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Biomedical subjects

B Urman

Publications and source records attributed to B Urman.

At least 37 records · Page 2Linked to original sources
PubMed1998

Evaluation of uterine cavity by sonohysterography in women scheduled for intracytoplasmic sperm injection.

A prospective study was performed to determine the feasibility of evaluating the uterine cavity by sonohysterography (SHG) in women who were scheduled for intracytoplasmic sperm injection (ICSI) due to severe male factor infertility and who had not had a previous hysterosalpingography (HSG). Sonohysterography was performed in 80 women scheduled for ICSI. A subsequent hysteroscopy was undertaken in patients with intracavitary lesions. The outcome of ICSI for the women undergoing SHG was compared with that of 240 cycles performed (during the same time period) in patients who had a normal HSG before admission to the clinic. There were no complications attributable to the SHG procedure. Hysteroscopy correctly identified all lesions depicted by SHG. SHG and HSG groups were comparable with regard to female age and duration of infertility. Clinical pregnancy rates per transfer were 40.2% and 42.5% in the SHG and HSG groups, respectively. Abortion rates in the two groups were also similar (14.8 and 11.0%, respectively). In conclusion, sonohysterography appears to be a simple, inexpensive, and safe alternative to HSG for evaluation of the uterine cavity in women scheduled for ICSI.

Female↗
PubMed1998

Progression of excess embryos to the blastocyst stage predicts pregnancy and implantation rates after intracytoplasmic sperm injection.

Excess embryos from patients undergoing intracytoplasmic sperm injection and embryo transfer for male infertility were cultured to determine the rate and timing of their progression to the blastocyst stage. In 194 embryo transfer cycles, four embryos with the morphologically best grading were transferred and at least two embryos were cultured. The cycles were classified as: group 1: no excess embryos reached blastocyst stage, group 2: >50% of embryos reached blastocyst stage by days 4-5, group 3: <50% of embryos reached the blastocyst stage by days 4-5, group 4: >50% of the embryos reached blastocyst stage by days 6-7, group 5: <50% of the embryos reached blastocyst stage by days 6-7. All groups were similar regarding female age, duration of infertility, and parameters of ovarian stimulation. In group 1, clinical pregnancy and implantation rates were 14 and 11% respectively, and were similar to those of group 4. In group 2, clinical pregnancy and implantation rates were 75 and 33%. Multiple implantations occurred in 81% of group 2 or 3 cycles, compared to none in group 1 cycles. The results suggest that the development potential of the embryo is intrinsic, and that embryos which carry a high potential for development yield a high clinical pregnancy rate and multiple implantations.

Adult↗
PubMed1997

Follicle-stimulating hormone levels on cycle day 3 to predict ovarian response in women undergoing controlled ovarian hyperstimulation for in vitro fertilization using a flare-up protocol.

OBJECTIVE: To determine whether cycle day 3 serum FSH levels predict poor ovarian response and cycle cancellation in women undergoing controlled ovarian hyperstimulation (COH) for IVF. DESIGN: Prospective case series. SETTING: University hospital IVF program. PATIENT(S): The study includes outcomes of 637 initial cycles of IVF. INTERVENTION(S): Controlled ovarian hyperstimulation was undertaken with a short, flare-up GnRH agonist and hMG protocol. The relation of cycle day 3 FSH levels with various cycle characteristics and outcomes was determined. MAIN OUTCOME MEASURE(S): The accuracy of cycle day 3 FSH levels in predicting poor ovarian response and cycle cancellation was evaluated. Receiver operating characteristic curves were constructed to determine the optimum cutoff value for the cycle day 3 serum FSH level that best predicted poor ovarian response and cycle cancellation. RESULT(S): A cycle day 3 serum FSH level > or = 13 mIU/mL (conversion factor to SI unit, 1.00) was associated with a high likelihood of poor ovarian response and cycle cancellation. The sensitivity, specificity, and positive likelihood ratio of an FSH level of 13 mIU/mL in predicting cycle cancellation were 52%, 91%, and 6.04, respectively. CONCLUSION(S): Cycle day 3 FSH screening appears to be a fairly accurate predictor of poor ovarian response and cycle cancellation in women undergoing COH using a short, flare-up GnRH agonist and hMG protocol.

Adult↗
PubMed1997

Hysteroscopic treatment of intrauterine adhesions is safe and effective in the restoration of normal menstruation and fertility.

