Biomedical subjects

C Dietterich

Publications and source records attributed to C Dietterich.

At least 19 recordsLinked to original sources

PubMed2005

Non-homogeneous hyperechogenic echo pattern three days after frozen embryo transfer is associated with lower pregnancy rates.

OBJECTIVE: To evaluate the association of mid-luteal phase echo patterns and pregnancy rates (PRs) following frozen embryo transfer (ET). METHODS: Sonographic evaluation of endometrial echo patterns was performed three days after ET in the first frozen ET cycle of women < 40 years of age who used their own oocytes as well as all donor oocyte recipients. RESULTS: The distribution of echo patterns and clinical PRs were similar in women using their own eggs and women who used donor oocytes; therefore all data was combined. The clinical PR was 49.5% with a hyperechogenic echo pattern vs 38.8% with a non-hyperechogenic pattern, p = .007. CONCLUSION: A larger study of frozen ET and mid-luteal echo pattern now demonstrates conclusions similar to the data from fresh ET in hyperstimulated in vitro fertilization (IVF)-ET cycles in that failure to attain a hyperechogenic echo pattern three days after ET is associated with lower pregnancy rates.

Adult↗

PubMed2005

A comparison of luteal phase support in graduated estradiol/progesterone replacement cycles using intramuscular progesterone alone versus combination with vaginal suppositories on outcome following frozen embryo transfer.

PURPOSE: To compare pregnancy outcome following frozen embryo transfer according to type of progesterone (P) support given in the luteal phase. METHODS: Retrospective cohort analysis of frozen embryo transfer (ET) cycles in which ovulation was suppressed by graduated estradiol in the follicular phase. Two P regimens in the luteal phase were compared: P vaginal suppositories and intramuscular P vs intramuscular alone. RESULTS: The clinical and viable pregnancy rates were significantly higher for the women receiving only intramuscular P (57.6% and 43.7%) vs those receiving combined therapy (45.9% and 35.6%, respectively). The implantation rates were not significantly different (22.6% vs 19.5%). CONCLUSION: The increased pregnancy rates with intramuscular P may have been related to a higher number of embryos transferred (3.69 vs 3.26). Nevertheless, intramuscular P alone is at least as effective, if not more effective, than combined therapy for frozen embryo transfers.

Adult↗

PubMed2004

Neither sildenafil nor vaginal estradiol improves endometrial thickness in women with thin endometria after taking oral estradiol in graduating dosages.

PURPOSE: To determine if sildenafil improves endometrial thickness better than vaginal estradiol (E2) in women with a history of thin endometria. METHODS: Women failing to attain an 8 mm endometrial thickness on either the oocyte retrieval cycle or their first frozen embryo transfer (ET) despite an oral graduated E2 regimen were treated again with graduated oral E2 and were also randomly assigned to vaginal sildenafil or vaginal E2 therapy. Endometrial thickness was compared between the groups. RESULTS: Neither vaginal E2 nor sildenafil significantly improved endometrial thickness or blood flow in the subsequent frozen ET-cycle. CONCLUSIONS: These data fail to corroborate previous claims that 25 mg sildenafil four times daily intravaginally can improve endometrial thickness.

Administration, Intravaginal↗

PubMed2003

Successful delivery despite conception with a maximal endometrial thickness of 4 mm.

PURPOSE: To evaluate the minimal endometrial thickness at the time of ovulation at which conception is possible. METHODS: Treatment with luteal phase progesterone support after oocyte release despite attainment of a maximal thickness of 4 mm. RESULTS: A pregnancy and successful delivery were achieved. CONCLUSIONS: Pregnancy is possible with only a 4 mm peak endometrial thickness, at least when follicle maturing drugs are not used.

Adult↗

PubMed2002

The effect on IVF outcome of small intramural fibroids not compressing the uterine cavity as determined by a prospective matched control study.

BACKGROUND: Several studies have reported that the presence of intramural fibroids affects conception following IVF. We attempted to corroborate or refute the conclusions relating to IVF and leiomyomas of the aforementioned studies. METHODS: Women with small intramural leiomyomata (< or = 5 cm) discovered on initial pelvic sonographic studies performed in preparation for IVF were prospectively matched by age, with the next patient of the same age undergoing IVF who did not demonstrate fibroids (controls). RESULTS: Though no significant differences were found in outcome when comparing these two groups, there was a distinct trend for lower live delivery rates and higher miscarriage rates. CONCLUSIONS: These data support the conclusions of the only other prospective matched control study evaluating similar factors, i.e. that small intramural fibroids can negatively affect IVF outcome. Nevertheless, we think that a multicentre study should be conducted first before evaluating whether myomectomy improves outcome or not.

