Assisted fertilization. Clinical studies with particular attention to ovarian stimulation, oocyte retrieval and transfer of gametes or embryos.
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Embryo Transfer↗
Biomedical subjects
T Tanbo
Publications and source records attributed to T Tanbo.
[Reduced ovarian function in infertile women. Experiences with the clomiphene test].
The authors briefly describe the current understanding of follicular maturation, the influence of FSH on follicular maturation and the regulation of FSH secretion. They discuss the complex mechanisms of the impacts of clomiphene citrate, and how clomiphene citrate can be used in a test of ovarian reserve based on the FSH response. The article reports of the clomiphene citrate challenge test in patients referred to in vitro fertilization.
Adult↗
The first attempt at IVF treatment. Results and requirements for a satisfactory success rate.
The purpose of this study was to report the success rate of the first IVF treatment in 161 patients who attended our department in 1988. The indications for IVF were tubal damage in 84 couples (52.1%), unexplained infertility and endometriosis (with patent tubes) in 61 couples (37.9%), and polycystic ovarian syndrome in 16 couples (10%). Clinical pregnancies were diagnosed in 40 patients, giving an overall clinical pregnancy rate of 35.4% per embryo transfer. In the group of patients with unexplained infertility or endometriosis one in three of the embryo transfer cycles will predictably result in a birth, one in four in the group of patients with tubal damage or polycystic ovarian syndrome. These results invite discussion of the possible reasons for the success of our IVF program.
Adult↗
In-vitro fertilization in infertile women with the polycystic ovarian syndrome.
Forty-four infertile patients with the polycystic ovarian syndrome (PCOS) resistant to other treatment modalities were treated in 58 cycles of IVF after accomplishment of pituitary gonadotroph suppression with a GnRH-agonist. Four cycles were cancelled before oocyte retrieval while embryo transfer was deferred for 10 cycles due to imminent ovarian hyperstimulation syndrome (OHSS). Follicle aspiration yielded 18.8 +/- 9 oocytes per cycle. The cleavage rate was 68%. There was no cleavage in five cycles. The pregnancy rate was 33.3% per embryo transfer. In 32 cycles 9.0 +/- 5 suitable supernumerary embryos were cryopreserved. Transfer of cryopreserved embryos gave three additional pregnancies. The accumulated pregnancy rate per patient was 36%. In clomiphene citrate resistant patients, transfer of cryopreserved embryos was accomplished after secretory transformation of the endometrium by oestradiol/progesterone substitution. Although seven pregnancies ended in a miscarriage, the 'take-home' baby rate was 20%. OHSS ensued in 28 (46.7%) cycles. In PCOS, in-vitro fertilization following pituitary gonadotroph suppression seems a treatment alternative with pregnancy rates comparable to normo-ovulatory women with tubal factor infertility. However, the incidence of OHSS is high and constitutes the major problem of cycle control.
Buserelin↗
Hormone-responsive adenylyl cyclase in the human fallopian tube.
Hormone-responsive adenylyl cyclase (AC) activity in biopsies from normal human Fallopian tubes was studied. Enzyme activity with a Km of 0.15 mmol/L and a maximum velocity of 13.8 pmol/mg.min in the basal condition was demonstrated. The addition of prostaglandin E1 (PGE1), PGE2, PGF2a, vasoactive intestinal polypeptide, isoproterenol, and terbutaline increased enzyme activity, with no change in the Km. Maximum stimulation of AC activity was obtained with PGE1, resulting in a 2- to 8-fold increase in AC activity. The response of AC to PGE1 revealed a possible topographical variation, with lowest responses to PGE1 in the isthmus. No such segmental variation in AC activity and response was seen after stimulation with PGF2a, vasoactive intestinal polypeptide, or isoproterenol.
Adenylyl Cyclases↗
Heterotopic pregnancy following in vitro fertilization.
