

Psychological considerations of anonymous oocyte donation.

This study involved 50 patients interviewed in conversations with a psychologist. It was found that it was possible to characterize the kind of couples using assisted reproductive techniques in terms of diagnostic and psychological profile. Other observations included the repercussions of this action on the couples' stability in case of failure or success, the desire for children and the plans concerning them, the secrecy theme and questions arising from the practice of anonymous or non-anonymous oocyte donation. The relationship between recipients and donors, as well as the specific relationship between couples and their consultants, were also examined. It is concluded that the problems encountered differ according to the infertility diagnosis. Donor anonymity allows oocyte recipients to impose their own identity patterns onto the future child and to introduce him/her in an unbiased way to their own lives. Artificial techniques to assist in the conception of a child do not appear to interfere with the couple's relationship and their desire for a child, which remains constant for each member of the couple.

Antineoplastic Agents↗
PubMed1993

The increased risk of complication observed in singleton pregnancies resulting from in-vitro fertilization (IVF) does not seem to be related to the IVF method itself.

Singleton pregnancies resulting from in-vitro fertilization (IVF) seem to have an increased risk of obstetric and paediatric complications. In a retrospective study we compared, during the same period, 162 IVF singleton pregnancies with 263 pregnancies resulting from stimulated cycles (without IVF) and with 5096 natural pregnancies. No significant difference was found between the first two groups concerning complications (i.e. prematurity, low birthweight, small-for-gestational-age and perinatal mortality). The results indicate that an adverse outcome is more common for pregnancies after ovarian stimulation (with or without IVF) compared to natural pregnancies. Therefore the increased risk does not appear to be linked to the IVF method itself but rather to a common factor in these two populations, i.e. population characteristics, underlying infertile status and/or ovarian stimulation.

Adult↗
PubMed1993

Pregnancy after subzonal insemination with spermatozoa lacking outer dynein arms.

The absence of outer dynein arms in the sperm flagellum induces an abnormal movement pattern associated with male infertility. These spermatozoa can decondense in zona-free hamster oocytes but result in a very low fertilization rate in in vitro fertilization. We hypothesized that subzonal insemination could help achieve fertilization and pregnancy. A randomized prospective trial (five couples, five cycles) comparing subzonal insemination (n = 31 oocytes) and routine IVF (n = 23 oocytes) was carried out. Oocytes were microinjected with 8.5 +/- 3.6 spermatozoa. In a second series (nine cycles), all the oocytes were microinjected with 10.5 +/- 4.3 spermatozoa. In the randomized series, the fertilization rate was 16.1% without polyploidy, whereas no fertilization was obtained after control IVF insemination. In the second series involving nine couples, six of whom were included in the first series, the fertilization rate increased to 57.8% with a 27.8% polyspermic rate. Eighty-eight per cent of the zygotes cleaved normally (29 out of 33). A total of 11 embryo transfers resulted in three pregnancies, one of which terminated one month later, a second being ongoing and the third delivering a healthy girl. A 21.4% pregnancy rate per cycle, with a 37.5% pregnancy rate per couple, justifies the use of subzonal insemination to treat this particular flagellar dyskinesia.

Adult↗
PubMed1993

Comparative prospective study of the psychological development of children born by in vitro fertilization and their mothers.

A comparative prospective survey of psychomotor development and mother-infant bonding was conducted on 33 children born after in vitro fertilization and two control groups composed of: a group of children born to infertile women who underwent ovulation induction treatment but with no medically assisted procreation; and a group of children born by natural procreation, with no medical intervention. No major disorders were observed. In the postpartum, the minor mother-infant relational problems seemed to be more frequent in the in vitro fertilization and infertility groups but with no statistical differences. At 9 months, the factors related to sleep disturbances in the child and maternal depressive syndromes seemed to be more frequent in the in vitro fertilization and infertility groups than in the controls. At 18 months these minor disturbances decreased and there were fewer differences across the three groups. This trend was confirmed at 3 years.

Case-Control Studies↗
PubMed1993

[Oocyte donors. Psychological aspects].

This study concerns 63 oocyte donors who were investigated after a semi-directed interview. In our procedure all "personalized anonymity" donation took place on two levels: symbolic donation for close recipient, real donation for unknown recipient. All donors agree with anonymity without which some would not have preceded. Narcissic weakness often linked with recent trauma (death...) is often seen in patients who do not achieve the gift. Oblativity and happy motherhood are the most important reasons for oocyte gift.

Adaptation, Psychological↗
PubMed1993

[Embryo expulsion induction in first trimester miscarriages. Use of mifepristone (RU 486) in a double blind prospective randomized study].

