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Amin A Milki

Publications and source records attributed to Amin A Milki.

At least 19 recordsLinked to original sources
PubMed2006

Effect of reduced oxygen concentrations on the outcome of in vitro fertilization.

We compared the effects of two standard oxygen concentrations, physiological (5% O(2), 5% CO(2), and 90% N(2)) and atmospheric (5% CO(2) with the balance as air), on fertilization, embryo development, and pregnancy rate in 106 patients undergoing IVF, excluding donor oocyte cycles and preimplantation genetic diagnosis cycles. The differences in oxygen concentration did not significantly affect fertilization rate, blastocyst formation, or pregnancy rate, but there was a significant difference in mean embryo score between physiological and atmospheric groups on day 3.

Adult↗
PubMed2005

Subclavian vein thrombosis following IVF and ovarian hyperstimulation: a case report.

Thromboembolic phenomena are a serious consequence of assisted reproductive technology. We present a case of upper extremity deep vein thrombosis (DVT) at 7 weeks gestation following ovarian hyperstimulation syndrome (OHSS) and IVF. Three weeks after recovering from OHSS, the patient presented with left neck pain and swelling. Ultrasound revealed a thrombus in the left jugular vein and left subclavian vein. Low molecular weight heparin (LMWH) was initiated with symptom resolution within 1 week. The patient remained on LWMH throughout her pregnancy and delivered at term. A literature review showed 97 published cases of thromboembolism following ovulation induction. A majority of these cases was associated with OHSS and pregnancy and the site of involvement was predominantly in the upper extremity and neck. Infertility physicians and obstetricians should be aware of this complication and keep in mind that it may occur weeks after resolution of OHSS symptoms.

Adult↗
PubMed2005

Monochorionic triplet gestation after in vitro fertilization using donor oocytes: case report and review.

OBJECTIVE: To report on a patient with a monochorionic triamnionic triplet pregnancy after IVF with donor oocytes. DESIGN: Case report. SETTING: Academic tertiary care hospital. PATIENT(S): A 42-year-old woman who underwent IVF with donor oocytes. INTERVENTION(S): After failed IVF attempts, the patient chose to undergo treatment with donor oocytes. Her 23-year-old oocyte donor underwent standard controlled ovarian hyperstimulation. Retrieved oocytes were fertilized in vitro, and two embryos were transferred at the blastocyst stage. MAIN OUTCOME MEASURE(S): Intrauterine pregnancy with single gestational sac and three fetal poles with cardiac activity. RESULT(S): After extensive counseling with perinatologists about pregnancy complications, the patient elected to terminate at 10 weeks of gestation. CONCLUSION(S): Several processes have been suggested to explain the increase in monozygotic twinning after IVF. These factors include advanced maternal age, superovulation, manipulation of the zona pellucida, and prolonged culture. It is possible that other factors may also play a role, especially in high-order monozygotic multiple pregnancies. All patients should be informed of the potential risk of a high-order multiple pregnancy after IVF, even when only one or two embryos are transferred.

Abortion, Induced↗
PubMed2005

The dilemma of endometriosis: is consensus possible with an enigma?

Many will agree that the use of laparoscopy to diagnose and potientially treat endometriosis in patients who suffer from infertility has been superseded by IVF and sometimes oocyte donation, especially in older patients. The findings of our study add another dimension to management of endometriosis in the setting of infertility and emphasize the importance of keeping laparoscopy in the infertility management equation.

Consensus↗
PubMed2005

Severe intrauterine growth restriction associated with the development of a submucosal leiomyoma during pregnancy: a case report.

BACKGROUND: Small, intramural leiomyomas are not generally considered a risk factor for poor reproductive outcomes. CASE: A patient with a 6-mm intramural leiomyoma and a normal uterine cavity by hysteroscopic evaluation who conceived after in vitro fertilization developed severe early-onset intrauterine growth restriction (IUGR), leading to pregnancy termination at 23.4 weeks' gestation. At 6 weeks postpartum, a 1.7-cm, intracavitary leiomyoma was detected on ultrasound evaluation and removed by hysteroscopic resection. The patient conceived in a subsequent in vitro fertilization cycle and gave birth to monozygotic twins with appropriate weights at 34 weeks of gestation. In the absence of other identifiable etiologies of the IUGR, it is plausible that the small, intramural leiomyoma enlarged and migrated into the cavity, causing abnormal placentation and leading to fetal growth restriction in the first pregnancy. CONCLUSION: Uterine cavity reevaluation is recommended in the investigation of IUGR before a woman attempts further pregnancies.

