PubMed Health⌕ Search

Biomedical subjects

A Golan

Publications and source records attributed to A Golan.

At least 73 records · Page 4Linked to original sources
PubMed1993

Reproductive outcome after laparoscopic local methotrexate injection for tubal pregnancy.

OBJECTIVE: To evaluate reproductive outcome after laparoscopic local methotrexate (MTX) injection for tubal pregnancy. DESIGN: Follow-up was performed after 77 women were treated with local MTX injection between January 1, 1987 and December 31, 1990. SETTING: Department of Obstetrics and Gynecology in a university medical center. MAIN OUTCOME MEASURES: Concise patient details about tubal patency in hysterosalpingography, pelvic findings at laparoscopy or laparotomy performed after the treatment, and the intrauterine and extrauterine pregnancy rates (PRs) are given. RESULTS: Intrauterine PR of 67% and extrauterine PR of 13% were achieved. CONCLUSION: Local MTX injection does not modify tubal or pelvic anatomy and does not impair subsequent reproductive performance.

Adult↗
PubMed1993

Overstimulated cycles under low-dose gonadotrophins in patients with polycystic ovary syndrome: characterization and management.

Among 30 patients with polycystic ovary syndrome, treated with low-dose gonadotrophins, 75 cycles were analysed in order to characterize overstimulated cycles that were at increased risk of developing ovarian hyperstimulation. Optimal response (one or two follicles > or = 14 mm diameter) was observed in 59 cycles (79%). The remaining 16 cycles (21%) exhibited an overstimulated response characterized either by growing more than two follicles or having an oestradiol level > 850 pg/ml (2 SD above the mean observed in optimal cycles). Six of the latter were handled prospectively when oestradiol levels were found to be too high according to the size of the leading follicle. This stage was termed as developing overstimulation and its identification was based on objective criteria obtained from the optimal group. Following the withholding of gonadotrophin, the follicles continued to grow; however, the final oestradiol level was lower compared with six other matched overstimulated cycles. Overall, 14 patients conceived (47%) of whom three (21%) had multiple pregnancies. Mild or moderate ovarian hyperstimulation syndrome occurred in three cases; all of which involved overstimulated cycles. Low-dose gonadotrophin treatment is associated with a substantial degree of overstimulated response. All cycles should be monitored carefully in order to recognize the overstimulated response, which deserves cautious management.

Dose-Response Relationship, Drug↗
PubMed1993

Pre-operative gonadotrophin-releasing hormone agonist treatment in surgery for uterine leiomyomata.

To determine whether pre-operative treatment with gonadotrophin-releasing hormone (GnRH) analogue may have a beneficial effect on surgery outcome, 53 patients with symptomatic fibroid uteri awaiting myomectomy or transabdominal hysterectomy (TAH), were randomly divided into a study group (n = 29) and a control group (n = 24). The study group of patients were treated by an i.m. injection of D-Trp6 LHRH microcapsules at 2 months and 1 month prior to surgery. The control group had no pre-operative treatment. Haemoglobin concentration and oestradiol, follicle-stimulating hormone and luteinizing hormone concentrations were measured at 2 months and 1 month prior to surgery, and at surgery. The duration of surgery was shorter in the study group (49 versus 70 min in the hysterectomy group) and intra-operative blood loss was less (208 versus 309 ml in the hysterectomies and 320 versus 476 ml in the myomectomies). Pre-operative treatment with GnRH-agonists which induces shrinkage of the uterus and fibroids is therefore efficient in shortening the duration of surgery, and diminishing the intra-operative blood loss in surgery for fibroid uteri. Such pre-operative treatment is therefore a useful addition to surgery in cases with symptomatic fibroid uteri.

Adult↗
PubMed1993

Human chorionic gonadotrophin is a better luteal support than progesterone in ultrashort gonadotrophin-releasing hormone agonist/menotrophin in-vitro fertilization cycles.

