Efficiency and cost effectiveness of three protocols for gamete transfer.
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Adult↗
Biomedical subjects
S G Awadalla
Publications and source records attributed to S G Awadalla.
Isolation, in vitro maturation, and fertilization of germinal vesicle oocytes obtained from the intact murine ovary.
The purpose of this investigation was to attempt to develop a process, utilizing a murine model, which would allow more efficient harvesting from the intact ovary and maturation in vitro of germinal vesicle (GV) oocytes. The recovery process yielded 25.5 +/- 4.5 (mean +/- SE) cumulus-free GV oocytes per animal. Treatment groups included culture medium (CM) supplemented with either estradiol (E2), follicle stimulating hormone (FSH), human chorionic gonadotropin (hCG), or prolactin (PRL). Among the hormone-free controls 83.2 +/- 1.6% of oocytes underwent GV breakdown, whereas 25.3 +/- 2.6% developed to the first polar body stage (PB-1) following 18 hr of incubation (n = 29 trials). Oocytes progressing to the PB-1 stage were inseminated in vitro. In vitro fertilization (IVF) of pooled in vitro matured (IVM) PB-1 oocytes (judged by two-cell formation) was 19.9%, which was significantly lower than in the group of in vivo matured oocytes (74.4%). E2 significantly increased the percentage of GV breakdown (control, 76.8 +/- 2.5%; E2 at 10 ng/ml, 92.9 +/- 2.5%, P less than 0.001; E2 at 100 ng/ml, 93.7 +/- 2.1%, P less than 0.001; and E2 at 1 micrograms/ml, 86.7 +/- 3.3%, P less than 0.05) but not PB-1 formation. Neither FSH nor hCG significantly increased GV breakdown or PB-1 formation.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Transuterine insertion of Veress needle in laparoscopy.
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Female↗
Atypical luteinizing hormone rise and associated fertilization failure in non-male factor in vitro fertilization patients.
The purpose of this investigation was to analyze fertilization failure in non-male factor infertility in vitro fertilization (IVF) patients. Twenty-five nonfertilized IVF patients were compared with 57 successfully fertilized IVF patients. Patients were matched for age, ovulation-induction protocol, and cycle. The two groups were similar with respect to infertility etiology, peak estradiol, and total oocytes retrieved at laparoscopy. There was a greater incidence of primary infertility (64 versus 49%) and mean years of infertility (5.4 +/- 0.4 versus 4.6 +/- 0.3) in the nonfertilization group, although these differences were not statistically significant. Most important, the nonfertilization patients had a greater incidence of an atypical LH rise prior to hCG administration (60 versus 18%; P less than .001) and fewer mature oocytes (2.0 +/- 0.3 verus 3.4 +/- 0.3; P less than .01). Stepwise linear regression analysis yielded four primary factors for predicting fertilization failure: infertility duration, primary infertility, number of mature oocytes, and presence of LH rise. These findings help characterize several potential factors other than oligozoospermia that are associated with nonfertilization, and support LH monitoring in IVF and gamete intrafallopian tube transport patients.
Adult↗
In vitro fertilization with concurrent pelvic reconstructive surgery.
The recent advent of ultrasound-guided follicular aspiration by various approaches now allows access to ovaries previously deemed inaccessible by laparoscopy; however, a small group of candidates for in vitro fertilization and embryo transfer (IVF-ET) require laparotomy for associated gynecologic disorders. Twenty-five IVF-ET cycles at the time of laparotomy were compared with 309 IVF-ET cycles in which oocytes were retrieved laparoscopically. Five pregnancies occurred in the IVF-ET cycle with laparotomy and one pregnancy occurred spontaneously following microsurgical tubal reconstruction. The pregnancy rate per embryo transfer was 25% in the laparotomy IVF-ET patients compared with 15.4% for the laparoscopy IVF-ET group. Obvious advantages of combining IVF-ET and pelvic reconstructive surgery include a single anesthesia exposure and economic benefits. Patients with a long history of infertility undergoing tubal reconstructive surgery may be offered combined IVF-ET. Extended anesthesia exposure with pelvic surgery demonstrated no adverse effects on the pregnancy rate.
Adult↗
Local peritoneal factors: their role in infertility associated with endometriosis.