We report 4 cases of heterotopic pregnancy following in vitro fertilization. All 4 patients were treated by surgical removal of the ectopic pregnancy products. In 3 patients, the intra-uterine fetus was alive prior to surgery. Two of the 3 gave birth to a healthy baby while the third pregnancy has progressed uneventfully for 12 weeks since the operation.
Adult↗
Assisted reproductive technology.
Several aspects of reproductive technology are discussed. In tubal infertility, the choice between surgery or in vitro fertilization and embryo transfer (IVF-ET) is addressed. In cases with bilateral distal occlusion or otherwise bad prognosis, IVF is probably more successful and less expensive. IVF in unstimulated cycles has given promising results, with pregnancy rates comparable to the results from the National IVF-ET Registry. If these results can be confirmed by more studies they will probably have a great impact on the choice of treatment in tubal infertility. The results obtained with various transfer procedures in nontubal infertility have still to prove tubal transfer to be a more effective procedure than IVF. Finally, studies on microinsemination in male infertility or unexplained infertility with previous fertilization failure in IVF show promising results with the subzonal insemination and partial zona dissection procedures.
Embryo Transfer↗
Endometriosis-associated infertility treated by long-term gonadotropin-releasing hormone agonist administration and assisted fertilization.
Two patients with long-lasting infertility associated with moderate and severe symptomatic endometriosis were treated with long-term GnRH-agonist suppression of ovarian function. Both patients were relieved of their endometriosis-related abdominal pains during the first treatment month. After an additional treatment period of 3 to 5 months, assisted fertilization was performed, resulting in an ongoing pregnancy for both patients.
Adult↗
Pregnancy after transfer of cryopreserved embryos in clomiphene citrate resistant polycystic ovarian syndrome.
Transfer of cryopreserved embryos in PCOS patients resistant to CC stimulation is an intriguing problem. Ovarian stimulation with hMG/hCG to create a secretory endometrium, will entail an unnecessary risk of OHSS. In this case study, we report the accomplishment of a successful pregnancy after transfer of cryopreserved embryos after secretory transformation of the endometrium by E2/P substitution in the absence of corpus luteum formation. However, the success rate of this treatment modality in terms of pregnancy per embryo transfer has still to be evaluated in an ongoing study.
Adult↗
Stimulation with human menopausal gonadotropin versus follicle-stimulating hormone after pituitary suppression in polycystic ovarian syndrome.
Stimulation with human menopausal gonadotropin (hMG) or follicle-stimulating hormone (FSH) was compared in 34 patients with polycystic ovarian syndrome after pituitary gonadotrope suppression with buserelin acetate. No differences were seen in the hormone parameters observed. Also, the duration of the stimulation period and the dose of gonadotropin used were the same. In both groups a multifollicular response was seen. Oocyte retrieval and in vitro fertilization resulted in identical ratios of mature to total oocytes and cleavage rates. Nine pregnancies occurred, four in the hMG group and five in the FSH group. Of the nine pregnancies, two were the result of transfer of frozen-thawed embryos in estradiol and progesterone substituted cycles.
Adult↗
Epithelial cells from human fallopian tube in culture.
The epithelial cells lining the inner surface of the Fallopian tube influence the reproductive process by both their ciliary and secretory activities. The aim of the present work was to establish a method to culture these cells as a model for more specific studies of their properties. Minor slices of the mucosal ridges were cut and minced extensively using a fine scissor. The resulting pieces were washed once, resuspended in RPMI 1640 with 20% fetal calf serum and seeded in plastic dishes. After 2 days, the medium was replaced with RPMI 1640 containing human albumin, insulin and transferrin. Seven to 10 days later, the cell number had increased 5-8 times in 70% of the cultures. The identity of the cells was assessed after 1-3 weeks in culture. Of the cells, 98% stained positive for the antibody to epithelial cell-specific protein cytokeratin. Electron microscopic studies of the cultures showed epithelial characteristics including cilia, microvilli and intercellular junctions in the form of desmosomes. The cells could be kept in culture for 6-8 weeks. In conclusion, a method to culture epithelial cells from the human Fallopian tube is described. The cells have been identified and they can be kept in culture for 6-8 weeks in quantities sufficient for experimental use.