OBJECTIVE: To assess the safety and efficacy of hysteroscopic adhesiolysis in patients with recurrent pregnancy loss and infertility. DESIGN: Retrospective case report series. SETTING: The obstetrics and gynecology clinic of a medical school. PATIENT(S): Forty women with recurrent pregnancy loss or infertility resulting from intrauterine adhesions. INTERVENTION(S): Hysteroscopic adhesiolysis in patients with recurrent pregnancy loss and infertility. MAIN OUTCOME MEASURE(S): Postoperative adhesion formation, intraoperative complication, conceivement after surgery, pregnancy rate, and pregnancies resulted in term or viable preterm infants. RESULT(S): Most patients with minimal or moderate adhesions were free of adhesions when compared with postoperative control subjects. However, adhesion re-formation was noted in 60% of the patients who initially had severe adhesions. Normal menstrual flow was restored in 81% of the patients. All the patients who had recurrent pregnancy loss conceived after treatment, and 71% of the pregnancies resulted in a term or viable preterm infant. Of the 16 infertile patients treated, 10 (63%) conceived and 6 (37%) were delivered of viable infants. CONCLUSION(S): Hysteroscopic adhesiolysis is a safe and effective procedure for restoring the normal menstrual pattern and fertility. The initial severity of the adhesions appears to correlate best with the reproductive outcome.

Adult↗
PubMed1997

In vitro permeation of human chorioamniotic membranes by Campylobacter jejuni.

In vitro penetration of human chorioamniotic membranes by Campylobacter jejuni was investigated by an organ culture model. Membrane permeation was detected by an immunoperoxidase technique and viable bacterial counts of membrane homogenates. Human clinical isolates of C. jejuni inoculated on the maternal side of the membranes penetrated to the fetal side suggesting that chorioamniotic membranes constituted a weak barrier against Campylobacter infection. Chicken fecal isolates did not penetrate chorioamniotic membranes. In vitro culture conditions did not affect the viability of membranes. Human placental extracts and amniotic fluids enhanced the in vitro growth of C. jejuni. These results suggest that certain strains of C. jejuni may penetrate intact fetal membranes and this event may play a role in the pathogenesis of infection.

Amnion↗
PubMed1997

Pregnancy in infertile PCOD patients. Complications and outcome.

OBJECTIVE: To evaluate the complications and outcome of pregnancy in women with polycystic ovary disease (PCOD). STUDY DESIGN: The course and outcome of 47 singleton pregnancies in women with well-documented PCOD were compared with those in 100 healthy controls. RESULTS: Women with PCOD had a significantly higher body mass index as compared to the control group (P < .05); however, the proportion of lean versus obese subjects in the two groups was similar. The incidence of an abnormal glucose challenge test, gestational diabetes mellitus and pregnancy-induced hypertension was significantly increased in pregnant women with PCOD (P < .05). When lean PCOD subjects were compared with lean control subjects, the difference in the incidence of the above complications was still significant (P < .05). The incidence of pregnancy complications was similar when obese PCOD subjects were compared with obese controls. CONCLUSION: Women with PCOD were at increased risk of gestational diabetes and pregnancy-induced hypertension, and this risk appeared to be independent of body mass index.

Adult↗
PubMed1996

Results of in vitro fertilization and embryo transfer in women with infertility due to genital tuberculosis.

OBJECTIVE: To determine the results of IVF-ET in women with infertility due to genital tuberculosis. DESIGN: Retrospective case-control study. SETTING: In vitro fertilization and ET unit of a university hospital. PATIENTS: Forty-four cycles of IVF-ET were undertaken in 24 women with genital tuberculosis and the results were compared with 366 cycles in 274 nontuberculous tubal factor couples. INTERVENTIONS: All women with genital tuberculosis were evaluated with hysteroscopy, endometrial biopsy, and acid fast bacilli stain before treatment with IVF-ET. RESULTS: Subjects with genital tuberculosis had higher basal FSH levels, required more exogenous gonadotropins for controlled ovarian hyperstimulation, reached lower peak E2 levels, and yielded fewer oocytes and embryos when compared with tubal factor patients. Furthermore, in women with genital tuberculosis, clinical pregnancy rate per cycle was lower and spontaneous abortion rate was higher. CONCLUSIONS: Women with genital tuberculosis appear to represent a less favorable subset within other tubal factor patients when treated with IVF-ET.

