Biomedical subjects
B Faratian
Publications and source records attributed to B Faratian.
Establishing pregnancies after follicular stimulation for IVF with clomiphene citrate and human menopausal gonadotrophin only.
Data are presented on establishing pregnancies by IVF during 1987 using only clomiphene citrate and human menopausal gonadotrophin for follicular stimulation. Of the 562 patients undergoing follicular stimulation, 80% reached oocyte recovery and 70% had at least one conceptus replaced. Patients having one or more (up to a maximum of four) conceptuses replaced demonstrated a significant increase in the establishment of pregnancies from one to two (14-29%: P = 0.035) and from two to three conceptuses (29-42%: P = 0.037). There was a significant decline in pregnancies when four conceptuses were replaced compared with three (P = 0.004). The data were also analysed according to the cause of infertility, specifically tubal, endometriosis, unexplained infertility and male factors only. After the replacement of conceptuses, the incidence of implantation and abortion was not significantly different. The incidence of pregnancy declined significantly after 35 years (26%) compared with women under 31 years (43%; P = 0.043). Of 129 women having three conceptuses replaced, in those greater than 35 years (63 patients) 23 (37%) became pregnant whereas in those less than 31 years (65 patients), 34 (52%; P = 0.05) became pregnant. Twenty-two per cent of stimulated cycles resulted in an endogenous LH surge and the incidence of patients having three conceptuses replaced in this group was lower than those in the HCG group (P = 0.007). Fertilization per oocyte was also significantly reduced (P less than 0.001) in patients with an LH surge. In total, 2824 oocytes were recovered and 57% fertilized with 54% of patients having three conceptuses replaced.(ABSTRACT TRUNCATED AT 250 WORDS)
The use of the GnRH analogue buserelin for IVF--does it improve fertility?
OBJECTIVE: To determine the effect of a short course of the GnRH analogue buserelin and human menopausal gonadotrophin (hMG), for ovarian stimulation in our IVF programme, on reproductive endocrinology and pregnancy rates compared with conventional clomiphene citrate and hMG treatment. DESIGN: Prospective randomized allocation to one of two ovulation stimulation regimens. SETTING: Fertility clinic. SUBJECTS: 373 infertile couples with various factors associated with their subfertility. All the women were less than 46 years of age and had normal menstrual cycles. INTERVENTION: The first group (n = 151) was given clomiphene citrate (CC) from days 2-6 of the menstrual cycle and hMG from day 5 onwards (CC/hMG). The second group (n = 222) was given buserelin from days 1-3 and hMG from day 2 (buserelin/hMG). MAIN OUTCOME MEASURES: Concentration of plasma luteinizing hormone (LH), oestradiol (E2) and progesterone, number of ovulatory follicles induced and the occurrence of pregnancy. RESULTS: Plasma LH, E2 and progesterone concentrations were reduced in the late follicular phase after buserelin/hMG compared with CC/hMG. Buserelin/hMG promoted the development of more follicles than CC/hMG. The overall pregnancy rate after buserelin/hMG was not significantly different from that following CC/hMG treatment. CONCLUSION: The chance of pregnancy is not improved by the short-term use of buserelin with hMG, provided adequate follicular phase management is maintained.
Evaluation of high vaginal insemination at oocyte recovery in patients undergoing in vitro fertilization.
The value of high vaginal insemination at the time of oocyte recovery for in vitro fertilization (IVF) has been assessed. A previous study reported a dramatic increase in the incidence of pregnancy in women after high vaginal insemination (53%) compared with those without insemination (23%). Of 306 patients undergoing IVF, 97 (32%) became pregnant and 20 (21%) miscarried. Those patients with tubal damage numbered 187. Sixty (33%) became pregnant and 10 (17%) miscarried. The data were assessed according to the numbers of conceptuses replaced, the age of the patient, and whether a spontaneous luteinzing hormone surge or human chorionic gonadotropin was a trigger for ovulation, each with a significant effect on the outcome of treatment. No significant effect of the use of high vaginal insemination was found.
Delivery of twins to a woman with surgically induced menopause after oocyte donation by the sister and cryopreservation of the conceptuses.
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Recovery of two human oocytes surrounded by a single zona pellucida.
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Endotoxins in culture medium for human in vitro fertilization.