Cells, Cultured↗
Assisted fertilization in infertile women with patent fallopian tubes. A comparison of in-vitro fertilization, gamete intra-fallopian transfer and tubal embryo stage transfer.
A comparison of the relative efficacy of in-vitro fertilization with uterine embryo transfer (IVF), tubal embryo stage transfer (TEST) and gamete intra-Fallopian transfer (GIFT) was performed in infertile patients with patent Fallopian tubes. A total of 150 couples with unexplained infertility, peritoneal endometriosis or reduced semen quality were included in the study. The three groups were comparable with regard to age distribution, indications, semen parameters, stimulation regimens, response to stimulation and numbers of oocytes retrieved. In the IVF and TEST groups there was no cleavage in 24% and a cleavage rate of only 47.6%. The highest cleavage rate was obtained in the endometriosis patients. The pregnancy rate was highest in the two groups in which in-vitro fertilization was performed, IVF = 45.7%, TEST = 37.9%, GIFT = 26.2%. To obtain one live intrauterine fetus, more oocytes had to be transferred in the GIFT group compared to the number of embryos in the IVF group, 14.4 versus 6.2, P less than 0.05. Due to a high success rate of IVF but at the same time a high frequency of no cleavage in cases of unexplained infertility or male subfertility, we recommend IVF as the primary procedure in infertile couples with patent Fallopian tubes.
Adult↗
Ovarian stimulation in previous failures from in-vitro fertilization: distinction of two groups of poor responders.
Forty-three patients who responded poorly to previous stimulation with clomiphene citrate (CC)/human menopausal gonadotrophin (HMG) for IVF were followed during 70 further cycles. Eighteen patients had a normal FSH response to CC in the previous cycle, while 25 had an abnormal FSH response. Three stimulation protocols were used: buserelin/HMG, CC/HMG and HMG only. No difference between the two groups was observed in the dose of HMG used for any stimulation protocol. More cycles were cancelled due to a poor response in the abnormal response group compared to the normal response group. In the completed cycles, the maximum oestradiol level and number of oocytes retrieved were lower in the abnormal response group compared to the normal response group. The total pregnancy rate per patient, including spontaneous conceptions during the study period, was lower in the abnormal response group compared to the normal response group, 4 versus 33%. We conclude that poor responders with an abnormal FSH response to CC have a latent ovarian failure with a low chance of success in further IVF attempts.
Adult↗
Ovarian hyperstimulation for in vitro fertilization preceded by prolonged administration of a gonadotropin-releasing hormone agonist.
In 51 patients, controlled ovarian hyperstimulation with clomiphene citrate (CC)/human menopausal gonadotropin (hMG), or hMG only, in 102 IVF cycles had previously resulted in a cancellation rate of 52% and no pregnancies. In 54 subsequent cycles the women were treated with prolonged administration of a gonadotropin-releasing hormone agonist (GnRHa) followed by hMG stimulation, the GnRHa group. The results were compared with the outcome of 47 cycles in patients who came for their first IVF attempt. In this group a CC/hMG regimen was used, the CC/hMG group. In the GnRHa group, 17 pregnancies were achieved, compared with 10 in the CC/hMG group. Only four cycles were cancelled in the GnRHa group, vis-à-vis 13 in the CC/hMG group, a significant difference. The study showed that prolonged use of GnRHa as a preparatory treatment is effective following previous failures of IVF.
Adult↗
Duration of the latency period in preterm premature rupture of the membranes. Maternal and neonatal consequences of expectant management.