In an attempt to determine the best luteal support in in-vitro fertilization (IVF) cycles treated with gonadotrophin-releasing hormone agonist (GnRHa) and human menopausal gonadotrophin (HMG) by the ultrashort protocol, 60 patients were prospectively randomized for either i.m. progesterone or human chorionic gonadotrophin (HCG) luteal support. The two groups did not differ in the mean number of oocytes retrieved and embryos replaced, nor in the mean age of the patients and the amount of HMG used. HCG maintained higher levels of oestradiol and progesterone during the luteal phase. Conception rate was significantly higher in the HCG group. We conclude that HCG is superior to i.m. progesterone as luteal support in IVF cycles in which GnRHa is used in the ultrashort protocol.

Adult↗
PubMed1993

Hydramnios in singleton pregnancy: sonographic prevalence and etiology.

One hundred and forty-nine cases of hydramnios were detected among 13,750 parturients undergoing 25,000 routine ultrasonographic examinations. The prevalence of hydramnios was 1.08%. Ninety-seven patients (65.1%) had no apparent cause for the increased amount of fluid volume. Twenty-eight newborns (18.8%) were congenitally malformed, and 22 (14.8%) patients had diabetes mellitus. Rh incompatibility accounted for only 1.3% of the cases. It seems that with the improvement of modern obstetrics, mainly improving the antenatal management of diabetes and Rh incompatibility, there is a decrease in the relative incidence of these two conditions as etiological factors of hydramnios.

Congenital Abnormalities↗
PubMed1992

Fetal malformations associated with chronic polyhydramnios in singleton pregnancies.

Forty-one congenital malformations were found in 28 newborns in a group of 197 cases of chronic polyhydramnios in singleton pregnancies. Of these, a total of 61% (17/28) was antenatally diagnosed ultrasonically. Nine newborns (4.5%) had malformations of the central nervous system (CNS), 9 (4.5%) cardiovascular malformations, 8 (4.1%) musculoskeletal anomalies, 7 (3.6%) malformations of the urinary and reproductive system, 4 (2%) respiratory system anomalies and 3 (1.6%) anomalies of the gastrointestinal system. Chromosomal abnormalities were found in three cases. As the association of polyhydramnios with fetal congenital anomalies is quite high (14.2% in our series), it is imperative to make a major effort to antenatally detect as many cases as possible. This means that in the case of hydramnios the following are required: ultrasound examination by an expert, echo ultrasonography when no other abnormalities are detected, and maybe even a chromosomal analysis.

Brain↗
PubMed1992

Indomethacin and amniocentesis-induced changes in fetal flow velocity waveforms.

The effect of genetic amniocentesis on flow velocity waveforms in the fetal aorta and the umbilical artery, and fetal heart rate and their correlation with uterine contractions was examined in 75 pregnant women who underwent this procedure. Forty-three were untreated and 32 were pretreated with indomethacin. Median maternal age was 36 years and median gestational age was 18 weeks. The resistance index of waveforms from the fetal aorta was stable at 0.8 throughout the approximately 20-h study period in both groups, but the systolic/diastolic ratio in the umbilical artery increased significantly after amniocentesis in the untreated group, and remained stable in the treated group. Fetal heart rate remained at about 150 beats/min throughout all measurements in both groups. These findings indicate that genetic amniocentesis causes an increase in downstream resistance in the umbilical artery which, however, remains within normal limits. This mild fetoplacental response to amniocentesis can be suppressed by the administration of a potent prostaglandin inhibitor like indomethacin.

Journal Article↗
PubMed1992

Methotrexate local injection for unruptured tubal pregnancy: an alternative to laparotomy?

Fifty-nine women with early unruptured tubal pregnancy were treated by a single local injection of methotrexate at laparoscopy. All 59 patients underwent the procedure without any adverse reaction, 47 (80%) of them needing no laparotomy. Twelve patients required a laparotomy for reasons such as rising beta-hCG levels and abdominal pain with or without rising levels of beta-hCG. Only one patient ruptured the tube. None of the women needed a blood transfusion. We found tubal patency in 19 out of 21 patients at follow up hysterosalpingography. Eleven pregnancies were subsequently reported, one of them tubal. The appearance of the injected tube was absolutely normal in three patients, one at cesarean section and two at repeated laparoscopy. No peritubal adhesions were observed. We suggest that this new technique is a safe and effective alternative to laparotomy in a patient with an early unruptured tubal pregnancy.

