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Biomedical subjects

B Fisch

Publications and source records attributed to B Fisch.

At least 55 records · Page 3Linked to original sources
PubMed1996

The impact of GnRH agonist and menotropin therapy on lipoprotein metabolism.

Two groups of women, 48 undergoing controlled ovarian hyperstimulation for in vitro fertilization (IVF) treatment with a gonadotropin-releasing hormone (GnRH) analog and human menopausal gonadotropin daily and a group of 15 treated with a GnRH analog using the 'luteal phase protocol' before the hyperstimulation for IVF, took part in a prospective randomized study at the IVF Unit of the Beilinson Medical Center, Israel. The aim was to evaluate the changes in lipid metabolism occurring in the course of a standard controlled ovarian hyperstimulation protocol during IVF treatment cycles by measuring serum lipid levels before and after treatment. In the former group, in parallel with the 17 beta-estradiol increase, the cholesterol and low-density lipoprotein-cholesterol levels dropped and the high-density lipoprotein-cholesterol levels increased significantly. The resultant atherogenic index demonstrated a statistically significant decrease. In the latter group the mean lipoprotein levels were slightly different after treatment, but no statistically significant difference was observed. Our results indicate that the GnRH analog alone, administered for 10-12 days, does not induce any significant change in serum lipid levels. When using a combination of a GnRH analog and menotropins, the change of lipoprotein levels is favorable.

Adult↗
PubMed1996

Intranasal nafarelin versus buserelin (short protocol) for controlled ovarian hyperstimulation before in vitro fertilization: a prospective clinical trial.

The aim of this study was to compare the effect of nafarelin acetate with that of buserelin acetate nasal spray, when administered in a 'short' protocol, as an adjunct to human menopausal gonadotropin (hMG) for controlled ovarian hyperstimulation before in vitro fertilization (IVF). Twenty-two IVF subjects were randomly recruited. Each underwent two consecutive treatment cycles; one with buserelin (900 micrograms/day) and another with nafarelin (400 micrograms/day). The treatment protocol included transnasal gonadotropin-releasing hormone (GnRH) analog from the second cycle day and hMG from the fourth day of the cycle. The buserelin and nafarelin cycles did not differ significantly in the following parameters: baseline hormone profile, duration of GnRH analog treatment, mean hMG dose required, peak estradiol levels, number of preovulatory follicles, number of aspirated oocytes, fertilization rate and number of transferred or frozen embryos. No side-effects or cancellations of treatment were recorded. The average dose required was lower for nafarelin and, because this analog was given only twice a day, it was more convenient to administer. These findings suggest that nafarelin is as effective as buserelin (when administered in a "short' protocol) in achieving controlled ovarian hyperstimulation. It even offers advantages over buserelin with respect to the total dose required (which probably reflects its relatively high potency) and the subjects' compliance.

Administration, Intranasal↗
PubMed1996

Augmentation of low ovarian response to superovulation before in vitro fertilization following priming with contraceptive pills.

Poor ovarian response to superovulation treatment is observed in a certain group of patients, the so-called 'low responders'. Despite the evolution of sophisticated controlled ovarian hyperstimulation (COH) regimens prior to the in vitro fertilization (IVF), the ideal stimulation protocol for the low responder has yet to be formulated. The objective of this study was to assess the effect of oral contraceptive pills (OCP), administered before the initiation of superovulation, on ovarian response and IVF treatment results in patients with previous 'low response' to exogenous gonadotropin stimulation. The study group comprised 42 patients who had exhibited poor ovarian response to standard superovulation protocols in at least two previous consecutive treatment attempts. Contraceptive pills were administered for 28-42 days and were immediately followed by menotropin treatment. The study group (n=50 cycles) was compared with the control group consisting of previous cycles (n=88) of the same women. Significant differences were noted in peak estradiol levels (983 +/- 739 vs. 517 +/- 249 pg/ml; P <0.01, paired Student's t test) and number of pre-ovulatory follicles between the study and the control groups. Thirty-three of the cycles (66%) reached the stage of ovum pick-up, compared with 22 (25%) of the previous IVF cycles in these women. The mean number of oocytes retrieved was 6.1 +/- 3.0 and 2.4 +/- 1.3 in the study and control groups, respectively (P <0.01; paired Student's t test). Embryo transfer (ET) was performed in 62% of the treatment cycles and resulted in five clinical pregnancies (16.1% per ET). No pregnancies were recorded in the control group. This study demonstrates the beneficial effect of OCP given prior to IVF treatment, and provides an efficient treatment modality for women who consistently respond poorly to standard COH protocols.