UNLABELLED: We investigated the use of oral mifepristone (RU486) for the induction of natural expulsion in women with spontaneously interrupted pregnancy in the first trimester in a double blind placebo controlled study against placebo. 46 women consulting for interrupted pregnancy diagnosed at ultrasound with no clinical sign of miscarriage were included in the trial. Main outcome measures were occurrence of natural expulsion, frequency of complete expulsion need for subsequent surgical evacuation, analgesia and need for transfusion. Natural expulsion occurred within 5 days in 82% patients receiving treatment versus 8% placebo treated patients (p < 0.001). All patients experienced bleeding after RU486 and 2 needed emergency aspiration for haemorrhagic expulsion. The treatment failed in 4 patients who underwent evacuation under local anesthesia. In the control group 19 patients underwent evacuation under local (n = 9) or general (n = 11) anesthesia. CONCLUSION: A standard oral pilot dose of 600 mg of Mifepristone induces natural expulsion in 82% women with non developing first trimester intra-uterine pregnancies.

Abortion, Incomplete↗
PubMed1993

[Must we still operate on ectopic pregnancies?].

Non surgical management of ectopic pregnancy has recently become an alternative to surgery. We have investigated a pretherapeutic score to define the indication for non-surgical and surgical treatment in 123 patients with ectopic pregnancy. The score was performed before the patients' inclusion in a non-surgical management scheme. The score used six criteria which were evaluated on a scale from 1 to 3: gestational age, human chorionic gonadotrophin (hCG) level, progesterone level, abdominal pain, haemoperitoneum volume and haematosalpinx diameter (estimated by laparoscopy or transvaginal ultrasound). Three scores, 10, 11 and 12 were studied in order to define a threshold beyond which surgical treatment should be performed. For each one, sensitivity, specificity and positive and negative predictive values were analysed. The success rate of non-surgical treatment was 82.1% (101/123). For patients undergoing medical treatment with a score < or = 12, the success rate was significantly higher compared with a success rate of 56% when the score was > 12. We conclude that a score < or = 12 permits non-surgical management with a success rate of 87%. A score > 12 indicates that laparoscopic surgery may be more suitable. The choice between different non-surgical approaches, did not influence the success rate. When ultrasound reveals embryo heart activity, medical treatment is always possible if the score is < or = 12.

Chorionic Gonadotropin↗
PubMed1993

[Value in gynecology of transvaginal pulsed and color Doppler. Study of ovarian vascularization].

Recently, pulsed Doppler has become available on high resolution vaginal ultrasound probes for studying ovarian blood flow. Doppler studies of ovarian blood flow are based on: semiquantitative analysis of Doppler flow waves recorded over the ovarian artery at its entry into the ovary; color Doppler mapping of intraovarian vessels. Semiquantitative analysis of the ovarian artery Doppler flow waves suffers from frequent difficulties at properly identifying the ovarian artery, particularly in multiparous women. Mapping of intraovarian vessels however, appears a most promising feature of vaginal Doppler for studying ovarian blood flow, provided that the proper ultrasound equipment is used. Specifically, transvaginal color Doppler mapping of intraovarian vessels allows for a positive visual detection of the onset of the ovulatory process prior to the actual follicular rupture. Thus, color Doppler mapping of ovarian vessels permits an improved and simplified approach for timing intercourses and inseminations in infertility patients. In controlled ovarian hyperstimulation (COH) used for in vitro fertilization (IVF), mapping of intraovarian vessels by color Doppler offers a fascinating new insight into normal and pathological responses of ovarian follicles to hCG. Finely, color Doppler appears a very promising asset to transvaginal ultrasounds for sorting suspicious ovarian cysts from their benign counter parts. In conclusion, we think that vaginal Doppler should be considered as a marvelous refinement of ultrasounds rather than as a truly new diagnostic tool. Yet vaginal color Doppler carries the potential for markedly improving the sensitivity and the specificity of vaginal ultrasound, particularly for diagnosing benign from potentially malignant ovarian conditions.

Arteries↗
PubMed1993

[Value of microfertilization for repeated in vitro fertilization failures: the role of female parameters].

