Biomedical subjects

S J Muasher

Publications and source records attributed to S J Muasher.

At least 73 records · Page 4Linked to original sources

PubMed1991

Ultrasonographic appearance of the endometrium in natural and stimulated in-vitro fertilization cycles and its correlation with outcome.

Ultrasonographic evaluation of the endometrium in 56 IVF patients was performed prospectively. Endometrial thickness and pattern were analysed in 18 natural-cycle and 38 stimulated-cycle patients. Thickness was measured from the echogenic interface of the endometrium-myometrium junction on a transverse section at the level of the fundus. Patterns were classified as A (homogeneous, hyperechogenic), B (mixed, with an outer hyperechogenic and inner hypoechogenic layer) or C (fluid-filled cavum with ring configuration). The thickness and pattern distributions were similar in natural- and stimulated-cycle patients. There was no correlation between thickness and serum oestradiol levels, the diameter of the largest follicle or the pregnancy outcome in either group. However, the occurrence of endometrial pattern A on the day prior to oocyte retrieval had a predictive value of 100% for a non-conceptional cycle. In contrast, pattern B occurred in a significantly greater proportion of pregnant than non-pregnant patients.

Adult↗

PubMed1991

Endometrial receptivities after leuprolide suppression and gonadotropin stimulation: histology, steroid receptor concentrations, and implantation rates.

The effect of markedly supraphysiologic levels of E2 and P4 on the endometrium was assessed by examining endometrial histology, E2 and P4 receptor concentrations, and embryo implantation rates in IVF cycles with and without leuprolide use. Results suggest that 1) the high ovarian response common in leuprolide pretreated cycles can advance endometrial histology, but only up to a certain limit, 2) P4 greater than 25ng/ml or E2 greater than 200pg/ml on the day of transfer was associated with non-lagging endometria, 3) implantation rate in high response cycles is not impaired and may be increased, 4) earlier P4 supplementation in low response cycles may be beneficial, 5) extraordinarily high response (E2 greater than 5000pg/ml) may be detrimental to implantation, and 6) the optimal histology for implantation appears to be at least day 16.

Antineoplastic Agents↗

PubMed1991

In vitro fertilization: effective alternative to surgery for distal tubal occlusion.

A total of 512 consecutive patients with tubal infertility underwent ovarian hyperstimulation for the purpose of IVF-ET, resulting in a total of 829 attempts and 890 transfers (fresh and cryo). Overall, 218 clinical pregnancies were achieved, of which 114 (52.3%) resulted in live births, and 38 (17.4%) were ongoing (greater than or equal to 20 weeks of gestation) at the conclusion of the study. The total live birth and ongoing pregnancy rate per patient was 29.7% (three patients conceived twice). The probability for a patient to achieve a live or ongoing pregnancy was 42.7% after three attempts and 85.3% after six attempts. We conclude that IVF-ET using contemporary technology offers an effective alternative to surgery for tubal obstruction.

Adult↗

PubMed1990

The prevalence of human immunodeficiency virus in patients and their spouses entering a large in vitro fertilization program.

Between September 1987 and August 1989, all patients and their spouses entering our in vitro fertilization (IVF) program were screened for the human immunodeficiency virus (HIV) using the enzyme-linked immunosorbent assay (ELISA). Of 848 patients and 848 spouses tested, all but 4 patients and 1 husband tested negative. Of those who tested positive on repeat testing with ELISA, only one was positive on Western blotting (HIV prevalence, 0.59 per 1000). During this same time period 1187 samples of human cord blood were used to make tissue culture medium for the IVF embryology laboratory. One sample was discarded because of positive HIV on ELISA and Western blotting; two other samples were discarded because of positivity to the hepatitis B surface antigen. While we believe that routine HIV screening of IVF patients and their spouses is indicated, this population is of low risk for HIV positivity. Furthermore, continued screening of human sera used to make tissue culture media for IVF is mandatory.

