Biomedical subjects
Publications and source records attributed to R Frydman.
The first children born as a result of oocyte donation are being subjected to a psychological study. Despite the small number of cases and the reservations required, it appears that the mother's denial of both infertility and filiation rupture is massive at the onset of pregnancy and subsequently persists. The harmonious psychological development of these children might be related to this denial.
To determine if reproductive hormones played a role at physiological levels on vascular resistance of uterine arteries, we studied young women having inactive ovaries who received exogenous estradiol (E2) and progesterone (P). Six women, ages 27 to 36 with absent or nonfunctioning ovaries, received transdermal E2 and vaginal P after a 28-day replacement regimen duplicating E2 and P levels seen in the menstrual cycle. Vascular resistance of uterine arteries was evaluated before treatment (baseline), on days 13 to 14 and on days 26 to 27, using transvaginal pulsed Doppler combined with real-time imaging. Doppler waveforms were analyzed by the pulsatility index (PI). Baseline evaluation showed narrow systolic Doppler flow waves with a PI of 5.2 +/- 0.4, mean +/- SEM. On cycle day 13, Doppler waveforms showed a marked broadening with uninterrupted diastolic flow indicative of a profound decrease in vascular resistance. This was reflected by a significant decrease in PI to 1.3 +/- 0.3, mean +/- SEM. Doppler measurements made on days 26 to 27 showed no significant change. Our results indicate that at physiological levels, E2 affects vascular resistance of uterine arteries. This represents a new parameter of estrogen action, readily measurable by a noninvasive technique that, in the future, may help for assessing the efficacy of various estrogenic treatments.
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Combined intra-uterine and ectopic gestations are uncommon. Heterotopic gestations in which the ectopic pregnancy is located in the ovary are exceptional. We are reporting a 22 week heterotopic gestation with two live fetuses, one fetus was developing in the uterus and one in the ovary. Surgical excision of the ovarian pregnancy was conducted without disturbing the intra-uterine live fetus who was ultimately delivered uneventfully at term.
Severe ovarian hyperstimulation syndrome (OHSS) was recorded in 8 of 413 patients after the use of gonadotropin-releasing hormone agonists (GnRH-a) associated with gonadotropins for in vitro fertilization. Seven of the 8 patients were pregnant. Common factors associated with the development of OHSS were high serum estradiol values on the day of ovulation induction and many follicles greater than or equal to 12 mm. Based on this experience, a new therapeutic schedule was used in a group of 10 patients who, after GnRH-a and gonadotropin stimulation, were judged to be at high risk of OHSS on the day of human chorionic gonadotropin (hCG). No hCG was administered and gonadotropins were stopped. The administration of GnRH-a was continued and, after a further period of pituitary desensitization, follicular stimulation was recommended with a lower dose of gonadotropins. No cases of OHSS occurred and 3 patients became pregnant.
A new protocol was developed to provide participants of our oocyte donation program with oocytes donated by donors who were not financially rewarded, were anonymous, and fertile. Each participant provided an oocyte donor selected among fertile friends or family members. The retrieved oocytes were anonymously exchanged between phenotypically matched donor-recipient pairs. In the first 30 months of activity, we obtained 111 embryos suitable for transfer or cryopreservation from 52 retrievals, and 40 embryo transfers (ETs) were performed. Recipients received oral Estradiol-valerate and vaginal micronized progesterone. Fifteen embryos were transferred in 8 ETs conducted after donor-recipient synchronization. This resulted in four pregnancies, all ongoing (ongoing pregnancy rate 50% per transfer). Of the 96 cryopreserved embryos, 82 were thawed for ET, and 45 surviving embryos were transferred in 32 ETs. This resulted in eight pregnancies, with six ongoing or delivered (ongoing pregnancy rate 19% per transfer). The overall ongoing pregnancy rate of 25% per transfer indicates that our approach is a viable method for obtaining donated oocytes while respecting the ethical guidelines that recommended that donation of human gametes should be free, and from anonymous and fertile donors. Furthermore, guaranteeing anonymous oocyte donation had practical importance because, for many volunteer donors, it played a crucial role in their decision to donate.
Most oocyte donation programs have experienced higher pregnancy rates than usually seen in regular in vitro fertilization (IVF), suggesting that the quality of either the oocytes or the endometrium is superior. To clarify this issue we analyzed the results of transfers of 136 cryopreserved embryos originating either from donated oocytes (18 transfers) or from regular IVF (118 transfers). Transfers of embryos originating from donated oocytes took place after administrating oral estradiol (E2) valerate and vaginal micronized progesterone (P) following a regimen designed to mimic the serum levels of E2 and P observed during the menstrual cycle. Transfers of embryos originating from regular IVF took place either in the natural cycle (53 transfers) or after suppressing ovarian function with a single injection of a gonadotropin-releasing hormone agonist (GnRH-a), Decapeptyl-Retard 3.75 mg, and administering the same hormone replacement regimen (E2/P) used in oocyte donation (65 transfers). Eighteen transfers involving 24 embryos originating from donated oocytes were affected, resulting in six pregnancies (4 ongoing). The ongoing pregnancy rate per transfer was 22%. Seventy-nine embryos originating from regular IVF were transferred (53 transfers) in the natural cycle resulting in six pregnancies (2 ongoing). One hundred three other embryos originating from regular IVF were transferred (65 transfers) after administration of GnRH-a and E2/P resulting in four pregnancies. The pregnancy rate after transfers of embryos originating from regular IVF was 9% per transfer. This was significantly less than the pregnancy rate of 33% per transfer seen after the transfers of embryos originating from donated oocytes.(ABSTRACT TRUNCATED AT 250 WORDS)
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
A prospective comparative study was carried out on the development of 40 infants born by in-vitro fertilisation (IVF) and of their relationships with their mothers. This group was compared with two control groups: Children born to infertile women after ovulation had been induced but where assisted reproduction was not used. A group of infants born after normal conception without medical intervention at all. The preliminary results at 9 months showed that there were no major developmental problems in IVF infants as compared with the controls. All the same, there are more troubles as far as sleep is concerned with IVF children and with the group of infertile mothers and these symptoms seem to be linked to difficulty in the mother-infant relationship. These troubles are minor ones and appear to be only temporary as far as can be told after 18 months.