UNLABELLED: Microfertilization technics as SUZI (sub-zonal insemination) can be indicated in cases of repeated in vitro fertilization (IVF) failure. Feminine parameters seem to play however an important role in optimalization of results. We studied 27 couples (32 IVF-SUZI cycles) who had previously presented 2 to 4 in vitro fertilization failures. These 32 cycles were divided in 2 groups according to women's age: group A < or = 35 and group B > 35 years. RESULTS: basal FSH levels were higher in group B (6.6 +/- 3.1 mIU/ml) in comparison to group A (3.7 +/- 1.5 mIU/ml). The amount of hMG necessary to accomplish ovarian stimulation was also higher in group B (39 +/- 21 ampules) than in group A (26 +/- 11 ampules). Maximal plasma estradiol levels were higher in group A (2,775 +/- 872 pg/ml) than in group B (1,824 +/- 559 pg/ml) such as the mean number of oocytes collected and micro-injected: 11.6 +/- 4.5 versus 4.7 +/- 2.2 in groups A and B, respectively. Eight pregnancies (44%), of which 7 were ongoing pregnancies, were obtained in group A. No pregnancy was obtained in group B. CONCLUSIONS: SUZI seems to be an available technic for treatment of repeated IVF failures; our results seem to indicate a decrease in SUZI results with age of the women (> 35 years old); they suggest the opportunity of a complete investigation of feminine parameters prior to each SUZI-IVF cycle.

Estradiol↗
PubMed1993

[Estradiol and progesterone physiological substitution effects on the hemodynamics of the humeral artery in women with inactive ovaries].

To determine the effects of female hormones on peripheral vasculature we studied the brachial artery circulation. Nine young women (27-37 yrs) having inactive ovaries received transdermal estradiol (E2) (0.1-0.4 mg/d) and vaginal progesterone (P) (300 mg/d) to duplicate the menstrual cycle levels of E2 and P. Brachial artery diameter, blood velocity and flow were measured by bidimensional pulsed Doppler in basal conditions, and during hand exclusion by a cuff inflated at suprasystolic pressure. Vascular resistance was calculated by the ratio of mean blood pressure over mean flow. Measurements were obtained before hormonotherapy (d0), on day 14 (d14, after E2), and on day 28 (d28, after E2 and P). The increase of brachial artery diameter began at d14 (3.73 +/- 0.12 mm, vs 3.66 +/- 0.11 mm; NS) to become significant at d28 (3.91 +/- 0.10 mm, p < 0.05). Blood velocity and flow increased at d28 (4.78 +/- 0.55 cm/s, vs 3.55 +/- 0.65 cm/s; P < 0.05 and 35.2 +/- 5.2 ml/mn vs 22.2 +/- 3.6 ml/mn, P < 0.05 respectively). No change was noted in mean blood pressure. The decrease of resistance began at d14, in order to be significant at d28 (158 +/- 17 mmHg/ml/s at d0 vs 263 +/- 31 mmHg/ml/s at d28; P < 0.05). Brachial vasoconstriction during hand exclusion, in response to low flow state disappeared at d14 with estradiol. In conclusion, in women deprived of ovarian function, physiological E2 and P replacement vasodilates small and large arteries, whereas E2 alone attenuates the large artery vasoconstriction in acute response to low flow state.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Cutaneous↗
PubMed1993

[Techniques, interrogations and results of medically assisted procreation].

In vitro fertilization has obtained a foreground position in therapeutics proposed to infertile couples. Technical developments could be improved in the obstetrical and pediatric field through a better understanding of events occurring in embryos implantation, and through a specific management of the subsequent pregnancies.

Adult↗
PubMed1993

[Assisted embryo hatching].

In spite of the progress in in vitro fertilization (IVF), implantation rate of IVF embryos remains low. Many factors seem to be involved in these results. Among them, impairment of the hatching process was incriminated by some authors. Assisted hatching seems to be an interesting method for repeated failures of IVF.

Adult↗
PubMed1993

[Weak transplacental passage of prazosin (Alpress) during the third trimester of pregnancy. 3 cases].

Prazosin is a selective peripheral alpha 1-adrenoceptor antagonist used in the treatment of hypertension and heart failure. This drug has the disadvantage of relatively short terminal half-life (of the order of 2 to 3 hours); its wide use has been limited by the number of daily administrations. Recently, a new formulation of prazosin has been commercialized i.e., prazosin-gastrointestinal therapeutic system (P-GITS) given once daily in doses of either 2.5 or 5.0 mg (i.e., Alpress). The potential suitability of this controlled-release system as treatment of hypertension during pregnancy seems important. However, the possible transplacental passage of PRZ was unknown. We aimed to study this phenomenon in three pregnant women given a once daily 5 mg dose of P-GITS during the third trimester of pregnancy. There is a slight transplancental passage of prazosin i.e., of the order of 10 to 20% of the maternal concentration level determined at the same time. Concerning neonatal outcome, no problems were noted and the babies left the hospital in good health. Prazosin-GITS offers a new approach to control and improve the outcome of hypertensive therapy during pregnancy.

Adult↗