Blotting, Western↗

PubMed1990

Ovarian stimulation for in vitro fertilization in low-responder patients using pulsatile intravenous follicle stimulating hormone.

There is a subset of patients who fail to respond adequately to exogenous gonadotropin stimulation for in vitro fertilization (IVF). In this study, six such low-responder patients who had inadequate stimulations with high-dose intramuscular (im) follicle stimulating hormone (FSH) were treated in a subsequent cycle with pulsatile intravenous (iv) FSH. A paired analysis was performed to compare the cycles using high-dose im FSH with those using pulsatile iv FSH. Trough serum FSH levels were significantly higher with pulsatile iv FSH. No significant difference was noted in the stimulation characteristics or the number or quality of oocytes retrieved and embryos transferred. No pregnancies occurred in either group. While pulsatile iv administration of gonadotropin increases serum FSH levels, it does not appear to have a major impact on follicular stimulation or outcome in low-responder patients undergoing IVF.

Female↗

PubMed1990

Ovarian stimulation for in vitro fertilization using pure follicle-stimulating hormone with and without gonadotropin-releasing hormone agonist in high-responder patients.

There is a distinct pattern of response to gonadotropin stimulation in some patients marked by high peak estradiol (E2) levels, multifollicular ovarian response, and elevated basal luteinizing hormone (LH)/follicle-stimulating hormone (FSH) ratios. We reviewed the stimulation profiles of five such high-responder patients who failed to conceive during in vitro fertilization with ovarian stimulation using pure FSH. All patients had baseline LH/FSH greater than 1.5 and peak E2 greater than 800 pg/ml. One cycle was canceled prior to hCG administration because of marked ovarian response (E2 greater than 2500 pg/ml, multiple small follicles). In a subsequent cycle, all patients were pretreated with the gonadotropin releasing-hormone agonist (GnRHa) leuprolide acetate for 10-14 days prior to initiation of FSH for ovarian stimulation. Leuprolide was continued until the day of hCG administration. During cycles using GnRHa, there was a statistically significant decrease (P less than 0.05) in serum FSH on day 3 (less than 5 vs 8.3 mIU/ml), serum E2 on day 3 (14.6 vs 34.6 pg/ml), and peak serum E2 (1197.6 vs 1923.0 pg/ml). Patients during cycles with GnRHa had a greater number of preovulatory (8.6 vs 3.0) and total (12.4 vs 6.0) oocytes retrieved (P less than 0.05). The fertilization rate of preovulatory oocytes was also higher during cycles using GnRHa (83 vs 64%). Two pregnancies occurred in the cycles pretreated with GnRHa. These preliminary data indicate that in high-responder patients, a combination of GnRHa and pure FSH results in lower E2 levels during the stimulation cycle and a greater number of total and mature oocytes retrieved and fertilized.

Adult↗

PubMed1990

Equivalency of human menopausal gonadotropin and follicle-stimulating hormone stimulation after gonadotropin-releasing hormone agonist suppression.

This study compares the use of human menopausal gonadotropin (hMG) versus follicle-stimulating hormone (FSH), after gonadotropin-releasing hormone agonist (GnRH-a) suppression for in vitro fertilization. Thirty-seven patients were randomized to ovarian stimulation with either hMG or pure FSH. The GnRH-a leuprolide acetate was administered to all patients beginning in the midluteal phase of the prior cycle and continuing until the day of human chorionic gonadotropin (hCG) administration. There were no significant differences between hMG and FSH cycles with regard to the day of hCG administration, mean peak estradiol levels, number of ampules of medication used, and number of oocytes aspirated, embryos transferred, or pregnancies. We conclude that there is no significant difference between hMG and FSH stimulation when used in conjunction with GnRH-a.

Adult↗

PubMed1990

High-dose follicle-stimulating hormone stimulation at the onset of the menstrual cycle does not improve the in vitro fertilization outcome in low-responder patients.

