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Biomedical subjects

S J Muasher

Publications and source records attributed to S J Muasher.

104 records · Page 6Linked to original sources
PubMed1988

Follicular atresia associated with concurrent initiation of gonadotropin-releasing hormone agonist and follicle-stimulating hormone for oocyte recruitment.

The ability of gonadotropin-releasing hormone agonist (GnRHa) to cause an initial stimulation of serum gonadotropins was used for follicular recruitment for in vitro fertilization (IVF) in 12 patients with a history of low estradiol (E2) response to conventional gonadotropin stimulation. Stimulation was initiated on cycle day 3 with concurrent administration of leuprolide (1 mg/day subcutaneously) and follicle stimulating hormone (FSH, 4 ampules/day intramuscularly). An 8-fold increase in basal serum luteinizing hormone (LH) and a 4-fold increase in basal serum FSH was seen on cycle day 4. Serum progesterone levels rose significantly by day 6. When compared to prior IVF attempts in these patients, the mean day of human chorionic gonadotropin administration and corresponding E2 levels were not significantly different. More atretic oocytes and fewer preovulatory oocytes were retrieved using GnRHa, and no increase was seen in total oocytes retrieved. One patient was canceled for poor E2 response, and one patient conceived, with a current viable pregnancy. It is concluded that concurrent initiation of leuprolide and FSH stimulation on cycle day 3 in patients with prior low response does not improve oocyte recruitment, and the high LH environment generated from initial stimulation of the agonist may be detrimental to normal oocyte development.

Embryo Transfer↗
PubMed1987

Results of in vitro fertilization attempts in women 40 years of age and older: the Norfolk experience.

Twenty-nine patients 40 years of age or older were stimulated with gonadotropins, starting on day 3 of the cycle, in a total of 64 cycles (January 1983 to June 1985) for multiple follicular development for in vitro fertilization. Most patients' infertility was due to tubal disease (n = 8) or pelvic endometriosis (n = 14). The mean number of preovulatory and immature oocytes recovered per laparoscopy was 2.53 +/- 1.73 and 1.57 +/- 1.58, respectively. There were no statistically significant differences between the number of preovulatory and immature oocytes harvested, fertilized, or transferred in this group and the number in patients younger than 40 years of age. No statistically significant differences were observed between peripheral estradiol and progesterone levels in patients 40 years of age or older and levels in patients 39 years of age or younger. There were 15 pregnancies in this group of patients, for a pregnancy rate of 23.4% per stimulated cycle, 27.7% per laparoscopy, and 29.4% per transfer. The ongoing pregnancy rate (12%) was lower, and the total abortion rate (60%) was higher, in patients 40 years of age or older in comparison with patients 39 years of age or younger. Patients 40 years of age or older should be counseled regarding the high abortion rate in this group.

Adult↗
PubMed1987

Results of in vitro fertilization attempts in patients with one or two ovaries.

The purpose of this communication is to evaluate the results of in vitro fertilization attempts in women with infertility due to a tubal factor, with one or two ovaries. Four hundred fifteen patients (788 cycles) with two ovaries and 86 patients (162 cycles) with one ovary were stimulated with gonadotropins starting on day 3 of the cycle for multiple follicular development. Although the mean number of preovulatory oocytes per laparoscopy and per transfer was significantly higher (2.33 versus 1.67 and 2.28 versus 1.99, respectively) in patients with two ovaries than in those with one ovary, the pregnancy rates per transfer were almost identical in the two groups (24.4% with two ovaries, 23.9% with one ovary). Results are presented according to different stimulation protocols and different age groups. It is concluded that although fewer fertilizable oocytes may be recruited from patients with one ovary, the potential for achieving a pregnancy is no different from that of patients with two ovaries.

Adult↗
PubMed1986

An analysis of the obstetric outcome of 125 consecutive pregnancies conceived in vitro and resulting in 100 deliveries.

One hundred twenty-five consecutive pregnancies conceived in vitro resulted in 100 deliveries of 115 babies. There were 23 clinical abortions (18.4%) and two tubal pregnancies. During the same interval 30 preclinical pregnancies occurred, but these pregnancies did not progress. There were 26 multiple pregnancies (37.1%) before the twelfth week; these reduced spontaneously to 14 (22.2%) multiple births at delivery. Eight infants were delivered prematurely, and three of these died. Three babies had some congenital abnormality. Vaginal bleeding occurred during pregnancy in 59% of patients. Cesarean section was the method of delivery in 56% of patients. Other complications of pregnancy were similar to those of comparable populations.

Abortion, Spontaneous↗
PubMed1986

The perimenopausal patient in in vitro fertilization: the use of gonadotropin-releasing hormone.