111 pregnancies complicated with premature rupture of the membranes (PROM) at a gestational age between 20 and 34 weeks, were observed prospectively with expectant management. Median duration of the latency period was 7 (0-109) days. The duration of the latency period was inversely related to the gestational age at PROM. Intra-uterine death ensued in 9.9% of the pregnancies. Clinical chorioamnionitis ensued in 12.6% of the pregnancies. Eight (7.6%) neonates developed sepsis. None of the babies died as a consequence of sepsis alone. Of the 43 (41.0%) neonates who developed idiopathic respiratory distress syndrome (IRDS), 8 (7.6%) babies died. The perinatal mortality rate was 18.6%. The study seems to justify the expectant management of PROM pregnancies of less than 34 weeks of gestation.
Adult↗
Follicle-stimulating hormone as a prognostic indicator in clomiphene citrate/human menopausal gonadotrophin-stimulated cycles for in-vitro fertilization.
Follicle-stimulating hormone (FSH), luteinizing hormone (LH), oestradiol and prolactin levels were studied in a sequential clomiphene citrate/human menopausal gonadotrophin (CC/HMG) regimen for in-vitro fertilization. At completion of CC administration, the median FSH level in 44 cancelled cycles was elevated compared to a control group of 65 completed cycles, 29 IU/l versus 15 IU/l, P less than 0.01. Also the median FSH/LH ratio was higher in the cancelled cycles than in the control group, 1.08 versus 0.71, P less than 0.05. Conversely, the median oestradiol level was lower in the cancelled cycles than in the completed cycles, 0.27 nmol/l versus 0.59 nmol/l, P less than 0.01. No difference was seen in the median LH and prolactin levels. An FSH value above the 95% confidence limit was found in 24 of the cancelled cycles, but in only two of the completed cycles. Based on this study, an elevated FSH value following CC administration predicts a poor response to further stimulation with an accuracy of 92.3% and should result in cancellation of the cycle.
Adult↗
Gonadotropin and ovarian steroid production in polycystic ovarian syndrome during suppression with a gonadotropin-releasing hormone agonist.
Six women with polycystic ovarian syndrome were treated with a gonadotropin-releasing hormone agonist prior to ovulation induction with gonadotropins. Buserelin nasal spray (600 micrograms/day) was given for 6 weeks. There was a gradual and significant decrease in the level of luteinizing hormone (LH) during the treatment period. No change was observed in the level of follicle-stimulating hormone. The estradiol, estrone, testosterone and androstenedione levels decreased significantly. No reduction was seen in the DHEAS level. After 4 weeks of treatment LH had reached postmenopausal levels, and testosterone and androstenedione were within the normal range. It is concluded that 4 weeks' treatment with 600 micrograms buserelin intranasally per day is sufficient to normalize the ovarian androgen production in polycystic ovarian syndrome prior to gonadotropin stimulation and to reduce the LH level avoiding premature luteinization or spontaneous LH surge.
Administration, Intranasal↗
Gonadotropin therapy of female infertility.
Anovulatory infertility in 134 women was treated with gonadotropins for a total of 318 cycles. The patients were classified into WHO group I, hypothalamic-pituitary failure (72 patients), and WHO group II, hypothalamic-pituitary dysfunction (62 patients). All patients in this group had failed to achieve pregnancy with clomiphene citrate therapy in repeated cycles. The pregnancy rate in group I was 72.2% vs 17.7% in group II. The 'take home' baby rate was 57.1% in group I vs 13.1% in group II. The rate of miscarriages was 14.3% without any significant difference between the groups. Multiple pregnancies occurred only in group I patients (19.2%). The conception rate was highest in the first four cycles, whereas no patient became pregnant after the sixth treatment cycle. Ovarian hyperstimulation syndrome occurred most frequently in group II patients, however, overall only 2.2% of the patients needed hospitalization because of hyperstimulation. Gonadotropin therapy must be considered an efficient and successful treatment of infertility in patients with hypothalamic-pituitary failure, whereas the success rate is rather poor in patients with hypothalamic-pituitary dysfunction.
Chorionic Gonadotropin↗