Adult↗
PubMed1996

The management of dermoid cysts--a comparative study of laparoscopy and laparotomy.

The aim of our study was to compare laparoscopy with laparotomy for the removal of ovarian dermoid cysts. Thirty-eight women with benign ovarian dermoid cyst were allocated for either laparoscopy (18 patients) or laparotomy (20 patients). The two groups were compared for operative and hospitalization times and postoperative course. Operating time was longer (93.6 +/- 23.8 min) and hospitalization time significantly shorter (22.4 +/- 6.6 h) in the laparoscopy group. No complications were reported in either group. We conclude that operative laparoscopy is a safe procedure for the removal of dermoid ovarian cysts and is as effective as laparotomy.

Adolescent↗
PubMed1995

Superovulation before IVF by recombinant versus urinary human FSH (combined with a long GnRH analog protocol): a comparative study.

PURPOSE: Gonal-F (Serono, Aubonne, Switzerland) is a recombinant human follicle stimulating hormone (FSH) synthesized in vitro by cells into which genes encoding for FSH subunits have been inserted. This preparation exhibits physiochemical, immunological, and pharmacological properties that bear great similarity to those of native human FSH. It has a high specific activity and can be administered subcutaneously. To compare the efficacy and safety of Gonal-F with those of urinary human FSH (Metrodin; Serono) in achieving superovulation for IVF purposes in a prospective, randomized study. METHODS: Twenty infertile patients (normo-ovulatory healthy women) were recruited for the study and allocated at random to the Gonal-F or Metrodin groups. The treatment protocol consisted of pituitary down regulation by GnRH analog (Buserelin; Hoechst, Frankfurt, Germany) employing the "long" protocol initiated at the mid-luteal phase (900 micrograms/day, intranasal administration). Gonal-F (SC) or Metrodin (IM) was injected daily (225 IU/day) starting on cycle day 3. Dose adjustment was performed, when necessary, from cycle day 7. RESULTS: Of the 20 cycles analyzed, none was canceled due to poor response. No cases of adverse effects (including local intolerance) or ovarian hyperstimulation syndrome were recorded in either group. They did not differ significantly in the following treatment-dependent variables: hormone profile, duration of FSH treatment, total FSH dose required to achieve follicular maturation, and the number of oocytes retrieved, fertilized, and replaced. CONCLUSIONS: These preliminary data concur with previous studies in demonstrating that Gonal-F is as effective and safe as Metrodin (when given in combination with a "long" protocol of GnRH analog) in inducing controlled ovarian hyperstimulation for IVF purposes. Its mode of administration (SC instead of IM) offers an additional advantage over the urinary human FSH.

Adolescent↗
PubMed1995

Membranous dysmenorrhea: the forgotten entity.

BACKGROUND: Membranous dysmenorrhea involves the spontaneous slough of the endometrium in one cylindrical or membranous piece that retains the shape of the uterine cavity. Because this entity is rarely mentioned in the medical literature, the purpose of this report is to describe two such cases. CASES: An 18-year-old nullipara with regular menstrual cycles presented with membranous dysmenorrhea after taking the contraceptive Gynera (Gestodene 0.075 mg, ethinyl estradiol 0.030 mg). Symptoms disappeared when the medication was discontinued. The second patient, a 26-year-old woman, gravida 1, para 1, was on a 10-day monthly regimen of Provera (medroxyprogesterone acetate) 2.5 mg/day for dysfunctional uterine bleeding. When the Provera dose was increased to 10 mg/day, the symptoms disappeared. CONCLUSION: Membranous dysmenorrhea is "a disease of theories" with various recommended medications. When this condition is caused by iatrogenic treatment, the best approach is to discontinue the offending drug or change its dosage.

Adolescent↗
PubMed1995

Assisted hatching by partial zona dissection of human pre-embryos in patients with recurrent implantation failure after in vitro fertilization.