Abortion, Spontaneous↗

PubMed2001

Effect of fibroids on cumulative probability of pregnancy in women taking follicle maturing drugs without assisted reproductive technology.

PURPOSE: To determine if the presence of uterine fibroids adversely affect in vivo conception rates. METHODS: Pelvic ultrasound evaluation of the presence or absence of fibroids in consecutive infertility patients not treated with assisted reproductive technology in a two-year period. Conception outcome noted. Data analyzed according to the presence or absence of fibroids. RESULTS: No difference in cumulative probability of pregnancy after five months was seen in patients with or without the presence of fibroids. There were no confounding variables found that could have skewed the pregnancy rates in one direction or the other. CONCLUSION: In general the presence of fibroids do not adversely affect conception outcome for in vivo pregnancies. However, since the majority of the fibroids were small (< 6 cm) and were not submucosal and did not compress the endometrial cavity, larger studies are needed to address specific subtypes and circumstances on pregnancy outcome.

Adult↗

PubMed2000

Non-homogeneous hyperechogenic pattern 3 days after embryo transfer is associated with lower pregnancy rates.

The purpose of this study was to investigate the relationship between mid-luteal phase echo patterns and IVF-embryo transfer outcome in women who have demonstrated adequate endometrial development by the late proliferative phase. A prospective study was carried out of 86 patients undergoing IVF-embryo transfer and 86 patients undergoing frozen embryo transfer who all underwent sonographic monitoring of the endometrium 3 days after embryo transfer. The cycles were classified into two groups: those with the homogeneous hyperechogenic (HH) pattern and those without it. The women who had an HH pattern had higher clinical pregnancy (32.8 versus 10.7%, P < 0.05) and implantation rates in stimulated cycles (14.3 versus 4.1%, P < 0.05 respectively) than those that did not. There was no significant difference in the clinical pregnancy or implantation rates by echo pattern (18.2 and 8.1% for non-HH and 18. 7 and 8.0% for HH respectively) in frozen embryo transfer cycles. These data demonstrate that in embryo transfer cycles where ovarian stimulation was used, there were decreased pregnancy and implantation rates in cycles where the HH pattern was not observed 3 days after transfer. The failure of the endometrium to display this pattern may indicate some endometrial abnormality resulting in implantation defects.

Adult↗

PubMed2000

No evidence of increased uterine vascular impedance with patient ageing following IVF.

A study was conducted to determine if uterine vascular impedance increases with advancing age in women undergoing ovarian stimulation for IVF. A group of 162 women who had undergone conventional IVF and embryo transfer was subdivided into three subgroups by age: 30-34 years (n = 49), 35-39 years (n = 79) and 40-44 years (n = 34). The pulsatility index (PI) and resistance index (RI) of the right and left uterine arteries were measured at baseline, on the day of oocyte retrieval, and at the mid-luteal phase. There were no differences in the average PI or RI by age at any phase of the cycle. In all age groups, the luteal phase values of PI and RI were lower than those observed earlier in the cycle. Endometrial thickness was not associated with age. There was no significant correlation between PI, RI and serum oestradiol and progesterone concentrations at any phase of the cycle. Ovarian response, as measured by average number of oocytes retrieved, decreased significantly with age. Thus, reduced pregnancy rates in older women undergoing ovarian stimulation are more likely to occur because of oocyte quality and quantity rather than uterine senescence. If future studies determine that the use of ovarian stimulation does decrease implantation rates more in older versus younger women, a mechanism other than increased uterine vascular impedance must be sought.

Adult↗

PubMed2000

A study to determine if certain sonographic uterine parameters are associated with multiple gestation.

The objective was to determine if lower uterine artery vascular impedance is associated with a greater likelihood of multiple gestation. Color Doppler parameters of pulsatility index, resistance index, endometrial thickness and echo patterns were measured in oocyte/retrieval cycles on days of human chorionic gonadotropin injection, oocyte retrieval, and mid-luteal phase in cycles where at least 3 embryos were transferred. Comparisons of these parameters were made in patients with single versus multiple gestations. There was no association between uterine environment as measured by vascular impedance and endometrial thickness and number of embryos implanted. Thus, a more ideal uterine environment, at least as determined by these sonographic parameters, does not seem to facilitate multiple embryo implantations.

Adult↗

PubMed2000

The presence of small uterine fibroids not distorting the endometrial cavity does not adversely affect conception outcome following embryo transfer in older recipients.