This report describes the obstetric outcome in 50 pregnancies resulting from the transfer of human embryos that had been cryopreserved for up to 2 years. The duration of cryopreservation did not influence the pregnancy rate after thawed embryo transfer. Thirty-one babies have been born from 28 pregnancies and a further seven pregnancies are currently in the second and third trimesters. Twenty-eight percent of the pregnancies failed to progress beyond the first trimester. One pregnancy was terminated at 22 weeks' gestation because of severe fetal malformation. Important antenatal events included premature uterine activity in six patients although only one patient with a singleton pregnancy ultimately was delivered prematurely. Retroplacental hemorrhage occurred in four patients but was of clinical consequence in only one. There was a high incidence of breech presentation at term in singleton pregnancies (12%). The cesarean section rate in this series was 21%. An international registry of cryopreserved pregnancies would facilitate data collection in this relatively new clinical field.
Luteinizing hormone-releasing hormone (LH-RH) agonists are being increasingly used in ovulation stimulation protocols in IVF programs. The results of two methods of utilization of LH-RH agonists are compared. There was difference in the ovarian response on the day of human chorionic gonadotropin (hCG) higher in the short protocol (69% vs 56%, P less than 0.001). The ongoing pregnancy rate per treatment cycle was similar in both groups (18% in the long protocol and 16% in the short protocol).
A randomized study of two transcervical biopsy methods was performed. One method involved the use of an aspiration catheter and the other a tissue biopsy forceps. 120 chorionic villus samplings were performed in 30 patients. The percentage of success in taking biopsies and the resulting number of karyotypes were identical in both groups. The amount of removed trophoblastic tissue was greater when the forceps was employed. When the aspiration catheter was used, a sufficient amount of trophoblastic tissue was obtained for karyotyping purposes. It was easier to insert the aspiration catheter than the forceps. The echogenicity of the catheter and forceps were identical. The aspiration catheter has two advantages. Firstly, it is malleable and fits to the anatomy of the cervical canal and the site from which the biopsy is to be taken. Secondly, it is disposable.
Diagnostic findings of four cases of cystic hygroma discovered at 11 weeks of gestation are reported. The discovery of cystic hygroma by echotomography was followed by sample taking of chorionic villi which revealed one case of monosomy X and three cases of trisomy 18. Caryotype determination in the presence of cystic hydroma is essential for diagnostic confirmation and subsequent genetic counselling.
The steroid content of 72 follicular fluids (FF) obtained from 42 women subjected to ovulation induction with the luteinizing hormone-releasing hormone analogue D-Trp6 and human menopausal gonadotropin was studied in terms of the evolution of in vitro fertilization (IVF) and embryo transfer (ET) results. The FF were classified into several categories based on oocyte evolution. Individual values of FF estrone and estradiol (E2), as well as androstenedione and testosterone could not be correlated with ET outcome. However, FF progesterone (P) levels for follicles leading to pregnancy were significantly lower when compared with those in the other categories. The correlation between the E2/P ratio and E2 permitted the definition of a band wherein IVF-ET outcome was successful and enabled the characterization of different functional follicular maturational states.
The corpus luteum-endometrial unit was investigated in in vitro fertilization (IVF) cycles using endocrine, morphologic, and biochemical measurements on the day normally scheduled for embryo transfer (day 16), in 12 stimulated and 4 natural cycles. Advanced endometrial histologic maturity was recorded in 9 of the 12 stimulated cycles. No in-phase endometria were seen when the preovulatory plasma estradiol (E2) was greater than 500 pg/ml or the day 16 plasma progesterone (P) greater than 10 ng/ml in natural or stimulated cycles. Significant negative correlations were noted between both preovulatory E2 and day 16 P and the concentration of cytosolic progesterone receptor (PRc). Advanced endometrial maturity tended to be associated with low concentrations of PRc. Regardless of endometrial maturity, the natural cycle was characterized by low cytosolic E2 receptors (ERc) and high PRc, whereas the concentration of both receptors was usually greatly reduced in stimulated cycles. It is concluded that the advanced endometrial maturation observed in stimulated IVF cycles is a consequence of the production of supraphysiologic levels of sex steroids by the corpus luteum that cause profound modifications of endometrial receptor dynamics.
A phase-I clinical trial of a mouse monoclonal anti-human chorionic gonadotropin (hCG) antibody designated as HT13 was conducted in three patients treated for ectopic pregnancy. Doses of 5 and 25 mg of purified antibody were injected into patients. Monoclonal antibody serum levels dropped to 0 within 1 to 5 days. Human antibodies directed against mouse immunoglobulins were not detected at up to 41 days after injection. In one patient, the tubal pregnancy resolved, as confirmed by hCG levels of less than 10 mUl/mL and by tubal patency at hysterosalpingography. The time of resolution was 30 days. In two patients, salpingectomy was performed because of persistence of elevated hCG levels, whereas HT13 had a striking effect on progesterone (P) and estradiol (E2) serum levels. The injection of anti-hCG antibody did not appear to interfere with the subsequent fertility of patients, and two out of three patients later developed a successful pregnancy. While the precise role of antibody injection in the interruption of ectopic pregnancy remains speculative, the injection of monoclonal anti-hCG antibody appears to induce a dramatic decrease in the production of both P and E2.