Adult↗
PubMed1992

Increased fertilization and pregnancy rate in polypronuclear fertilization cycles in in vitro fertilization-embryo transfer.

OBJECTIVE: To compare fertilization and pregnancy rates between cycles with polypronuclear fertilizations and cycles with normal fertilizations. DESIGN: In vitro fertilization-embryo transfer (IVF-ET) cycles in which oocytes were retrieved were divided into two groups according to the nature of fertilization. PATIENTS: All patients were participants of our IVF-ET program. RESULTS: A significantly higher fertilization rate was found in the polypronuclear fertilization cycles (61% versus 36.6%) and also an improved pregnancy rate (47.5% versus 19.6%) and per embryo transfers (53% versus 28.8%). The vast majority of polypronuclear fertilizations occurred in mature oocytes. CONCLUSION: We believe that the increased receptability of the oocytes improves fertilization and conception rates. The polypronuclear fertilization is an extreme expression of such improved receptibility and should be considered as an encouraging sign for conception.

Embryo Transfer↗
PubMed1992

Hysteroscopic findings after missed abortion.

OBJECTIVE: To identify the relation of missed abortions and intrauterine pathology. DESIGN: A postabortal hysteroscopy was performed 8 to 12 weeks after a dilatation and curettage (D&C) for missed abortion. SETTING: Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel. PATIENTS: Sixty patients after a D&C for a missed abortion. MAIN OUTCOME MEASURES: The hysteroscopic appearance of the uterine cavity. RESULTS: Intrauterine adhesions occurred in only 10 patients (16.7%) with most of them of the mild type. A previous missed abortion was recorded in 60% of these cases. Uterine anomaly was found in one quarter of the cases, mainly an incomplete uterine septum. CONCLUSION: We believe that missed abortion does not predispose for intrauterine adhesions to the extent that was previously believed. A partial uterine septum is a major factor predisposing for the occurrence of missed abortion. Hysteroscopy after a missed abortion is an easy and efficient means for both identifying such uterine anomaly and excluding intrauterine adhesions.

Abortion, Missed↗
PubMed1992

Prediction of in vitro fertilization outcome by sperm penetration assay with TEST-yolk buffer preincubation.

OBJECTIVE: To evaluate sperm penetration assay (SPA) value as a screening tool before in vitro fertilization (IVF). DESIGN: Follow-up study comparing sperm variables and IVF outcome. SETTING: Infertile couples in an academic research environment. PATIENTS, PARTICIPANTS: Two hundred forty-one infertile couples scheduled for IVF. INTERVENTIONS: Sperm penetrating assay with cold Tes-TRIS (TEST) Yolk buffer semen preincubation and IVF. MAIN OUTCOME MEASURES: Percent of egg penetration recoded into poor and good category (0% to 20%, 21% to 100%) and compared with fertilization, embryo transfer, and pregnancy rate (PR) in IVF, as well as sperm count motility and morphology. RESULTS: Sperm penetrating assay predicted fertilization with a high negative (74%) and positive (82%) predictive rate and good specificity value (0.96). One of 31 patients in the poor SPA category (3%) fertilized less than 50% of eggs; no pregnancy occurred. In the good SPA category, 87 of 210 patients (41%) fertilized greater than or equal to 50% of eggs with 34.3% PR. Sperm penetrating assay correlated better with fertilization rate than did sperm count and motility but not morphology. CONCLUSIONS: Sperm penetrating assay is a useful screening assay before IVF together with sperm morphology.

Adult↗
PubMed1992

Ultrashort gonadotropin-releasing hormone agonist (GnRH-a) protocol in comparison with the long-acting GnRH-a protocol and menotropin alone.