PURPOSE: To determine if uterine fibroids have a negative impact in older patients having embryo transfer (ET). METHODS: Comparison of clinical and viable pregnancy rates, implantation rates, and spontaneous abortion rates in older (>35) oocyte or embryo recipients with uterine leiomyomata compared to comparable patients without fibroids. RESULTS: The clinical pregnancy rate per transfer was 56% in the fibroid group vs 64% for the controls. Implantation rates were also very similar (33 vs 32%7). There were no spontaneous abortion or preterm deliveries <32 weeks in the fibroid group and the average term of pregnancies was also similar. CONCLUSION: Small fibroids not distorting the uterine cavity do not seem to negatively affect conception outcome even in older women.

Adult↗

PubMed1998

A matched study to determine whether low-dose aspirin without heparin improves pregnancy rates following frozen embryo transfer and/or affects endometrial sonographic parameters.

PURPOSE: The objective of the matched, controlled study was to determine whether low-dose aspirin therapy without heparin improves pregnancy rates following frozen embryo transfer. METHODS: Thirty-six women who did not achieve a pregnancy following fresh embryo transfer and who had frozen embryos available for another transfer were included. Eighteen women were treated with 81 mg aspirin from day 2 of the cycle through pregnancy testing. If the beta-human chorionic gonadotropin level was positive, aspirin was continued through the pregnancy. Eighteen women were not given aspirin. The mean outcome variables were pregnancy and implantation rates. RESULTS: The clinical pregnancy rate in the aspirin group was 11.1%, compared with 33.3% for the controls, and implantation rates were 2.9 and 10.9%, respectively. CONCLUSIONS: No positive effects of low-dose aspirin therapy on pregnancy rates following frozen embryo transfer were observed.

Antibodies, Antiphospholipid↗

PubMed1997

Comparison of pregnancy outcome of natural twin pregnancies versus multifetal pregnancies selectively reduced to twins.

The high rate of multiple gestations following ovulation induction with and without assisted reproductive technologies (ART) has led to an increased interest in selective reduction. The aim of this study was to compare pregnancy outcome of 6 triplet and 2 quintuplet pregnancies following selective reduction to twins to a group of 30 natural twin pregnancies delivered during the same time period. Outcome variables compared included birth weights, gender, gestational age at delivery, route of delivery, and neonatal complications. Results failed to demonstrate an adverse effect of selective reduction on pregnancy outcome.

Adult↗

PubMed1997

A comparison of early gestational age markers in viable twin pregnancies resulting from in vitro fertilization-embryo transfer versus spontaneous conception with ovarian stimulation.

The objective of this study was to determine whether there were differences in gestational age markers in dizygotic twin pregnancies resulting from in vitro fertilization-embryo transfer (IVF-ET) when compared with dizygotic twin pregnancies spontaneously conceived following ovulation inducing therapy drugs without assisted reproductive techniques (ART). Thirty-one sets of twins conceived by IVF-ET and 33 sets of twins conceived without ART were monitored by serum beta human chorionic gonadotropin (B-hCG) levels and transvaginal sonographic measurements of sac size (SS) and crown-rump length (CRL). Comparison between groups found that SS was significantly smaller in the IVF-ET group as compared to the non-ART group 21-35 days post-ovulation (p < .05). The CRL was similar in both groups as well as the doubling times of B-hCG. These data indicate that in dizygotic twin pregnancies initial development of SS may be slower following IVF-ET than in spontaneously conceived twins.

Adult↗

PubMed1995

The effect of consecutive cycles of clomiphene citrate therapy on endometrial thickness and echo pattern.

OBJECTIVE: To determine whether successive cycles of clomiphene citrate affect endometrial thickness. METHODS: Thirty-four women presenting for treatment of anovulation, oligoovulation, or follicle maturation defects were given the smallest dose of clomiphene citrate necessary to attain a mature follicle. If no pregnancy ensued, the same dose was continued if a follicle 18-24 mm in diameter and a serum estradiol (E2) level greater than 200 pg/mL were achieved. Ethinyl E2 was supplemented for poor cervical mucus only. Endometrial thickness and echo patterns were measured each cycle at peak follicular maturation. RESULTS: There was no difference in mean endometrial thickness during the first six cycles of therapy, nor was there a trend for thickness to increase or decrease with successive cycles with or without the addition of ethinyl E2. There was no change in the distribution of echo patterns with successive cycles of clomiphene citrate. Post-treatment measures of thickness and echo pattern did not differ from baseline pre-treatment values. The homogeneous hyperechogenic pattern was the rarest. Mean serum E2 and progesterone levels at mid-cycle did not change with successive cycles. CONCLUSION: One proposed mechanism for the dichotomy between ovulation and pregnancy rates after clomiphene citrate therapy is that the drug adversely affects the endometrium. If clomiphene citrate does affect implantation adversely, the mechanism does not seem to be related to thinning the endometrium or causing an echo pattern that indicates a poor prognosis. The data also suggest that estrogen supplementation does not influence endometrial thickness and would best be used exclusively for hostile cervical mucus.