OBJECTIVE: To examine the potential of the partial zona dissection technique to promote successful implantation by assisting embryo hatching after IVF. DESIGN: The study and the control group included 72 and 82 patients, respectively, each had undergone at least three failed IVF-ET attempts. Assisted hatching was performed on four- to six-cell stage embryos by creating a slit in the zona pellucida using the partial zona dissection technique. After 90 minutes incubation (5% CO2, 37 degrees C), the embryos were transferred to the uterus. SETTING: Infertility and IVF Unit of an academic tertiary referral medical center. RESULTS: In the assisted hatching group, 230 micromanipulated embryos were replaced (3 or 4 treated embryos per patient) compared with 295 nonmanipulated embryos in the control group. Clinical pregnancy rates (PRs) were similar in the assisted hatching and control groups (n = 15; 20.8% and n = 12; 14.6%, respectively). However, the contribution of assisted hatching by partial zona dissection to successful implantation was related to the patients's age: patients older than 38 years showed a markedly higher PR after assisted hatching: 23.9% in the study group compared with only 7% of the controls. CONCLUSIONS: These results demonstrate that assisted hatching by partial zona dissection is a quick and efficient method that does not induce any visible damage to the embryos replaced. In a selected group of patients (aged over 38 years, who have failed to conceive in at least three previous IVF attempts) it significantly increases the chances for pregnancy after ET.

Adult↗
PubMed1995

Detection of immunoglobulin A anticardiolipin antibodies in cervical mucus from in vitro fertilization patients and fertile women.

OBJECTIVE: To identify and quantify antiphospholipid autoantibodies of the immunoglobulin (Ig) A isotype in cervical mucus obtained from IVF patients and fertile controls. DESIGN: The study was performed prospectively. Blood and cervical mucus samples were obtained from patients undergoing IVF treatment (n = 27) at the time of expected E2 peak, before administering hCG. Control samples were taken from fertile women (n = 16) around the time of ovulation during a spontaneous nonstimulated menstrual cycle. Anticardiolipin activity was tested using ELISA. SETTING: Infertility and IVF unit of an academic tertiary referral medical center and university-based basic research laboratory. RESULTS: Forty-eight percent (13/27) of the IVF patients and 43.8% (7/16) of the fertile controls exhibited anticardiolipin IgA activity in aspirated cervical mucus. The mean activity measured for the positive cases was similar in both groups. This activity was higher than that measured in peripheral blood of the women studied. No difference was noted between infertile patients undergoing IVF treatment and fertile women in this respect. CONCLUSIONS: In this preliminary work, we demonstrated for the first time anticardiolipin IgA activity in human cervical mucus. These observations have to be substantiated by larger scaled studies to assess their possible clinical significance.

Adult↗
PubMed1995

Heterotopic abdominal pregnancy following in-vitro fertilization/embryo transfer presenting as massive lower gastrointestinal bleeding.

We present a case that, as far as we know, is the first report of lower gastrointestinal haemorrhage as a complication of heterotopic pregnancy induced by artificial reproductive technology. The heterotopic abdominal pregnancy caused erosion of the intestinal wall and massive rectal bleeding, 8 weeks after in-vitro fertilization/embryo transfer. The source of the bleeding could not be identified despite comprehensive investigation including gastroscopy, ultrasonography, sigmoidoscopy, 99Tc (technetium) scanning and angiography. Tagged-erythrocyte isotope scanning revealed an abnormal concentration in the left lower quadrant, compatible with active bleeding in the area of the terminal ileum. Laparotomy disclosed a heterotopic abdominal pregnancy, causing erosion of the intestinal wall at this site. As assisted reproductive technologies become more and more common this rare complication of intestinal erosion should be kept in mind in case of lower gastrointestinal bleeding.

Abdomen↗
PubMed1994

Human gamete fusion test: an experimental model for assessing the fusion potential of sperm from nonfertilizing normospermic patients.

OBJECTIVE: To develop an experimental model for assessing the ability of sperm to bind and subsequently fuse with the oolema and to use this test for evaluating the fusion potential of nonfertilizing human sperm. DESIGN: Aged human oocytes (n = 108) were denuded of their zonae and loaded with DNA-specific bisbenzamidazole fluorochrome. Sibling oocytes were inseminated by semen samples from either normospermic patients (study group; n = 12) who have repeatedly failed to achieve fertilization in vitro or patients demonstrating high fertilization rates (control; n = 12). Gamete fusion was ascertained by fluorescent microscopy and validated by scanning electron microscopy. Test results were analyzed in relation to current partial zona dissection treatment outcome. SETTING: Infertility and IVF Unit of an academic tertiary referral medical center and university-based basic research laboratory. RESULTS: In samples achieving fertilization by partial zona dissection (7/12; 9% to 23% fertilization rate), the mean numbers of fused spermatozoa were similar to those of the control (2.1 compared with 2.6) and significantly higher than in the partial zona dissection-failed fertilization subgroup. In six of seven cases in which partial zona dissection yielded embryos, fluorescent spermatozoa were detected on the oolema, whereas in all but one partial zona dissection-failed cases gamete fusion was not observed. CONCLUSIONS: The suggested human gamete fusion test may help focus on specific sperm dysfunction in nonfertilizing patients. It correlates well with the outcome of partial zona dissection-assisted IVF trials and may provide useful information before this treatment is attempted.

