Biomedical subjects

C Dietterich

Publications and source records attributed to C Dietterich.

34 records · Page 2Linked to original sources

PubMed1993

The effect of endometrial thickness and echo pattern on in vitro fertilization outcome in donor oocyte-embryo transfer cycle.

There have been some conflicting data concerning the importance of endometrial thickness and echo patterns before transfer in different IVF-ET situations under different COH regimens. We previously found in women undergoing IVF-ET after luteal phase LA-hMG a significantly higher PR in those patients attaining at least a 10-mm endometrial thickness and a lower rate in those women with an entirely homogeneous hyperechogenic endometrium (pattern C). The present study evaluated the relationship of endometrial thickness and echo pattern to PRs in donor oocyte recipient immediately before transfer. There were 16 pregnancies in 58 cycles (27.5%). Conclusions similar to the previous COH study were reached concerning the > or = 10-mm thickness levels correlating with improved PRs (9% versus 38.7%, P < 0.01). In contrast, no correlation with echo pattern was found.

Adult↗

PubMed1993

Adverse effect of a homogeneous hyperechogenic endometrial sonographic pattern, despite adequate endometrial thickness on pregnancy rates following in-vitro fertilization.

We have previously presented data to show that in patients who had in-vitro fertilization (IVF)-embryo transfer using ovarian stimulation involving the luteal phase leuprolide acetate--human menopausal gonadotrophin (HMG) regimen, poor pregnancy results ensued if either the endometrial thickness was < 10 mm or a homogeneous hyperechogenic sonographic pattern was present immediately prior to taking a human chorionic gonadotrophin (HCG) injection. There were only 15 cases with this hyperechogenic type endometrium (and no pregnancies). The purpose of the present study was to evaluate the influence of a hyperechogenic endometrium when the endometrial thickness was > or = 10 mm, in a more extensive series, in women having IVF-embryo transfer using the same ovarian stimulation regimen. A total of 273 consecutive cycles, where endometrial thickness was > or = 10 mm, were evaluated (not including the 85 cycles previously reported). Of 22 patients with the hyperechogenic pattern, one achieved a chemical pregnancy (beta-HCG > 500 mIU/ml) and none achieved clinical pregnancies (ultrasound confirmation). In contrast, 67 of 251 (26.7%) patients conceived with other echo patterns (chi 2 analysis = 5.9, df = 1, P = 0.01). These data thus confirm, in a larger series, the negative influence of this type of echo pattern on subsequent pregnancy rates following the luteal phase leuprolide acetate--HMG ovarian stimulation regimen.

Embryo Transfer↗

PubMed1993

The effects of multiple gestation and selective reduction on fetal outcome.

A group of 32 women with at least 3 or more viable fetuses by sonography at approximately 8 weeks gestation were given the option of selective reduction. They were advised that this was a relatively new procedure but heretofore in a small series was not associated with a significant increase in fetal demise. Only 7 of 32 women chose this option. six of these 7 had triplets reduced to twins, 1 woman had quadruplets reduced to twins. Thirteen of 14 viable babies were successfully delivered at a mean of 36.8 weeks gestation; 2 of 7 (28.6%) delivered before 37 weeks. In contrast, 7 of 25 (24%) not having reduction lost all babies (6 triplets, 1 quadruplet). Four other women lost at least 1 of their gestations (total of 5 babies). Pre-term deliveries (< 37 weeks) occurred in 16 of 18 (88.8%) patients delivering at least 1 live baby, with a mean of 33.7 weeks gestation. Thus the high rate of total fetal loss and prematurity for multiple gestation and the low pregnancy wastage and pre-term delivery rate following selective reduction might make the latter a reasonable therapeutic option to patients interested in having the best chance of delivering healthy viable babies.

Abortion, Therapeutic↗

PubMed1992

The effect of follicle maturing drugs on side of ovulation in successive cycles.

Our previous study has demonstrated that ovulation in unstimulated cycles is random with an equal likelihood of ipsilateral or contralateral ovulation occurring in the following cycle. This study evaluated women taking ovulation-inducing drugs to see if the side of ovulation in the preceding cycle has an influence on the side of ovulation in the succeeding cycle. Ovulatory patterns in consecutive pairs of cycles in anovulatory women treated with ovulation-inducing drugs were evaluated through sonographic studies of follicular maturation. The results demonstrated that when unilateral ovulation occurred, there was an equal likelihood of ipsilateral or contralateral ovulation in the succeeding cycle. However, ovulation-inducing drugs increase the incidence of bilateral or multiple ovulation.

Clomiphene↗

PubMed1992

The effect of follicle-maturing drugs on mid-cycle androgen levels in women with normal baseline levels.

Theoretically, clomiphene citrate or human menopausal gonadotropins might have a higher chance of inducing pregnancy per cycle were it not for the concomitant rise in androgens induced by these follicle-maturing drugs. In the present study, mid-cycle androgen levels were evaluated in anovulatory women with normal baseline early follicular levels who were treated with either clomiphene citrate or human menopausal gonadotropins. The only mid-cycle androgen to rise above the normal range was androstenedione. However, no negative effects of elevated androstenedione levels on pregnancy rates were apparent. Thus, at least in women with normal baseline androgen levels, the use of follicle-maturing drugs does not appear to cause a rise in androgen levels except for androstenedione, and the rise in androstenedione at mid-cycle appears to have no adverse effect on conception.

Androgens↗

PubMed1991

Influence of endometrial thickness and echo patterns on pregnancy rates during in vitro fertilization.

