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Biomedical subjects

B Gocial

Publications and source records attributed to B Gocial.

34 records · Page 2Linked to original sources
PubMed1989

Outcome in 242 in vitro fertilization-embryo replacement or gamete intrafallopian transfer-induced pregnancies.

Two centers combined data on 152 in vitro fertilization embryo replacement and 90 gamete intrafallopian transfer generated pregnancies. The outcomes of the pregnancies with respect to abortion, ectopic gestation, and multiple gestation were evaluated independently by method and by center. Only with multiple gestation by center was a difference seen. Variables examined included estradiol levels, luteal phase support, maternal age, and prior reproductive history, and the number of eggs or embryos replaced.

Abortion, Spontaneous↗
PubMed1989

Intrauterine insemination and ovulation stimulation as treatment of infertility.

Fecundity rates were measured for 302 patient-couples in 991 cycles of intrauterine insemination (IUI) between January 1984 and December 1986 in terms of the diagnoses and whether human menopausal gonadotropin (hMG) was also employed. Those rates were compared with the fecundity rates in 255 of the couples followed in 2,668 untreated cycles. IUI was most beneficial for cervical factor infertility, with a monthly yield of 0.11 in conjunction with hMG and for poor postcoital tests in general but was less impressive when seminal parameters were abnormal. The addition of hMG when ovulation was normal (as an independent variable) did not yield results statistically superior to those of IUI alone (fecundity = 0.06 versus 0.03), but the addition of hMG to the regimen gave an improvement over IUI alone when endometriosis had been diagnosed and in the presence of cervical factor infertility. One serious side effect of therapy was a pelvic abscess, which required hospitalization but not surgery.

Adult↗
PubMed1989

Measurement of the force necessary for laparoscopic trocar entry.

A study was designed to measure the force necessary for trocar insertion before laparoscopy. A strain gauge was used to measure the force used with a reusable, pyramid-tipped trocar system sharpened at regular intervals and a disposable trocar system also with a pyramidal point and of equal diameter (10 mm). Variables studied for both groups, 50 patients each, included the type of incision made at the umbilicus; the opening and closing laparoscopic gas source pressure; the volume of gas delivered to create the pneumoperitoneum; the age, weight and height of the patient; and whether the laparoscopy was the first or a repeat. The variables were matched for both groups. The disposable device required half the force for entry required with the reusable device. Since many gynecologists are now women and thus may have less upper body strength than men do, this finding could be important for them. Further, the disposable trocar affords an operator of any size and strength greater control over the potentially dangerous trocar insertion into the abdomen since less force is required.

Disposable Equipment↗
PubMed1988

Correlations between results of the immunobead test and the sperm penetration assay.

Immunobead testing (IBT) and human sperm-hamster egg penetration assay (SPA) were performed in 233 infertile men. Positive immunologic results were recorded in 31 (13.3%). Significant reduction in SPA scores was found in patients with IgG antisperm antibodies alone but not in patients with IgA alone or in combination with IgG. Normal SPA scores were seen in 56% of immunonegative patients (n = 113) vs. 32% of immunopositive patients (n = 10). Therefore, a normal SPA does not rule out the presence of significant levels of antisperm antibodies.

Animals↗
PubMed1988

Urinary follicle stimulating hormone treatment for luteal phase defect.

A deficiency in follicle stimulating hormone (FSH) levels during the early follicular phase of the menstrual cycle has been shown to result in luteal phase defect (LPD). A short course of human urinary FSH (uFSH) (Metrodin, Serono Laboratories) was given for a maximum of six cycles to 18 women with endometrial-biopsy-proven (EBX-proven) LPD. Adjunctive therapy in the form of midcycle human chorionic gonadotropin was given after the third therapy cycle. The uFSH therapy reduced the mean EBX lag time (2.0 +/- 0.6 days with therapy vs. 4.1 +/- 0.4 pretherapy, P less than .01), normalized the follicular phase length (15 +/- 0.4 days vs. 17.2 +/- 0.8 pretherapy, P less than .25) and increased the luteal phase length (12.7 +/- 0.4 days vs. 10.8 +/- 0.2 pretherapy, P less than .001). Twelve of 46 cycles (26%) in which uFSH was given without adjunctive therapy were anovulatory. Seven patients conceived; the result was seven viable pregnancies, all delivered at term. The cumulative pregnancy rate approached 48% by the sixth therapy cycle. uFSH therapy is useful for the correction of LPD and yields an acceptable pregnancy rate.

Adult↗
PubMed1986

Antibodies to phospholipids and nuclear antigens in patients with repeated abortions.

The frequency of positive tests for antibodies to nuclear antigens (antinuclear, deoxyribonucleic acid, Ro, La, Smith, and ribonucleoprotein) or to phospholipids was investigated in 82 patients with isolated repeated abortions. Patients with a positive antibody test (positive or negative deoxyribonucleic acid antibodies) appeared to be a separate subgroup of those with unexplained repeated abortions from those with antibodies to cardiolipin. A total of 13.1% of the 61 patients with unexplained repeated abortions had elevated levels of IgM and/or IgG anticardiolipin antibody, while none were found in patients with explained abortions (p less than 0.1). Enzyme-linked immunosorbent assays for antibodies binding to other phospholipids suggested that sera from patients with repeated abortions who had the lupus anticoagulant contained antibodies that were most often of the IgG class with affinity for negatively charged phospholipids. Binding of IgG but not IgM antibodies to cardiolipin correlated closely with that to other negatively charged phospholipids. The use of clotting tests for the lupus anticoagulant to screen patients with repeated abortions for associated autoantibodies is likely to significantly underestimate the extent of this clinical problem.