Cellular Senescence↗
PubMed1994

Poland anomaly after in vitro fertilization.

OBJECTIVES: To describe an extremely rare anomaly in an infant born after IVF-ET, and to assess its possible relationship to the artificial reproductive technology. DESIGN: Case report. SETTING: Infertility and IVF Unit, in a tertiary academic medical center. PATIENT: A 31-year-old healthy patient with a 9-year history of secondary, unexplained infertility. INTERVENTION: Standard IVF-ET treatment cycle, using GnRH-a (short protocol) and hMG for controlled ovarian hyperstimulation. RESULTS: Poland anomaly (asymmetric thorax with absence of the right pectoralis major muscle, low set rudimentary right nipple, and very mild hypoplasia of the right upper limb) is described for the first time in an infant who is one of a trizygotic triplet after IVF treatment. CONCLUSIONS: In view of the currently held hypothesis concerning the pathogenesis of Poland anomaly, the possibility of a teratogen or an event related to the reproductive procedure as the cause of this anomaly seems unlikely.

Adult↗
PubMed1994

Safety characteristics of the conically sculpted Nd:YAG laser fiber for operative laparoscopy.

The objective of this study was to define the effects and safety margins of available Nd:YAG laser fibers with flat and conically sculpted tips for operative laparoscopy. An in vitro agar base model was designed to define the effect of the conically sculpted fiber at distances of 5 and 10 mm beyond the fiber tip, and an in vivo rat model was used to assess similar effects in the contact mode, as well as at 1, 3, 5, and 10 mm beyond the tip. The beam divergence emitted through conically sculpted tips demonstrated significant reduction in power density at 3-5 mm beyond the tip, which is suggestive of minimal risk of undesired effects. Threshold energy levels required for thermal effects are lower for darker organs than for light-colored objects. The Nd:YAG laser cutting effect is satisfactory when the conically sculpted tips are in contact with soft tissue, and subjacent organs are relatively more protected when compared to the flat tips. The potential advantages of this tool over other laser and conventional accessories for operative laparoscopy has yet to be determined.

Animals↗
PubMed1994

A human monoclonal IgA autoantibody--185/12--behaves like an autoimmune antiphospholipid antibody.

A human monoclonal anticardiolipin autoantibody (ACA) of the IgA-k isotype, designated 185/12, is described. The antibody was prepared from peripheral B cells, obtained from a patient with a history of habitual abortion, by immortalization with Epstein-Barr virus (EBV). The antibody displays a strong binding activity to cardiolipin and phosphatidyl L-serine, but not to phosphatidylcholine, phosphatidylinositol, ssDNA and dsDNA. It binds to cardiolipin in a concentration-related and saturable manner (Kd = 3.0 x 10(-8) M). This reaction is dependent upon the presence of bovine serum, and is fully inhibited by cardiolipin vesicles. The 185/12 antibody exhibits different binding patterns to the solid-phase bound cardiolipin-serum complex and to its individual components (cardiolipin and bovine serum). The Bmax of 185/12 binding to the complex (0.968 OD units) is higher than the sum of the Bmax values calculated for each one of the complex components (0.352 + 0.179 = 0.531 OD units). Bovine serum as well as purified beta 2-glycoprotein I (beta 2-GPI) in suspension inhibit the binding of 185/12 to the complex. 185/12 binding capacity increases in direct relation to the rising concentration of beta 2-GPI. Collectively, these data may be interpreted to suggest that 185/12 antibody, which is an IgA isotype, exhibits characteristics usually attributed only to antiphospholipid autoantibodies (APA) of the IgG isotype, that are associated with the clinical spectrum of APA syndrome (APA-S). It is, therefore, possible that autoantibodies of the IgA isotype could play a pathogenic role, which may be different from that of the IgG isotype, in the development of autoimmune phenomena.

