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Biomedical subjects

R Frydman

Publications and source records attributed to R Frydman.

At least 325 records · Page 18Linked to original sources
PubMed1988

[In vivo and in vitro fertilizing ability of immature human epididymal spermatozoa].

In cases of congenital absence of vas deferens (9 patients) or after failure of previous epididymovasostomy (2 patients), in vitro fertilization (IVF) was attempted with spermatozoa surgically obtained at the epididymal caput level. These sperm populations showed little progressive motility (5.9 +/- 6.5%) and an marked necrozoospermia (19.3 +/- 17.4%). Stimulation by caffeine (4.5 mM) alone or associated with heterologue normal seminal fluid resulted in most of the cases in an initiation of motility with an improvement of the progressive velocity. In 9 IVF attempts, 31 mature oocytes were inseminated with 5.10(3) to 1.5.10(6) motile spermatozoa. The dynamic characteristics in 3 inseminated sperm populations were Vp (24.2 +/- 8.3 microns/s), Ah (8.6 +/- 2.0 microns) at room temperature. Sperm binding to zona pellucida was decreased (0 to about 20 spermatozoa per oocyte) and there was no fertilization. In the same period, 21 attempts of intra uterine insemination and 14 attempts of intracervical inseminations were made in 5 couples who remained infertile after patent high epididymovasostomy (4) or vasovasostomy (1) and having immature spermatozoa stimulated as previously described. Antisperm antibodies were detected on the ejaculated spermatozoa in four men. No pregnancy was obtained with these immature stimulated spermatozoa. The fertility of the female partners was confirmed in 3 women after insemination with donor sperm.

Adult↗
PubMed1988

Spontaneous resolution of ectopic pregnancy.

Fourteen patients with ampullary tubal pregnancy confirmed by laparoscopy were initially managed conservatively. Serum human chorionic gonadotropin (hCG) levels were measured daily and strict clinical monitoring performed. In nine patients (64%), the tubal pregnancy spontaneously resolved. In four cases (29%), surgery was ultimately necessary. One patient with a coexistent intra- and extrauterine pregnancy was also successfully managed conservatively. There was a high probability of spontaneous resolution of the pregnancy when the serum hCG level at diagnosis was less than 1000 mIU/mL. Hysterosalpingography was performed after the spontaneous resolution of the tubal pregnancies. Tubal patency was demonstrated in all six patients, and three are currently pregnant. We conclude that conservative therapy allows spontaneous resolution of certain types of ectopic pregnancy.

Abortion, Spontaneous↗
PubMed1987

Human embryo viability related to freezing and thawing procedures.

Freezing and thawing procedures did not affect the chances of successful transfer of human embryos. The postimplantation viability of frozen-thawed embryos was equivalent to that of fresh, immediately transferred embryos. Selection of the embryos that were more suitable for freezing did influence the pregnancy rate after transfer of the remaining fresh embryos. The therapeutic efficacy of in vitro fertilization and embryo transfer programs will be greatly increased if only one embryo is transferred in the in vitro fertilization cycle, the others being separately frozen for further embryo transfer in subsequent cycles.

Embryo Transfer↗
PubMed1987

Importance of semen preparation in avoidance of reduced in vitro fertilization results attributable to bacteria.

Although the physical treatment of semen for IVF and related procedures is sufficient to remove most organisms present in semen, the pathogenic varieties tend to be more resistant. The supplementation of oocyte culture medium with both penicillin and streptomycin was associated with the eradication of 100% of organisms in the current study. In these circumstances, the presence of pathogenic organisms in the untreated semen is not associated with reduced oocyte fertilization in vitro.

Bacteria↗
PubMed1987

Factors influencing the success rate of human embryo freezing in an in vitro fertilization and embryo transfer program.

Certain factors influencing the success of embryo cryopreservation were analyzed from 124 cycles of in vitro fertilization and embryo transfer (IVF-ET) program in which 193 1- or 2-day embryos were frozen and had already been thawed. There were 100 transfers of one or two surviving embryos from which 26 pregnancies were initiated. Several factors significantly influenced embryo survival after thawing. They were: the developmental stage of frozen embryos; the appearance of the embryo at the time of freezing; and the mode of ovarian stimulation in the IVF cycle. The pregnancy rate after frozen-thawed embryo transfer was higher with 4-cell frozen embryos than with embryos at all other stages combined. There were also tendencies for the pregnancy rate to be higher if a spontaneous luteinizing hormone surge occurred in the transfer cycle or if the duration of embryo storage did not exceed 1 to 2 months. The results obtained support a new policy in IVF-ET programs: it should be advantageous for the sterile couple if the immediate fresh embryo transfer is only performed with the categories of embryos that demonstrate a poor aptitude for survival following cryopreservation procedures.