Adult↗
PubMed1996

Adhesion formation and reformation after laparoscopic removal of ovarian endometriomas.

STUDY OBJECTIVE: To evaluate the extent of adhesion formation after laparoscopic removal of endometriomas. DESIGN: Prospective case series. SETTING: A university hospital. PATIENTS: Nineteen infertile women with ovarian endometriomas. INTERVENTIONS: All patients underwent laparoscopic cystectomy with total stripping of the cyst capsule when possible. A second-look laparoscopy was performed after 3 months of postoperative treatment with a gonadotropin-releasing hormone analog. MEASUREMENTS AND MAIN RESULTS: The extent of adhesion reformation was dependent on the extent and severity of adhesions at initial laparoscopy. One (5.2%) woman had a residual ovarian endometrioma at second-look laparoscopy. De novo adhesion formation was not seen. Nine women (42.8%) conceived during the postoperative follow-up period (range 11-22 mo). CONCLUSIONS: Laparoscopic removal of endometriomas is effective in eradicating the disease. Adhesions at second-look laparoscopy depend on adhesions at the initial laparoscopy. Crude pregnancy rates are satisfactory in infertile women.

Adult↗
PubMed1996

Uterine rupture following hysteroscopic lysis of synechiae due to tuberculosis and uterine perforation.

A patient with genital tuberculosis who conceived with in-vitro fertilization and embryo transfer following hysteroscopic synechiolysis complicated by a fundal uterine perforation subsequently presented with uterine rupture at 36 weeks gestation. Immediate Caesarean section and repair of the ruptured uterus were performed. Women with a history of uterine perforation should be counselled regarding the risk of uterine rupture during their subsequent pregnancies.

Adult↗
PubMed1996

Pathophysiology of adhesion formation and strategies for prevention.

OBJECTIVE: To review the mechanism of adhesion formation and to briefly discuss the possible sites of action of various preventive measures and adjuvants. STUDY DESIGN: Literature review. RESULTS: Although good surgical technique, designed to minimize trauma, is a crucial part of adhesion prevention, technique alone cannot effectively eliminate de novo formation and especially reformation of adhesions. CONCLUSION: To date, no adjuvant has proven uniformly effective in preventing postoperative adhesions. Nonreactive barriers show promise in selected situations, especially in the presence of apposing, injured peritoneal surfaces. Development of new and more effective compounds and advances in molecular cell biology may provide a more definitive answer to this perplexing problem, which has eluded surgeons for so long.

Humans↗
PubMed1995

Diagnosis of early tubal pregnancy by salpingoscopy.

Salpingoscopy was performed to diagnose any early tubal pregnancy that could not be identified at laparoscopy. The procedure may prove to be a valuable tool in such cases not only for diagnosis but also as a guide to proper endoscopic treatment by determining the site of the gestation.

Adult↗
PubMed1995

The results of in vitro fertilization-embryo transfer in couples with unexplained infertility failing to conceive with superovulation and intrauterine insemination.

OBJECTIVE: To determine the results of IVF-ET in couples with long-standing unexplained infertility who had failed to conceive with four to six cycles of superovulation and IUI. DESIGN: Retrospective case control series. SETTING: University IVF-ET center. PATIENTS: One hundred seventeen couples with unexplained infertility who had failed to conceive with superovulation and IUI underwent 157 cycles of IVF-ET. Results were compared with 194 tubal factor couples subjected to 250 IVF-ET cycles within the same time period. RESULTS: Total fertilization failure events were more common (20.4% versus 7.6%) and tended to be repetitive in couples with unexplained infertility. When total fertilization failure events were excluded, fertilization rates (57.8% versus 60.9%) and cumulative clinical pregnancy rates over three cycles (55.4% versus 46.5%) were similar in unexplained infertility and tubal disease groups. CONCLUSIONS: Couples with unexplained infertility failing to conceive with superovulation and IUI have a favorable outcome when treated subsequently with IVF-ET. Conception rates similar to couples with tubal disease may be expected despite a higher incidence of total fertilization failure events.

Adult↗
PubMed1994

Salpingoscopic findings in women with occlusive and nonocclusive salpingitis isthmica nodosa.