In an attempt to improve their outcome with in vitro fertilization (IVF), 34 low-responder patients were stimulated with six ampules of follicle-stimulating hormone (FSH) daily starting on day 1 (n = 17) or day 2 (n = 17) of their menstrual cycles. The stimulated cycles showed a mean peak estradiol of 443 +/- 173 pg/mL, mean days of human chorionic gonadotropin of 7.6 +/- 1.4, 2.67 +/- 1.5 preovulatory oocytes per retrieval, and 2.56 +/- 1.3 oocytes per transfer. Three clinical pregnancies resulted after 25 embryo transfer cycles (12%). With paired analysis, we compared 8 patient cycles with prior six ampules of FSH stimulation starting on day 3; all parameters examined showed no significant differences. In a comparison of 22 patient cycles with prior 4 ampules of FSH stimulation on cycle day 3, no significant differences in any parameters were observed except in the higher number of ampules used in the present study. We conclude that high-dose FSH stimulation at the onset of the menstrual cycle does not improve the IVF outcome in low-responder patients.

Adult↗

PubMed1990

Preclinical abortions: incidence and significance in the Norfolk in vitro fertilization program.

Clinical and prognostic significance of preclinical abortions in assisted reproduction is ill defined. Strict diagnostic criteria include a transient and synchronous elevation of serum beta-human chorionic gonadotropin (hCG), estradiol, and progesterone levels 13 days after hCG administration, ending in a bleeding episode no more than 14 days after the missed period. The preclinical abortion study group (54 patients, 178 cycles) was compared with matched control groups A (54 patients, 132 cycles) and B (54 patients, 155 cycles), representing normal term pregnancies and all outcomes, respectively. Control group C included the overall population during the study period. The abortion rate per transfer (preclinical abortion and total miscarriage rates) and total pregnancy wastage in the study group were significantly higher; the ongoing pregnancy rate was significantly lower. Preclinical abortion should be considered as a true reproductive failure with similar implications.

Abortion, Spontaneous↗

PubMed1990

Survival of the cornual pregnancy in a heterotopic gestation after in vitro fertilization and embryo transfer.

We present a case of combined intrauterine and cornual (interstitial) pregnancy after IVF-ET, with survival of the infant after the cornual pregnancy. The diagnosis of this rare phenomenon is difficult; a high index of suspicion and frequently ultrasound monitoring may enable early diagnosis in other forms of heterotopic pregnancy. Although the benefits of IVF-ET far outweight the risks of ectopic pregnancy, it is imperative that physicians who care for these patients be fully aware of the possibility of such a complication in this high-risk population.

Adult↗

PubMed1990

Gonadotropin stimulation for in vitro fertilization and embryo transfer in insulin-dependent diabetics: follicular response, oocyte quality, embryo development, and follicular environment.

Two IDD patients were stimulated with gonadotropins for IVF and ET. Both patients had high E2 response and greater than or equal to 5 preovulatory oocytes retrieved, normal fertilization and cleavage rates, and transfer; neither conceived. Follicular fluid showed levels of E2, P, A, hCG, and PRL similar to non-IDD. Epidermal growth factor could not be detected in FF. Insulin-dependent diabetes patients can undergo gonadotropin stimulation for IVF with customary responses. Their follicular milieu resembles that of non-IDD patients except for a lack of EGF.

Adult↗

PubMed1990

Are implantation and pregnancy outcome impaired in diethylstilbestrol-exposed women after in vitro fertilization and embryo transfer?

Forty-six infertile women with a history of diethylstilbestrol (DES) exposure in utero underwent 149 stimulation attempts for in vitro fertilization (IVF). The mean (+/- SE) number of preovulatory oocytes harvested at retrieval and transferred was 3.9 +/- 3.3 (536/138) and 2.6 +/- 1.4 (328/124). When compared with patients with tubal factor infertility and less than or equal to 4 pre-embryos transferred, the clinical pregnancy rate (15.3% versus 22%) was not statistically different. However, the term/ongoing pregnancy rate was significantly lower in the study group (8% versus 16%). Comparison of the IVF outcome with different uterine anomalies as detected by hysterosalpingogram (n = 29) showed a trend for a worse prognosis in women with constrictions and a combination of T-shape and constrictions. It is concluded that implantation and pregnancy outcome are impaired in DES-exposed women after IVF.