Embryo Transfer↗
PubMed1987

Reduction of the number of embryos in a multiple pregnancy: quintuplet to triplet.

The technique for reduction of the number of embryos was applied in a patient who conceived following IVF and transfer of six embryos. On the 10th week of gestation, the number of embryos was reduced from five to three by an U/S-guided intra-uterine procedure. Two healthy girls and a boy were delivered in the 36th week by cesarean section. No trace of the other two fetuses was found. The moral and technical aspects of partial preventive termination of multiple pregnancy are discussed.

Abortion, Induced↗
PubMed1987

Morphological anomalies in the placentae of IVF pregnancies: preliminary report of a multicentric study.

Macroscopic characteristics of 100 fetal adnexae from pregnancies obtained by in-vitro fertilization and embryo transfer (IVF-ET) were compared with data for normal pregnancies taken from the literature. Material was obtained from 63 singleton, 15 twin, one triplet and one quadruplet pregnancies. The fetal and placental weights as well as the fetal:placental weight ratio were within the normal range for gestational age. Whilst placental morphology was normal, the insertion of the umbilical cord was frequently abnormal. Marginal (15%) and velamentous (14%) insertions of the umbilical cord were found more frequently than in a general obstetrical population (6% and 1% respectively). Excluding placentae from multiple pregnancies (which are known to have a higher incidence of abnormal cord insertion) the frequency did not decrease and remained significantly higher than in a normal population (P less than 0.01 and P less than 0.001, for marginal and velamentous insertion respectively). Abnormal insertion of the cord is of major clinical importance because of its association with vasa praevia and fetal haemorrhage (Benkiser Syndrome). Since this condition is thought to be caused by disturbed orientation of the blastocyst at implantation it is probably related to the IVF-ET procedure.

Embryo Implantation↗
PubMed1987

The effect of dydrogesterone supplementation in an IVF programme.

Various treatments are given during the luteal phase by most IVF programmes, without any proof of their efficacy. We have performed a double-blind, randomized study with dydrogesterone (125 transfers) against placebo (133 transfers). The pregnancy rate was 21.6 versus 15.0% per transfer cycle with dydrogesterone or placebo, respectively. There was no significant difference between these figures, but taking into account the usual success rate in IVF programmes (15-20%) a difference of 5% would be significant only with two groups of 1500 subjects. This paper discusses the question of how we can come to a definite conclusion on the efficacy of hormonal supplementation during the luteal phase.

Adult↗
PubMed1987

Uterine evaluation by microhysteroscopy in IVF candidates.

Over an eight-month period, microhysteroscopy was performed on 180 women, candidates for in-vitro fertilization (IVF). One hundred and two of them were suspected of having uterocervical pathology (group I), and 78 were not (group II). Group I had microhysteroscopic abnormalities in 60.8% and group II in 21.8%. Microhysteroscopy showed 30.6% of 36 positive hysterographies to be false positive and 37.5% of 144 negative hysterographies to be false negative, producing a confirmation rate of 63.9%. Admission to the IVF programme depended on microhysteroscopic normality. One hundred and one women were accepted directly, and 20 refused ('primary decision'). Fifty-nine were deferred with treatable hysteroscopic abnormalities, pending medical (22) and surgical (37) treatment, 14 via the microhysteroscope. Of the 59 women deferred, 51 were finally admitted and 8 rejected after a microhysteroscopic check ('secondary decision'). Finally, 152 of the 180 candidates (84.4%) were admitted. Microhysteroscopy helped to determine the optimal route for embryo transfer in 23 women with cervical pathology. Term pregnancy rates per embryo transfer were similar with hysteroscopic findings primarily normal, or normal after successful treatment (11.2 and 10.8% respectively). Microhysteroscopy seems useful for selection of cases for IVF, accurately determining utero-cervical pathology or normality, aiding in surgical correction of abnormalities and facilitating the process of embryo transfer. We suggest that microhysteroscopy should be performed routinely on all IVF candidates.

Adult↗
PubMed1987

One year's experience with programmed oocyte retrieval for IVF.

We have previously described a simplified form of ovulation stimulation for IVF in which the day of presumed oocyte retrieval is determined several weeks in advance. This paper retrospectively analyses this technique in 296 unselected patients over a one year period to assess if the method is suitable for routine use in an IVF programme. Oocyte retrieval was performed on the predetermined day in 70% of patients commencing stimulation. In the remainder, the presumptive day of oocyte retrieval was modified, or the cycle was cancelled. Compared with 356 patients undergoing a comparable classically monitored IVF stimulation during the same period, there was no significant difference in the cancellation rate of cycles prior to oocyte recovery, in the numbers of oocytes or embryos obtained or in the pregnancy rate between the two populations. It is concluded that programmed oocyte retrieval does not have a deleterious effect on the success rate of IVF compared with classical clomiphene citrate/HMG stimulation and it considerably facilitates the administration of an IVF programme.