STUDY OBJECTIVE: To characterize ampullary endosalpingeal findings in women with occlusive or nonocclusive salpingitis isthmica nodosa. DESIGN: Prospective case study. SETTING: Obstetrics and Gynecology Department of a University Hospital. PATIENTS: Twenty women (38 tubes) with occlusive or nonocclusive salpingitis isthmica nodosa were studied. INTERVENTIONS: Salpingoscopy was performed during diagnostic laparoscopy in 20 women (38 tubes) with hysterosalpingographic evidence of salpingitis isthmica nodosa. MAIN OUTCOME MEASURES: Salpingoscopic findings were recorded and the patients were managed accordingly. RESULTS: Of the 38 tubes 10 appeared radiographically and laparoscopically normal. Two tubes were occluded distally. Of the 26 tubes with occlusive or nonocclusive salpingitis isthmica nodosa, 5 (19.2%) showed varying degrees of endosalpingeal abnormality. Patients with abnormal salpingoscopy were regarded as having bipolar tubal disease and were referred for assisted conception. The remaining patients were scheduled for microsurgical tubal reconstruction. CONCLUSIONS: One in five patients with proximal tubal disease may have ampullary endosalpingeal damage of varying degrees. However, the significance of this finding in relation to subsequent management strategies and fertility outcome is yet to be characterized.

Adult↗
PubMed1994

Results of Second-Look Laparoscopy Following Removal of Endometriomata

Despite widespread use of operative laparoscopy for removal of endometriomata, there are inadequate data regarding subsequent adhesion formation. We performed second look laparoscopy (SLL) within 6 months of laparoscopic endometriosis cystectomy in 21 infertile women. Mean age and mean duration of infertility were 30.5 &plusmn; 4.4 and 7.1 &plusmn; 4.9 years respectively. Cysts were removed with the following technique: incision of the ovarian cortex, cystoscopy (biopsy when necessary), and total stripping of the cyst capsule. All patients received postoperative suppressive therapy for 3 months. Total AFS score decreased significantly in all patients (34.1 &plusmn; 14.7 vs 12.3 &plusmn; 10.7; P<0.001). The adhesion score assessed at SLL improved in 3 (14.3%) remained the same in 13 (61.9%) and worsened in 5 (23.8%). Mean adhesion score at SLL was significantly less compared with adhesion score during cystectomy (7.1 &plusmn; 5.2 vs 8.7 &plusmn; 6.4; P=0.038). None of the patients had de novo adhesions. Adhesion scores were similar in women where ovarian cortical defect was left open or suture closed. Of the 21 women, 4 (19%) conceived within six months of SLL. In conclusion, laparoscopic removal of ovarian endometriomata was not associated with increased adhesion formation at SLL. Adhesions at SLL were mainly dependent upon adhesions at laparoscopic cystectomy.

Journal Article↗
PubMed1994

Laparoscopic treatment of polycystic ovarian disease.

There has been a recent surge of interest in laparoscopic treatment of polycystic ovarian disease (PCOD) that is unresponsive to first-line ovulation-inducing agents. Laparoscopic treatment options include multiple ovarian punch biopsy, ovarian electrocauterization and laser vaporization or photo-coagulation. These procedures are relatively easy to perform, devoid of major complications, and yield satisfactory ovulation and conception rates. Adhesion formation, however, is a potential complication following such procedures. Furthermore, women subjected to laparoscopic destructive ovarian procedures also need to be critically assessed regarding other long-term risks, such as premature ovarian failure. Laparoscopic treatment of PCOD, at present, should be viewed as experimental awaiting further trials assessing its long-term safety.

Electrocoagulation↗
PubMed1994

In vitro infection of human fetal membranes with Candida species.

To assess whether Candida species can penetrate intact fetal membranes under in vitro conditions, Candida albicans, Candida tropicalis, Candida guilliermondii, Candida pseudotropicalis and Candida glabrata were inoculated onto the surface of the maternal side of the membranes obtained from 4 pregnant women undergoing repeat cesarean section. After incubation under culture conditions, membranes were evaluated by histological examination. C. albicans inoculated onto the maternal side penetrated and passed to the fetal side and caused some degeneration of the structure of the membrane epithelium. The other four Candida species grew heavily on the maternal surface but did not penetrate and invade the membranes. This effect of C. albicans on fetal membranes may explain the potential mechanism in the development of Candida infections of the amniotic fluid, fetal membranes and possibly the fetus.

Amniotic Fluid↗