Adult↗

PubMed1995

The relationship of endometriosis to endometrial sonographic studies prior to administration of human chorionic gonadotrophin in patients undergoing in-vitro fertilization and embryo transfer.

The objective of this prospective comparative study was to investigate the relationship of endometriosis to endometrial thickness and sonographic echo pattern prior to the administration of human chorionic gonadotrophin (HCG). Patients were matched by age and ovarian stimulation protocol. A total of 210 patients undergoing in-vitro fertilization (IVF) and embryo transfer at a university-related IVF centre were enlisted. Of these, 105 women with laparoscopic confirmation of endometriosis were compared to an equal number of patients with laparoscopic confirmation of no endometriosis. Mean endometrial thickness did not differ between the groups (12.7 +/- 2.9 versus 12.2 +/- 2.5 mm). The distribution of echo patterns was also the same, irrespective of diagnosis. Evaluation of clinical pregnancy rates showed no reduction in patients with endometriosis, regardless of stage, nor when comparing patients to controls. Endometriosis has no effect on the endometrial thickness or echo pattern measured by sonography prior to administration of HCG or the pregnancy rates following IVF and embryo transfer.

Adult↗

PubMed1995

Relationship of endometrial thickness and echo patterns on pregnancy rates in patients with luteal phase defects.

The objective of this prospective comparative study was to investigate the relationship of sonographic measurements of the endometrium at the time of peak follicular maturation to conception outcome in patients treated for luteal phase defects (as determined by out-of-phase endometrial biopsies). Treatments for luteal phase defects included progesterone supplementation with or without follicle-maturing drugs, depending on whether the patient attained a follicle of at least 18 mm and a serum estradiol of > 200 pg/ml. No differences in pregnancy rates were found by the thickness of endometrium (< 10 vs. > or = 10 mm) or echo pattern in any of the treatment modalities. Thus, contrary to findings in stimulated cycles for in vitro fertilization, endometrial thickness at the time of peak follicular maturation is not predictive of outcome in patients treated for luteal phase defects in natural cycles.

Adult↗

PubMed1995

Relationship of endometrial thickness and sonographic echo pattern to endometriosis in non-in vitro fertilization cycles.

The objective of this study was to investigate the effect of endometriosis on the proliferation of the endometrium as determined by sonographic measurements of endometrial thickness and echo pattern at peak follicular maturation. A prospective study of 60 infertility patients was conducted in which the endometrium was evaluated sonographically, both before and after laparoscopy. Prior to laparoscopy, the mean endometrial thickness was 10.5 +/- 1.9 mm in the group without endometriosis (n = 20) and 11.7 +/- 2.8 mm in the group with endometriosis (n = 40) (p > 0.05). Following the laparoscopy, there was no change in the mean thickness within each group. The incidence of an unfavorable echo pattern was negligible in both groups. Endometriosis does not cause a reduction in endometrial thickness, nor does it appear to influence the development of an unfavorable echo pattern at time of peak follicular maturation.

Adult↗

PubMed1995

Comparison of androgen levels in conception vs. non-conception cycles following controlled ovarian stimulation using the luteal phase gonadotropin-releasing hormone agonist protocol.

Serum concentrations of androstenedione, testosterone and dehypdroepiandrosterone sulfate (DHEAS) as well as estradiol and progesterone were measured throughout the in vitro fertilization (IVF) cycle and compared by conception outcome to try to determine if differing levels of androgens could help elucidate the endocrine environment conducive to successful IVF cycles. The luteal phase gonadotropin-releasing hormone agonist (GnRH-a) protocol was used for ovarian stimulation. of the 46 women enrolled in the study, 11 conceived and 35 did not conceive. Throughout the follicular phase, levels of androstenedione and DHEAS were found to rise but the same pattern of increase was found in both conception and non-conception cycles. The pattern of testosterone increase in non-conception cycles was faster than that in conception cycles. Differences in mean levels of androstenedione, testosterone, estradiol and progesterone by conception outcome in the late luteal phase can be attributed to secretion by the corpus luteum. It is possible that those women having multiple failed cycles with rapidly rising serum testosterone levels should be considered for longer use of the GnRH-a. Differences in the pattern of testosterone rise should be monitored.

Adult↗