Abortion, Induced↗
PubMed2004

Monozygotic twin birth after the transfer of a cleavage stage embryo resulting from a single pronucleated oocyte.

PURPOSE: To present a case involving the transfer of a single pronucleated oocyte resulting in a monozygotic twin pregnancy. METHOD: A descriptive case report of a single patient. RESULTS: The patient conceived and was found to have a monochorionic diamnionic pregnancy which resulted in the birth of normal identical twin boys at 32 weeks of gestation. CONCLUSIONS: The case report addresses an issue that has not received proper attention in the literature. It illustrates that observing a single PN in an oocyte at fertilization check should not be an absolute deterrent to transferring the resulting embryo even in an older patient with a high FSH level. This report also suggests that single observations, especially at the assessment of fertilization, in the IVF laboratory are limited when evaluating embryo potential and normalcy.

Adult↗
PubMed2004

Rate of aneuploidy in miscarriages following in vitro fertilization and intracytoplasmic sperm injection.

OBJECTIVE: To evaluate the incidence of aneuploidy in miscarriages after IVF and intracytoplasmic sperm injection (ICSI) procedures. DESIGN: Retrospective study. SETTING: University IVF program. PATIENT(S): All IVF patients with missed abortions undergoing uterine curettage. INTERVENTION(S): Cytogenetic analysis of products of conception (POC). MAIN OUTCOME MEASURE(S): Incidence of aneuploidy in POC. RESULT(S): Thirty-two of 59 specimens (54%) reviewed were abnormal. The patients with ICSI were more likely to have aneuploidy identified in their POC than conventional IVF, 76% vs. 41%. The average ages in these groups were similar: 37.1 vs. 37.8 years. There was a trend toward decreased aneuploidy with day 5 compared to day 3 embryo transfers; 38% vs. 63%. CONCLUSION(S): We found a significantly higher aneuploidy rate in the abortuses of patients who conceived with ICSI. It is possible that this increased incidence is due to abnormalities in the sperm of patients with ICSI, but could also be partially related to the technique itself.

Abortion, Spontaneous↗
PubMed2004

Assisted hatching is associated with a higher ectopic pregnancy rate.

In a retrospective analysis of 623 clinical pregnancies conceived after IVF, a 5.4% ectopic pregnancy rate (14/258 clinical pregnancies) was found in cases where assisted hatching (AH) was performed compared to 2.2% (8/365) in the group without assisted hatching. In view of the widespread use of AH, it may be relevant to assess the effect of AH on the incidence of ectopic pregnancy in a large multicenter effort.

Female↗
PubMed2004

Elective single blastocyst transfer.

This report describes our initial experience with elective single blastocyst transfer in 19 patients who had a mean age of 36.3 +/- 2.4 years. The ongoing pregnancy rate, 53% after the fresh embryo transfer and 68% when thaw cycles are included, suggests that single blastocyst transfer has a place in this relatively older patient population.

Adult↗
PubMed2004

Successful pregnancies in the setting of exaggerated endometrial thickness.

OBJECTIVE: To report successful pregnancies in the setting of exaggerated endometrial thickness. DESIGN: Case report. SETTING: Two infertility practices. PATIENT(S): Two IVF patients. INTERVENTION(S): IVF and ET. MAIN OUTCOME MEASURE(S): Endometrial thickness on the days of hCG injection, oocyte retrieval, and ET. RESULT(S): Two successful twin pregnancies, each after the transfer of two embryos, in the setting of an endometrial thickness of 16 mm in one case and 20 mm in the other. CONCLUSION(S): This report illustrates the possibility for a successful outcome in the setting of an exaggerated endometrial thickness, including for the first time a value of 20 mm on the day of egg retrieval.

Adult↗
PubMed2004

The effect of a two-hour, room temperature incubation of human spermatozoa in TEST-yolk buffer on the rate of fertilization in vitro.