Abortion, Habitual↗
PubMed1994

Effects of oestrogen on progesterone synthesis and arachidonic acid metabolism in human luteal cells.

OBJECTIVE: Locally produced oestrogens and prostaglandins (PGs) are implicated in the regulation of luteal lifespan in the human ovary. This study (1) assesses direct effects of these factors on progesterone synthesis in isolated luteal cells, and (2) explores interactions between luteal age and treatment with gonadotrophin or oestrogen on the metabolism of arachidonic acid (prostaglandin precursor) by steroidogenic luteal cells in vitro. DESIGN: Primary monolayer cultures of human luteal cells obtained at different stages of the luteal phase were used to investigate the effect of oestradiol, catechol oestrogens (2- and 4-hydroxyoestradiol), diethylstilboestrol, PGE2 and PGF2 alpha on basal and human chorionic gonadotrophin (hCG) stimulated progesterone production in vitro. The role of PGs as modulators of luteal cell function was further investigated by studying the metabolic fate of radioactively labelled arachidonic acid in hormone treated (oestradiol and hCG) and control cultures, assessed by high performance liquid chromatography. PATIENTS: Corpora lutea were enucleated from nine women with regular ovulatory cycles undergoing microsurgical reversal of tubal sterilization. Granulosa cell aspirates were obtained from three patients undergoing in-vitro fertilization treatment. RESULTS: PGE2 and PGF2 alpha at various concentrations did not have a consistent effect, whereas oestradiol, diethylstilboestrol (and 2-hydroxyoestradiol in early luteal cell cultures) significantly inhibited basal and hCG stimulated progesterone biosynthesis. Evidence for direct inhibition of 3 beta-hydroxysteroid dehydrogenase enzymic activity by oestradiol was obtained. Both major metabolic pathways of arachidonic acid (lipoxygenase and cyclo-oxygenase) were operative in steroidogenic luteal cells recovered throughout the luteal phase. The ratio of PGE2 to PGF2 alpha synthesis in vitro by human luteal cells from endogenously incorporated arachidonic acid did not change significantly with corpus luteum age, with PGE2 tending to predominate. Oestradiol treatment shifted arachidonic acid metabolism from the lipoxygenase towards the cyclooxygenase pathway in cells isolated from ageing corpora lutea. CONCLUSIONS: Oestradiol, at relatively high concentrations, is a potent inhibitor of basal and hCG induced luteal cell steroidogenesis in vitro. No support is provided for the concept that luteolysis is mediated by local production of PGF2 alpha. The putative luteolytic effect of oestradiol may entail reduced metabolism of arachidonic acid to lipoxygenase derived products by luteal cells rather than direct stimulation of prostaglandin production by itself.

Arachidonic Acids↗
PubMed1993

Cryopreservation of rat blastocysts: a comparative study of different cryoprotectants and freezing/thawing methods.

Cryopreservation has proved to be a highly successful method for long-term storage of viable embryos. The objective of this study on rat blastocysts was to define conditions for their cryopreservation. Three cryoprotectants, dimethyl sulfoxide, glycerol, and propanediol/sucrose, were compared in two cooling programs (to -30 or -80 degrees C) and two thawing protocols. The cooling was followed by immersion in liquid nitrogen. Programmed thawing was at the rate of 8 degrees C per minute; fast thawing consisted of direct exposure of the frozen embryos to the ambient laboratory temperature. The survival after the freeze/thaw was assessed from the post-thaw embryo morphology and ability to develop into apparently normal offspring in uteri of foster mothers (embryonic survival). The best method for preservation of rat blastocysts proved to be programmed cooling to -80 degrees C followed by fast thawing with glycerol as cryoprotectant (embryonic survival of 28.1%). In all the experimental groups, the proportion of embryos with good to excellent preservation of morphology was high. With dimethyl sulfoxide, after programmed cooling to -80 degrees C, embryonic survival was 9.9% (programmed thawing) and 17.5% (fast thawing). No embryos survived after programmed cooling to -30 degrees C. However, when the cryoprotectant was propanediol/sucrose, no difference was observed between programmed cooling to -80 degrees C with either method of thawing and programmed cooling to -30 degrees C and fast thawing (12.3, 6.2, and 8.0%, respectively).

Animals↗