Clomiphene↗
PubMed1987

In-vitro fertilization results from thirteen women with anti-sperm antibodies.

Thirteen infertile women with high titres of spermagglutinating antibodies in their serum and/or in cervical mucus underwent in-vitro fertilization (IVF) and embryo transfer (ET). Fertilization occurred in 68% of the oocytes in a serum-free medium. Eight pregnancies were obtained in 22 IVF cycles (36.4%). Anti-sperm antibodies were found in the follicular fluids of 5 out of the 11 women with circulating antibodies. Fertilization results were independent of both the localization and the level of anti-sperm antibodies. From these data we can conclude that IVF-ET is a suitable treatment for long lasting female infertility linked to anti-sperm immunity.

Antibodies↗
PubMed1987

Systematic semen culture and its influence on IVF management.

Semen specimens from 519 men were cultured for organisms 2 weeks before oocyte recovery for in-vitro fertilization (IVF). The cultures from 72 men contained more than 5000 bacteria/ml and the IVF attempt was postponed. The IVF outcome was assessed in 382 couples in relation to the semen culture result. The pregnancy rate per cycle was significantly reduced when the semen culture contained organisms compared with axenic semen (P less than 0.05). This was independent of the cleavage rate of oocytes and the number of embryos transferred. Although mycoplasma was frequently cultured, chlamydial infection was very rare and no viruses were isolated in this study.

Bacteria↗
PubMed1987

Physiological studies of human chorionic gonadotropin (hCG), alpha hCG, and beta hCG as measured by specific monoclonal immunoradiometric assays.

Several libraries of monoclonal antibodies have been produced against epitopes that reside on hCG, alpha hCG, and beta hCG. Having characterized them physically, we explored their use in the construction of highly specific and sensitive immunoradiometric assays. There were several important immunochemical considerations with respect to developing assays that accurately detect low levels of free subunits in serum in the presence of high concentrations of the native hormone. These include physical properties and specificities of the monoclonal antibodies, choice of capture antibody on the solid phase support, assay design, and purity of hormone standards. Using such assays, we found early pregnancy (in vitro fertilization) to be characterized by the sequential appearance of hCG, followed by beta hCG and then alpha hCG. Molar ratios of beta hCG to alpha hCG and beta hCG to hCG were highest in early gestation. However, there was a reversal of the beta hCG to alpha hCG ratio at 12-13 weeks gestation, and an excess of free alpha hCG was observed thereafter. Except for values obtained in very early pregnancy, the beta hCG to hCG ratio remained remarkably constant at approximately 0.5% throughout gestation. In contrast, choriocarcinoma was distinguished by absolute serum beta hCG concentrations 3-100 times greater than the maximum values observed during pregnancy and, more importantly, by exceedingly high beta hCG to hCG ratios. For comparison, we studied hCG, alpha hCG, and beta hCG levels in an additional 178 patients with nontrophoblastic tumors. Ectopic production of alpha hCG and beta hCG was rare (3%), and thus far, we have been unable to demonstrate the presence of hCG in such patients. Therefore, hCG and the free subunits appear not to be useful as serological markers for nontrophoblastic tumors.

Adolescent↗
PubMed1987

Scanning electron microscopy of postovulatory human endometrium in spontaneous cycles and cycles stimulated by hormone treatment.

The ultrastructure of the luminal surface epithelium was compared in endometrial samples taken from 23 normally cycling women and from 22 patients submitted to ovarian stimulation with clomiphene citrate (100 mg/day for 5 days), human menopausal gonadotrophin (hMG) and human chorionic gonadotrophin (hCG). On day 2 after ovulation, only four out of nine specimens taken from the women in the hormone-treated group were identical to those of normally cycling women. On day 6 after ovulation, only two out of the 13 biopsy specimens from the treated group were the same as those from normally cycling women at that stage. Apical protrusions (pinopodes), typical for this period of the cycle, were missing in 11 of the 13 endometrial samples from the treated group. These observations suggest that the hormonal treatment applied to induce ovulation (clomiphene citrate, hMG and hCG) can modify the normal development of the prenidatory endometrium, and may thus have a negative effect on the rate of egg implantation.

Adult↗
PubMed1987

[Value of RU 486 in failed terminations of pregnancy].

One of the complications of therapeutic termination of pregnancy is the complete retention of the embryo. The authors present four cases of repeated failure to evacuate the uterus associated with multiple fibroids or a malformation of the uterus. The use of RU 486 to soften the cervix and to allow it to dilate spontaneously made it possible in each case to aspirate the products completely. This action on the cervix of RU 486 could be used to make it easier to terminate early pregnancies up to the 12th week and particularly when there is associated uterine pathology.

Abortifacient Agents↗