Adult↗

PubMed1990

Intercycle variability of day 3 follicle-stimulating hormone levels and its effect on stimulation quality in in vitro fertilization.

Prior studies have demonstrated that gonadotropin stimulation quality and pregnancy rates are better in in vitro fertilization (IVF) patients with low basal cycle day 3 follicle-stimulating hormone (FSH) levels. The records of 81 patients who had undergone three or more IVF attempts during a 2-year period were studied to determine the degree and potential impact of intercycle variability in basal FSH concentrations. The mean of the individual standard deviations for all 81 patients was 4.2 +/- 0.4 mIU/mL. However, the patients with a mean basal FSH of less than 15 mIU/mL had a mean deviation of only 2.6 +/- 0.2 mIU/mL, whereas those with a mean basal FSH of greater than or equal to 15 mIU/mL had a mean deviation of 7.3 +/- 0.7 mIU/mL. Intercycle variability in basal FSH values did not predict changes in ovarian response to gonadotropin stimulation and thus may not be used to select an optimal cycle in which to stimulate an individual patient. Furthermore, patients with large intercycle variation responded poorly to gonadotropin stimulation independent of their basal FSH concentration. This information allows more precise counseling of patients regarding their appropriateness for assisted reproduction.

Animals↗

PubMed1990

Progesterone levels on the day of human chorionic gonadotropin administration in cycles with gonadotropin-releasing hormone agonist suppression are not predictive of pregnancy outcome.

In in vitro fertilization (IVF) cycles using gonadotropin-releasing hormone agonist (GnRH-a) suppression, we investigated whether an elevated progesterone (P) level on the day of human chorionic gonadotropin (hCG) administration indicates premature luteinization and is associated with a lower pregnancy rate. We retrospectively studied 101 patients treated with the GnRH-a leuprolide acetate, begun in the luteal phase of the prior menstrual cycle and continued until the day of hCG administration. On the day of hCG, 72 patients had P less than 0.9 ng/mL and 29 had less than or equal to 0.9 ng/mL. Patients in the high P group had a significantly greater estradiol level on the day of hCG. No significant difference in clinical pregnancy rates or ongoing pregnancy rates occurred between the low P and high P groups. We conclude that in IVF cycles pretreated with GnRH-a, P levels on the day of hCG are not predictive of conceiving in that cycle.

Adult↗

PubMed1990

Non-functional ovarian cysts do not affect ipsilateral or contralateral ovarian performance during in-vitro fertilization.

Reports on the significance of ovarian cystic structures during in-vitro fertilization (IVF) have been conflicting. This study examined the effect of such structures on ovarian performance during IVF. Twenty-one patients with one or more cystic structures of 20-50 mm in diameter, detected on day 6 of the menstrual cycle, were compared to 35 non-cystic controls. Differences (cyst versus non-cyst) included basal oestradiol (E2) levels (40 +/- 4.8 versus 29 +/- 2.0 pg/ml; P less than 0.01), ampoules of gonadotrophins administered (24 +/- 2 versus 16 +/- 1; P less than 0.001) and peak E2 concentrations (415 +/- 45 versus 744 +/- 88 pg/ml; P less than 0.05). There were no differences in the number of follicles aspirated or oocytes retrieved. In 19 patients with unilateral structures, the ipsilateral ovary produced fewer follicles (2.5 +/- 0.5 versus 3.9 +/- 0.6; P less than 0.05); however, there were no differences in the number or maturity of oocytes recovered. Since the numbers of oocytes recovered were equivalent in the presence or absence of ovarian cystic structures, their presence is not an indication to cancel an IVF cycle.