Endotoxins were detected in a few batches of culture medium during the authors' human in vitro fertilization program. Two distinct levels of endotoxins were assayed: greater than 1 ng/ml and less than 1 ng/ml. The source of endotoxin was traced to culture media obtained from a reputable manufacturing company. The incidence of fertilization per patient was not significantly affected by the presence of endotoxins, but fertilization assessed on the overall number of oocytes was significantly reduced (53%) when endotoxin levels were greater than 1 ng/ml compared with an assay negative for endotoxins (66%) (P = 0.047). The percentage of oocytes cleaving after the observation of two pronuclei was not significantly different, but the degree of fragments observed in the conceptus was significantly more severe if the endotoxin level reached 1 ng/ml. In this investigation, the incidence of pregnancy was 8% when the endotoxin level was greater than 1 ng/ml, 30% if less than 1 ng/ml, and 32% if no endotoxins were detected. This study suggests that, although endotoxins may be present in the culture medium at a deleterious level of at least 1 ng/ml, fertilization and cleavage will be obtained, but there will be a significant increase in the incidence of conceptuses with cytoplasmic fragments; this may result in a reduction in the incidence of pregnancy.
General anesthesia for intrauterine placement of human conceptuses after in vitro fertilization.
General anesthesia has been used for the replacement of human conceptuses after in vitro fertilization (IVF). Two adjuvants, enflurane and halothane, have been compared. Halothane significantly reduced the incidence of implantation compared to enflurane. In 356 replacements, the incidence of implantation for enflurane and halothane was 34 and 17%, respectively (P = 0.005). Sixty-four percent of all replacements had three conceptuses; the incidence of implantation for enflurane and halothane in this group was 43 and 19%, respectively (P = 0.002). The incidence of multiple pregnancy was similar for both anesthetic agents (20%) and the demise of implantation sacs 5 weeks postovulation was 11% for enflurane and 12% for halothane.
Offering GIFT in an IVF unit.
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Intrauterine and ectopic pregnancy after in-vitro fertilisation.
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Presentation of information on in-vitro fertilisation.
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Premenstrual syndrome: weight, abdominal swelling, and perceived body image.
One hundred forty-eight menstrual cycles were studied in 52 women, and in each cycle various parameters were measured to determine an objective means of assessing the syndrome. Daily mood assessment, body weight, plasma 17 beta-estradiol levels, and plasma progesterone levels were measured. The abdominal dimensions were measured in the lateral and anteroposterior diameters at the level of the umbilicus and 10 cm below; at the same time the same dimensions were measured as perceived by the patient. Mood score showed a marked increase during the premenstrual phase of each cycle. The symptom of bloatedness was marked during the premenstrual phase of the cycle. Despite these highly elevated scores for bloatedness there was no increase in body weight or the measured body dimensions in any plane. However, the patient's perception of body size did increase, and the discrepancy between the perceived body size and the actual body size (perception error) was significant.
Levels of circulating immune complexes in patients with ovarian cancer.
Sera from patients with ovarian tumours were assayed for circulating immune complexes (CIC) by four well established assays based on the interaction of immune complexes with components of the complement system. There was no difference in control, pre- or post-operative or BCG-treated patients' sera. Levels were also unchanged in sera in antigen excess. In patients with ovarian tumours therefore the measurement of CIC would appear to be of little value as a screening test, as a guide to the extent of disease, prognosis or therapy. In a small pilot therapy-trial there was no difference in the survival rate between patients with stage III and IV ovarian cancer treated with cyclophosphamide plus BCG and those who received only cyclophosphamide. Treatment with BCG was associated with postoperative pyrexia and a prolonged hospital stay.
Effect on low implantation of the placenta on maternal blood pressure and placental function.
Low implantation of the placenta may protect against the development of pregnancy-induced hypertension (PIH) and is associated with improved values in tests of placental function. PIH occurred in six of 201 (3%) consecutive patients with placenta praevia managed at the City Hospital, Nottingham, from 1 April 1973 to 30 June 1981. None of the six patients developed associated proteinuria. Of the total number of 24,549 patients delivered in the same hospital for the years 1974-1978, 3744 (15%) developed PIH. Of the patients with placenta praevia, 52% had serum levels of human placental lactogen above the 95th centile and 25% had 24-h urinary oestriol levels above the 95th centile. The birthweight distribution was not different from that of the total live births at the City Hospital, Nottingham (based on 1975-1976 deliveries).