In order to detect peritoneal abnormalities that could account for infertility associated with endometriosis, 122 infertile individuals were studied at the time of laparoscopy for diagnostic purposes or for in vitro fertilization. Four groups were defined: group 1, laparoscopy without endometriosis; group 2, laparoscopy with endometriosis; group 3, in vitro fertilization without endometriosis; and group 4, in vitro fertilization with endometriosis. Mean peritoneal fluid volume was greater, although not significantly so, in group 4 (29.0 +/- 6.6 ml, mean +/- SEM) than in group 3 (18.2 +/- 2 ml). The concentration and total number of pelvic macrophages were similar for groups 1 and 2. The total number of pelvic macrophages was increased in group 4 (16.9 +/- 4.2 x 10(6)) versus group 3 (10.0 +/- 1.8 x 10(6)) (p = 0.08). The mean sperm phagocytosis in vitro did not differ among the four groups studied. Interleukin 1 activity within the peritoneal fluid and the in vitro interleukin 1 production rate did not differ between individuals with and without endometriosis. Peritoneal fluid and macrophage supernatants from individuals with endometriosis were not embryotoxic when studied in an in vitro mouse embryo system.
Adult↗
Adnexal torsion as a complication of superovulation for ovum retrieval.
Adnexal torsion has not been reported previously following hMG/hCG for superovulation induction during an IVF cycle. It is clear that the enlarged ovary from the superstimulation cycle and coital activity contributed to the torsion in this case. Portable ultrasonography helped in making the diagnosis and may be an aid for diagnosis in future cases. Medications used for ovulation induction should be used cautiously and judiciously with close monitoring. Clinicians involved with this type of therapy are obligated to keep a constant watch for such infrequent but devastating complications.
Adnexal Diseases↗
In vitro fertilization and embryo transfer in patients with one ovary.
The purpose of this investigation was to compare follicular response and pregnancy rates in patients with one and two ovaries who have undergone in vitro fertilization (IVF). No statistically significant difference was found in serum estradiol levels on the day of human chorionic gonadotropin administration, mean number of follicles (greater than 15 mm), mean total number of oocytes recovered, mean number of mature oocytes recovered, or number of pregnancies per transfer. The total number of oocytes recovered in the one- and two-ovary groups was 47 and 123, respectively. There was a significantly greater mean number of immature oocytes recovered (1.5 +/- .03 versus 0.5 +/- 0.2, P less than 0.01) and embryos transferred (2.7 +/- 0.3 versus 1.7 +/- 0.3, P less than .04) in patients with two ovaries. Though not statistically significant, a trend was noted in the two-ovary group for a greater number of pregnancies per transfer (9:25 versus 2:14). The authors conclude that single-ovary patients may have a reduced outcome with IVF compared with patients with two ovaries.
Adult↗
Follicular stimulation for in vitro fertilization using pituitary suppression and human menopausal gonadotropins.
Multiple follicular stimulation is a prerequisite to the efficient use of in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT). For some individuals, however, this stimulation may be difficult using standard superovulation protocols because of dominant follicle formation, suboptimal estradiol response, or premature luteinizing hormone surge. A group of such individuals with several previous failed attempts at superovulation were studied. Follicular stimulation was accomplished using a long-acting agonist of gonadotropin-releasing hormone (GnRH) for pituitary suppression followed by human menopausal gonadotropin (hMG) for follicular stimulation. Fourteen cycles (12 IVF, 2 GIFT) were completed in 12 individuals. There were no cycle cancellations. Mean number of prior cycle cancellations per patient was 3.1 +/- 0.4. Mean number of mature oocytes recovered was 3.9 +/- 0.5. Two pregnancies resulted. Pituitary suppression with a long-acting agonist of GnRH followed by hMG appears to be an effective adjunct to current superovulation regimens.
Adult↗
In vitro fertilization and embryo transfer: treatment-dependent versus -independent pregnancies.
In order to determine the true incidence of treatment-dependent versus -independent pregnancy in an in vitro fertilization (IVF) program, 274 women who underwent 492 cycles of superovulation were studied. Overall, the treatment-dependent pregnancy rate was 15%. The treatment-independent pregnancy rate was 6.6%. When a subgroup of individuals with at least one patent fallopian tube was selected for analysis, the treatment-dependent and -independent pregnancy rates were 13.9% and 11.9%, respectively. While the mean observation interval following an attempt at IVF was 2 years, 83.3% of all treatment-independent pregnancies occurred within 6 months after a trial of IVF-ET (embryo transfer). Patient characteristics that predispose to treatment-independent pregnancy are discussed.
Adult↗
In vitro fertilization and embryo transfer as a treatment for male factor infertility.