PURPOSE: To reassess the use of TEST-yolk buffer (TYB) in an in vitro fertilization (IVF) program by comparing fertilization rates achieved in a glucose-free cleavage medium by the standard IVF preparation of sperm versus a 2-h, room temperature incubation of sperm in TYB. METHODS: Oocytes collected for IVF were randomly split into two groups and inseminated with either TYB-treated sperm or IVF-prepared sperm. SETTING: Stanford Reproductive Endocrinology and Infertility Center. PATIENTS: Fifty couples undergoing IVF with at least 10 mature oocytes. MAIN OUTCOME MEASURES: Fertilization rates in vitro. RESULTS: Fertilization rates were significantly higher (p = 0.015) with TYB treatment. The average 2PN fertilization rate was 49.6% (188/379) for the IVF group and 57.4% (221/385) in the IVF with TYB group. CONCLUSIONS: A 2-h, room temperature incubation of sperm in TYB produces significantly higher 2PN fertilization rates as compared to standard IVF preparation of sperm in a current generation cleavage medium.

Culture Media↗
PubMed2003

Ectopic pregnancy rates with day 3 versus day 5 embryo transfer: a retrospective analysis.

BACKGROUND: Blastocyst transfer may theoretically decrease the incidence of ectopic pregnancy following IVF-ET in view of the decreased uterine contractility reported on day 5. The purpose of our study is to specifically compare the tubal pregnancy rates between day 3 and day 5 transfers. METHODS: A retrospective analysis of all clinical pregnancies conceived in our IVF program since 1998 was performed. The ectopic pregnancy rates were compared for day 3 and day 5 transfers. RESULTS: There were 623 clinical pregnancies resulting from day 3 transfers of which 22 were ectopic (3.5%). In day 5 transfers, there were 13 ectopic pregnancies out of 333 clinical pregnancies (3.9%). The difference between these rates is not statistically significant (P = 0.8). CONCLUSIONS: Our data suggests that the ectopic pregnancy rate is not reduced following blastocyst transfer compared to day 3 transfer. While there may be several benefits to extended culture in IVF, the decision to offer blastocyst transfer should be made independently from the issue of ectopic pregnancy risk.

Journal Article↗
PubMed2003

Incidence of monozygotic twinning with blastocyst transfer compared to cleavage-stage transfer.

OBJECTIVE: To evaluate the incidence of monozygotic twinning (MZT) in pregnancies conceived after blastocyst transfer compared to cleavage-stage transfer. DESIGN: Retrospective study. SETTING: University IVF program. PATIENT(S): All IVF patients with viable pregnancies conceived during a 4-year period. INTERVENTION(S): Blastocyst transfer or day 3 ET. MAIN OUTCOME MEASURE(S): Incidence of MZT assessed by transvaginal ultrasound. RESULT(S): There were 11 incidences of MZT in 197 viable pregnancies (5.6%) with blastocyst transfer compared to 7 of 357 viable pregnancies (2%) with day 3 ET. In 10 of 18 pregnancies, MZT was observed in the setting of a higher order multiple gestation (6 of 11 for blastocyst transfer and 4 of 7 for day 3 ET). In the day 3 ET group, assisted hatching or intracytoplasmic sperm injection (ICSI) did not increase MZT (4 of 213, 1.9%) compared to cycles without zona breaching (3 of 144, 2.1%). Similarly, in the blastocyst-transfer group, ICSI did not increase the incidence of MZT (4 of 74, 5.5% for ICSI and 7 of 123, 5.7% for non-ICSI IVF). CONCLUSION(S): Compared to day 3 ET, blastocyst transfer appears to significantly increase the incidence of gestations with MZT. This information should be taken into account when counseling patients about the pros and cons of extended culture.

Blastocyst↗
PubMed2003

Significance of one pronucleus before fertilization.

OBJECTIVE: To describe a case of primary infertility associated with oocytes having one pronucleus before fertilization on repeated IVF attempts. DESIGN: Case report. SETTING: A university-based assisted reproduction unit. PATIENT(S): A 30-year-old woman with primary infertility and oocytes containing one pronucleus before fertilization. INTERVENTION(S): Oocyte donation. MAIN OUTCOME MEASURE(S): Pregnancy. RESULT(S): Conceived triplets after transfer of three embryos using donor oocytes. CONCLUSION(S): This patient's infertility was likely associated with an oocyte abnormality, as evidenced by the premature formation of one pronucleus before fertilization. In the future, more studies on the appearance of a single pronucleus before fertilization will be needed to determine its overall significance on fertility.

Adult↗