OBJECTIVE: To compare the in vitro fertilization and embryo transfer (IVF-ET) outcome of a 3-day gonadotropin-releasing hormone agonist (GnRH-a) administration: ultrashort protocol with the outcome of long-acting GnRH-a cycles or human menopausal gonadotropin (hMG) alone. DESIGN: Ninety-two cycles of the ultrashort protocol were matched with 92 cycles with long GnRH-a and with 92 hMG cycles. SETTING: The IVF-ET program. MAIN OUTCOME MEASURES: Amount and duration of hMG treatment, hormonal profile on the day of human chorionic gonadotropin administration, cancellation rate, number of oocytes retrieved, and fertilization and pregnancy rates (PRs) were examined and compared among the three groups. RESULTS: The ultrashort group needed a higher number of hMG ampules than the hMG group but significantly less than in the long GnRH-a regimen. The number of oocytes in the ultrashort protocol was the same as in the long GnRH-a, but the number of embryos per retrieval was significantly lower than with the long GnRH-a protocol and similar to that found in the hMG group. The ultrashort protocol yielded 10% PR per cycle and 17% per replacement, significantly lower than with the long GnRH-a protocol, 26% and 36%, respectively, but also lower than in the hMG one, namely 13% and 28%. CONCLUSION: The ultrashort protocol, although being convenient and having some advantages found in the long GnRH-a protocol, is inferior in its outcome compared with the two other protocols.

Chorionic Gonadotropin↗
PubMed1992

Diagnostic hysteroscopy: its value in an in-vitro fertilization/embryo transfer unit.

A total of 324 patients participating in our in-vitro fertilization/embryo transfer (IVF) programme underwent a diagnostic hysteroscopy. Of these, 152 women were referred before their first IVF attempt, because of some hysterosalpingographic suspicion of an intra-uterine abnormality; the other 172 patients had failed to conceive after IVF and transfer of good quality embryos. An intra-uterine pathology (mainly intra-uterine adhesions) was diagnosed in 50% of the patients in each group. Hysterosalpingography, although very sensitive, had low specificity (23%), a false positive rate of 44% and false negative rate of 10%. The main risk factor for intra-uterine pathology was a previous abortion. Conception rates were 22% after surgical treatment and 38% after the diagnostic procedure. We think that hysteroscopy should be performed in every patient failing to conceive after replacement of good quality embryos. It is also recommended whenever a suspicious finding is revealed by hysterosalpingography, before IVF. Routine hysteroscopy before entering an IVF programme should be seriously considered.

Adult↗
PubMed1992

Impaired corpus luteum function and other undesired results of pregnancies associated with inadvertent administration of a long-acting agonist of gonadotrophin-releasing hormone.

Spontaneous pregnancies associated with inadvertent periconceptional administration of long-acting gonadotrophin releasing-hormone agonist (GnRHa), in in-vitro fertilization, occurred in 11 of 161 patients with non-tubal infertility. All these cases exhibited impaired function of the corpus luteum in terms of declining progesterone levels, despite rising levels of human chorionic gonadotrophin. The patients were categorized according to the timing of GnRHa administration: periovulatory (three cases), midluteal (five cases) and late luteal (three cases). Altogether, of the 11 pregnancies, seven ended with a normal livebirth, three with a preclinical gestation and one with a blighted ovum. It appears that spontaneous pregnancies associated with inadvertent administration of GnRHa are not rare. Awareness for early diagnosis and close hormonal monitoring are recommended for the assessment of corpus luteum function and adequate supplementation.

Adult↗
PubMed1992

Prerequisite work-up of the couple before in-vitro fertilization.

Prerequisite examinations, including immune status for rubella and hepatitis B antigens, cultures for Chlamydia trachomatis and mycoplasmas, Pap smear and hystersalpingogram were performed in 227 couples before their enrollment into an in-vitro fertilization (IVF) programme. The examinations were completed in 187 couples. Immune status for rubella had already been documented in 45% of the women: of the remainder, 11 patients were not immune (6%). A screening test for hepatitis B antigens had already been documented in only 10% of the patients; eight of the remaining women (5%) were carriers of hepatitis B antigen. C. trachomatis and Mycoplasma hominis were each isolated from 14% of the patients and Ureaplasma urealiticum from 16%. Pap smears had been previously performed in only 35% of the enrolled women. Six (5%) of the 122 newly referred cases had cervical intra-epithelial dysplasia. In 21 (11%) cases some pathology in the uterine cavity was demonstrated. One patient conceived after diagnostic hysteroscopy; another two patients conceived following lysis of adhesions and before IVF treatment. The results of this study show the importance of the preparatory examinations before the IVF and embryo transfer procedure, and raise the medical and medico-legal aspects of this prerequisite work-up.

Adult↗