In vitro fertilization was attempted in 25 consecutive cycles as a treatment for male factor infertility. These cycles were compared with 25 control cycles in which a male factor was not present. The fertilization rates for mature oocytes in male factor cases and controls were 17% and 70%, respectively (P less than 0.001). For immature oocytes, the fertilization rates for study patients and controls, respectively, were 16% and 57% (P less than 0.001). Embryos were available for transfer in 36% of study cycles and in 88% of control cycles (P less than 0.01). The pregnancy per transfer rate for study cycles was 33% and for control cycles was 32%. The hamster ova penetration assay was 100% specific and 50% sensitive in predicting fertilization in vitro among male factor patients.
Adult↗
Persistent ectopic syndrome: a case report and literature review.
A case report is presented of an ampullary ectopic pregnancy which was treated by salpingostomy. Twenty-six days later, the patient underwent repeat operation due to the persistence of trophoblastic tissue within the fallopian tube. A review of the English literature reveals nine cases including our own that have been reported to date. In eight of nine cases, trophoblastic tissue was recovered at the time of the second operation. In the four cases where human chorionic gonadotropin (hCG) titers were available before and after the second procedure, the titers were positive initially and reverted to negative postoperatively. The disappearance curve for human chorionic gonadotropin after excision of an ectopic gestation is discussed. A recommendation is made for a single determination of beta-hCG two weeks after a conservative procedure for an ectopic gestation to screen for persistence of trophoblastic tissue.
Adult↗
The effect of cauterization of the rabbit ovary on adhesion formation.
A new treatment modality that involves laparoscopic electrocautery of the ovary has been described as an alternative to ovarian wedge resection. The authors investigated the effect of multiple cautery of the rabbit ovary on adhesion formation. Twenty animals were studied after being divided into four groups of five animals each. Group 1 animals underwent a control operation that involved opening and closing of the peritoneum only. All other animals underwent cautery of the right ovary, with the left ovary used as a control. Group 2 animals had no intraperitoneal substance instilled. Group 3 animals had 2.5 ml/kg of sterile normal saline instilled intraperitoneally. Group 4 animals had 2.5 ml/kg of 32% dextran 70 instilled intraperitoneally. Two weeks later, adhesions were evaluated with a macroscopic and a microscopic scoring system. Cautery of the ovaries was associated with the formation of a significant amount of adhesions. The mean macroscopic adhesion score for a cauterized ovary was 2.73 +/- 0.38 and for the control ovary was 0.00 +/- 0.00 (P less than 0.01). According to the microscopic scoring system, the adhesion scores were 1.86 +/- 0.16 and 1.20 +/- 0.28, respectively (P less than 0.05). The 32% dextran 70 group had the lowest mean macroscopic adhesion score, but this was not statistically significant.
Animals↗
Significance of endometrial cultures performed at cesarean section.
To determine the bacterial pathogenesis of postcesarean endomyometritis, swab endometrial cultures of the lower uterine segment were taken intraoperatively in 160 cases. Both aerobic and anaerobic cultures were obtained. Of all patients, 16.8% developed endomyometritis. There was a statistically significant relationship between positive cultures and the development of endomyometritis. The organisms isolated were those commonly found in other types of pelvic infection: pathogenic aerobes and anaerobes as well as commensals. An average of 1.3 organisms were recovered per patient with positive cultures. An analysis is provided for findings depending on the status of membranes and the influence of labor. The following risk factors were identified for the development of endomyometritis: primary cesarean section, labor, ruptured membranes, and postoperative hematocrit. Implications of these findings and a review of similar studies is provided.
Bacterial Infections↗
New approaches to the management of acute puerperal uterine inversion.
Six cases of acute puerperal inversion of the uterus are reported. In four of these, tocolytic agents were used to facilitate replacement of the inverted uterus; and in five, Prostin-15M was given after replacement. The use of tocolytics may obviate the need for general anesthesia for uterine replacement in some patients with uterine inversion. Prostin-15M serves to minimize bleeding and to maintain uterine position after replacement.
Adult↗
Pregnancy complicated by intraamniotic infection by Salmonella typhi.
There are few reports of transplacental infection by Salmonella typhi. A case of a primagravida at 26 weeks' gestation with severe S typhi gastroenteritis, sepsis, and disseminated intravascular coagulation is presented. Shortly after institution of antibiotic therapy, she spontaneously aborted a previable infant. Amniotic fluid was turbid and subsequently grew S typhi.
Abortion, Spontaneous↗