Adult↗

PubMed1990

Implantation and pregnancy rates in relation to oestradiol and progesterone profiles in cycles with and without the use of gonadotrophin-releasing hormone agonist suppression.

The oestradiol (E2), progesterone (P4) levels, the corresponding E2/P4 ratios and pregnancy and implantation rates were studied in 565 in-vitro fertilization (IVF) cycles stimulated with gonadotrophins alone and in 320 cycles stimulated with adjunctive treatment of a gonadortrophin-releasing hormone agonist (GnRHa, leuprolide). The overall pattern of serum E2 and P4 levels and the E2/P4 ratios were similar in both groups, though significantly higher absolute levels were demonstrated in leuprolide cycles. Similar profiles were observed in conception and nonconception cycles within each group; significantly higher levels were noted in conception cycles starting nine days after embryo transfer. Though the overall pregnancy rate per fresh transfer in leuprolide cycles was significantly higher than in non-leuprolide cycles (32 versus 22%, P less than 0.001), this was largely due to the transfer of more embryos; the implantation rate per embryo transferred did not differ significantly between groups (11.8 versus 10.5%). We conclude that the use of GnRHa in IVF cycles increases the pregnancy rate as a consequence of more embryos being transferred, since implantation rate was unaltered by GnRHa. Further, GnRHa does not alter the basic E2 and P4 progesterone pattern observed in gonadotrophin-stimulated cycles (though the absolute levels are higher); moreover, these patterns could not be used to predict pregnancy outcome.

Adult↗

PubMed1989

Correlation of follicular diameter with oocyte recovery and maturity at the time of transvaginal follicular aspiration.

Forty-four consecutive patients undergoing transvaginal follicular aspiration for in vitro fertilization underwent ultrasonic measurement of follicular diameter at the time of oocyte retrieval to determine the correlation of follicular size with recovery rates and oocyte maturity. Based on the results of 412 follicles aspirated, the data were grouped by size (less than or equal to 11, 12-14, 15-17, 18-20, and greater than or equal to 21 mm) and oocyte maturity. Recovery rates were significantly higher in 18- to 20-mm follicles (P less than 0.01) and lower in those less than or equal to 11 mm (P less than 0.001). The probability of retrieving a metaphase I or II oocyte was significantly lower in follicles less than or equal to 11 mm (P less than 0.001), somewhat higher in 12- to 14-mm follicles (P less than 0.01), and equally high among the other groups. There were no differences in the incidence of fractured zonas. We conclude that follicles greater than or equal to 15 mm provide the highest probability of retrieving mature oocytes and the low recovery rates of mature oocytes from follicles less than or equal to 11 mm suggest that, in selected circumstances, the operating surgeon may choose not to aspirate them.

Cell Cycle↗

PubMed1989

A prospective randomized comparison of single- and double-lumen needles for transvaginal follicular aspiration.

Patients undergoing ultrasound-directed transvaginal follicular aspiration in a large in vitro fertilization (IVF) program were randomized for retrieval with either a single-lumen needle (SLN; N = 22) or a double-lumen needle (DLN; N = 22) to compare recovery rates and the technical aspects of their use. Two hundred ten and two hundred two follicles were aspirated with each needle, respectively. Follicular diameters were measured ultrasonically at the time of aspiration and recorded. One or more washes were performed when using the DLN and the SLN was withdrawn each time to recover the fluid in the dead space of the needle. The distribution of follicular sizes was the same for both needles. Oocyte recovery rates (SLN = 65.7%; DLN = 63.9%) and the incidence of fractured zonae (SLN = 9.1%; DLN = 6.4%) were the same for both needles (alpha greater than 0.50; beta less than 0.01). Although there were no differences between the two needles in the number of oocytes provided for IVF, there were technical differences. The DLN needle was more flexible and frequently deviated from the projected path as observed by ultrasound. The SLN may be preferable because it is technically easier to use; however, there may remain specific indications for the use of the DLN.

Evaluation Studies as Topic↗