Abortion, Habitual↗
PubMed1984

Peritoneal fluid and serum steroids in infertility patients.

Peritoneal fluid and serum were collected from 78 patients at the time of laparoscopy. Twenty-two were fertile controls (CTL), and 56 were infertility patients, who were subdivided into three main groups: endometriosis (EMS), pelvic adhesions (ADH), and ovarian dysfunction (OvDF). Based on control group data, biochemical criteria indicative of the presence of a stigma, S(+), were established: (1) serum progesterone (P) greater than or equal to 2 ng/ml, (2) peritoneal fluid P greater than or equal to 50 ng/ml, and (3) peritoneal fluid/serum ratio of P greater than or equal to 3. Direct visualization by laparoscopy showed that 21% CTL, 75% EMS, 69% ADH, and 56% OvDF subjects had luteinized unruptured follicle (LUF) syndrome. Biochemical criteria, however, demonstrated only 7% CTL, 37% EMS, 23% ADH, and 56% OvDF subjects had LUF. Peritoneal fluid estradiol (E2) and P concentrations and total content were significantly lower in LUF than in non-LUF patients, whereas serum E2 and P concentrations were not different between the two groups. Values for testosterone and androstenedione in peritoneal fluid and serum were similar between these two groups. Endometrial dating in LUF versus non-LUF patients were also similar. The usual indicators of ovulation, i.e., serum P, endometrial dating, and basal body temperature, failed to identify LUF. The diagnosis of LUF can be best made by P assay of peritoneal fluid and serum.

Androgens↗
PubMedDate not supplied

Treatment of endometriosis with a Nd:YAG tissue-contact laser probe via laparoscopy.

The neodymium:yttrium-aluminum garnet (Nd:YAG) laser was used via laparoscopy in 84 patients complaining of infertility and/or pelvic pain. All patients in the study had biopsy-proven or visually confirmed pelvic endometriosis. The Nd:YAG laser was used in conjunction with sapphire probes as a touch technique on tissue. Problems usually encountered, such as mirror alignment, beam focus, and smoke plume, with carbon dioxide laser systems were avoided, and use of the laser in a liquid environment was possible. Restoration of fertility was seen in 39.7% with short follow-up; pain relief was excellent, especially in conjunction with uterosacral denervation.

Adult↗
PubMedDate not supplied

A pelvic scoring system for infertility surgery.

A pelvic scoring system for infertility surgery was devised in which pelvic pathology is assessed for comparative and prognostic purposes. Pelvic pathology was divided into three areas: adhesions (ADH), salpingitis (SPG), and tubal occlusion (TOC). The extent of pathology was scored as mild (1), moderate (2), severe (3), or extensive (4). The maximum scores for adhesions, salpingitis, and tubal occlusion were 48, 24, and 28, respectively--various weightings were applied and subareas accounted for. The pelvic score (PLV#) was simply the sum of the adhesions (ADH#), salpingitis (SPG#), and tubal occlusion (TOC#) scores. The stage of pelvic pathology was arbitrarily assigned as stage 0, I, II, III, and IV with PVL#'s of 0, 1-25, 26-50, 51-75, and 76-100, respectively. A close correlation (r = .960-.990) of PLV# was noted between different observers using this system. Poorer reproductive potential was observed in the patients with higher scores and stages. This scoring system properly reflects clinical experience and can be relied on for patient counseling via prediction of prognosis. This system can be utilized to compare objectively the results of infertility surgery between surgeons as well as among institutions.

Constriction, Pathologic↗
PubMedDate not supplied

Primary therapy for tubal disease: surgery versus IVF.

Infertility involves fallopian tube occlusion or other malfunction in over 25% of cases. Reconstructive surgery offers the possibility of natural conception, but the success rate overall is less than 30% and if the hydrosalpinx is severe or other factors are involved, much lower than that. IVF-ET currently offers a much higher success rate. Although the cost of IVF per cycle is over three-fourths the total cost of tubal surgery, the eventual success rate of IVF is so much better than that of surgery that the costs per baby delivered are some 10% lower. In addition, more infertile couples are rewarded in their quest to have a child.

Embryo Transfer↗
PubMedDate not supplied

A double-blind comparison of nafarelin and leuprolide acetate for down-regulation in IVF cycles.

OBJECTIVE: To compare nafarelin (NAF) with leuprolide acetate (LA) for pituitary down-regulation in IVF cycles. MATERIALS AND METHODS: Patients in a private IVF program who received both nasal spray and subcutaneous injections starting in the luteal phase prior to intended stimulation with any one route containing active drug in a randomized, prospective, double-blind study. Variables measured included the usual hormonal values as well as oocyte data, but not pregnancy rates, because of sample size and the heterogeneity of the study group. RESULTS: There were no differences between the two groups in the areas studied. CONCLUSION: Either NAF or LA can be used satisfactorily as an agent for pituitary down-regulation in IVF cycles.

Adult↗