The perimenopause, incipient ovarian failure, is a major problem in stimulation failures during an in vitro fertilization program. This must be recognized as not necessarily related to age but also associated with adnexal inflammatory and operative processes. Although ovulation occurs uninterruptedly, the follicle-stimulating hormone in the early follicular phase is elevated and the luteinizing hormone is normal. Characteristically, there is no estradiol response to human menopausal gonadotropin therapy or a rapid response with a premature luteinizing hormone surge. These problems sometimes may be overcome with pulsatile intravenous gonadotropin-releasing hormone therapy, 5 or 10 micrograms/90 or 120 minutes. The major therapeutic problem is in the identification of a luteinizing hormone surge in these patients. Of eight women who were treated, two failed to respond with follicular maturation, three either had no oocytes aspirated from apparently postmature follicles or had postmature oocytes; and one had treatment cancelled due to ovulation. The four latter patients may have failed because of unrecognized ovulation. In the remaining two patients, one oocyte was fertilized and transferred, and one pregnancy occurred.

Female↗
PubMed1985

The combination of follicle-stimulating hormone and human menopausal gonadotropin for the induction of multiple follicular maturation for in vitro fertilization.

One hundred fifty-one cycles in 134 consecutive patients were stimulated with 150 IU of human urinary follicle-stimulating hormone (FSH) and 150 IU of human menopausal gonadotropin (hMG) on cycle days 3 and 4 and then with 150 IU of hMG daily for the purpose of multiple follicular development for in vitro fertilization (IVF). Seventy-three patients did not have a prior IVF attempt, and 61 patients in 78 cycles had prior IVF attempts at least once with their previous cycles stimulated with the same method and/or hMG and/or FSH. There was an average of three preovulatory oocytes retrieved per laparoscopy and a pregnancy rate of 27% per transfer cycle. The results were equally favorable in "new" and "old" patient cycles. The pregnancy rate increased with the transfer of two or more conceptuses of preovulatory origin. The multiple pregnancy rate, but not the abortion rate, increased with increased numbers of conceptuses transferred.

Abortion, Spontaneous↗
PubMed1984

Experience with diethylstilbestrol-exposed infertile women in a program of in vitro fertilization.

Twenty infertile women with a history of diethylstilbestrol exposure in utero were seen in Norfolk for the purpose of in vitro fertilization. Seventeen patients had undergone 25 stimulated cycles with harvest of oocytes by laparoscopy. The serum estradiol response to stimulation in these patients and the number and quality of oocytes retrieved did not differ significantly from those of patients with infertility due to blocked fallopian tubes. There were four pregnancies in 17 patients after 21 cycles of embryo transfers, for a pregnancy rate of 23.5% per patient, or 19% per embryo transfer. Two of the pregnant patients have had a term delivery, one has had a preclinical abortion, and one has a single intrauterine gestation in progress.

Adult↗
PubMed1984

Wedge metroplasty for the septate uterus: an update.

Twenty-one patients with septate uteri and 2 patients with a T-shaped uterine anomaly and recurrent abortions underwent wedge metroplasty during the period from September 1978 to August 1983. Thirteen patients had a characteristic history of one or more abortions associated with the septate uterus and absence of other metabolic and endocrine abnormalities. Ten other patients, including the two with a T-shaped uterine anomaly, either had one or more abortions of an uncharacteristic nature with absence of other abnormalities or had one or more characteristic abortions in addition to the presence of other metabolic, endocrine, or surgically correctable disease. The application of wedge metroplasty for the surgical reconstruction of the uterus yielded equally gratifying results in both groups with approximately two thirds of the patients having a term delivery or carrying a pregnancy in the third trimester.

Abortion, Habitual↗
PubMedDate not supplied

The outcome of clinical pregnancies following intracytoplasmic sperm injection is not affected by semen quality.

The objective of this study was to investigate the impact of severe oligoasthenoteratozoospermia (OAT) on pregnancy outcome. For this purpose 279 consecutive intracytoplasmic sperm injection (i.c.s.i) cycles were retrospectively evaluated and compared to 436 consecutive IVF cycles performed during the same time frame. Group A (n = 62) included ICSI patients with severe OAT; group B (n = 217) included patients who underwent ICSI for other indications; and group C (n = 436) included couples who underwent standard IVF. The mean age of female patients and mean number of embryos transferred were comparable in all groups. No difference was observed regarding implantation, clinical pregnancy, delivery and miscarriage rates between all three groups, but fertilization rate was significantly lower in group A than in groups B and C. It is concluded that couples undergoing ICSI with severe male infertility (OAT) have a slightly reduced fertilization rate but their chances of delivery and pregnancy loss are similar to those of other patients undergoing clinical ICSI and IVF with non-male infertility.

Abortion, Spontaneous↗