Previous data has suggested that improved PRs were seen in women with increased endometrial thickness as determined by sonography before oocyte retrieval. The hyperstimulation protocol used was CC-hMG. The study presented herein was initiated to evaluate if a similar trend was evident in women whose hyperstimulation protocol included the long LA-hMG therapy. We also demonstrated an improved PR in women with greater endometrial thickness, but in general, the endometrium was thicker in the pregnant women treated with the gonadotropin-releasing hormone agonist than in those treated with CC.

Embryo Transfer↗

PubMed1991

Ipsilateral versus contralateral ovary selection of dominant follicle in succeeding cycle.

There is still confusion as to whether ovulation in a succeeding cycle is a random event or is more likely to occur at the ipsilateral or contralateral ovary. Both histologic and sonographic data support alternating ovulation. Some ultrasound studies have suggested that ipsilateral ovulation is more likely in succeeding cycles, and another found right-sided ovulation to be more common. Because many of the studies are based upon small numbers, we initiated a large study to determine the more likely side of ovulation. Furthermore, the present investigation attempted to confirm biochemically the true existence of the dominant follicle by demonstrating appropriate serum estradiol levels. Evaluation of natural cycles (286 pairs) demonstrated 52.4% ipsilateral ovulation and 47.6% contralateral ovulation. Right-sided ovulation occurred in 54.5% of cycles. Our data suggest that the side of ovulation in successive cycles is not influenced by the side of ovulation in the preceding cycle.

Female↗

PubMed1991

Relationship of small-for-dates sac size to crown-rump length and spontaneous abortion in patients with a known date of ovulation.

Spontaneous abortion after established sonographic viability is rare. This study prospectively evaluated 39 late first-trimester abortions after fetal viability was established by ultrasound. The average crown-rump length measurement and mean sac diameter in this group were determined and compared with predicted values based on known conception dates, and the discrepancy between actual and predicted measurements was noted. The same calculations were then made on 39 prospectively matched non-aborting controls. We also determined the difference between sac size and crown-rump length in both groups. Significant differences were found for all three measures. Small-for-dates sac size and small-for-dates crown-rump length were defined as having a discrepancy score greater than 1 standard deviation (SD) above normal. Small-for-dates sac/crown-rump length was defined as having a discrepancy score less than 1 SD below normal. A high percentage of aborters was correctly predicted by a mean sac diameter (82%) or crown-rump length (77%) that was greater than +1 SD, with few false positives (12.8 and 5.1%, respectively). The cutoff for differences of sac minus crown-rump length measurements (10.1 mm) was less sensitive (56%), but just as specific (82%). When both the mean sac diameter and crown-rump length were smaller than expected (according to known date of ovulation), the ability to predict abortion was 71% with few false positives (3.5%).

Abortion, Spontaneous↗

PubMed1990

Pelvic sonography can predict ovum release in gonadotrophin-treated patients as determined by pregnancy rate.

Ultrasonographic monitoring of ovum release was performed in two consecutive cycles in each of 220 patients treated with gonadotrophin. Definite release occurred in 69% of cycles, indeterminate in 24% and non-release in 7%. Support for the accuracy of sonography in diagnosing the luteinized unruptured follicle (LUF) was demonstrated by a much higher pregnancy rate in those patients showing ovum release. There was a definite tendency for non-release to recur in the next cycle. Thus, the data support the routine use of sonography 2-3 days after human chorionic gonadotrophin (HCG) injection to monitor ovum release in gonadotrophin-treated patients (HMG).

Chorionic Gonadotropin↗

PubMed1986

New approaches to the diagnosis and therapy of the luteinized unruptured follicle syndrome.

Ultrasound has been employed in diagnosing the luteinized unruptured follicle syndrome (LUF). Eighty-nine of 333 infertility patients were found to have LUF. The patients were divided into three groups. Group 1 was on no fertility medication. Twenty-five of 39 of this group released with HCG alone. Ten of the nonreleasers to HCG did release with HMG mixed with HCG. Group 2 patients had been treated with clomiphene and found to have LUF. Thirteen of 16 patients released with HCG and one of the failures released with HMG-HCG. Group 3 patients had been treated with HMG and had failed to release the ova despite HCG. Thirty-one of 33 did release with HMG-HCG. Twenty-six of 89 patients achieved a pregnancy within six months of therapy and 20 of 36 patients with all fertility factors corrected achieved a pregnancy.

Anovulation↗

PubMed1985

Serum estradiols versus pelvic sonography in monitoring HMG therapy.

Therapy with human menopausal gonadotropin (HMG) conventionally has been monitored by estrogen measurements. Pelvic sonography may offer a more accurate method of monitoring HMG therapy. In this study 67 anovulatory patients were treated with HMG until at least one follicle had a diameter of 17 mm. The serum estradiol level was noted at the time a mature follicle was achieved. There was a correlation between the ultrasound data and the serum estradiol range in 57% of the cases. However, in 24% it was necessary to push the estradiol level above the allowable maximum of 2000 pg/mL. Twenty percent of the patients attained a 17-mm follicle before reaching the minimum required estradiol level of 500 pg/mL. Sonographic monitoring should improve the efficacy of HMG therapy.

Anovulation↗

PubMedDate not supplied

Comparison of various therapies for the luteinized unruptured follicle syndrome.

A study was initiated to evaluate the prevalence of the luteinized unruptured follicle (LUF) syndrome in a group of 355 women with infertility. The diagnosis was established by carefully observing daily sonograms along with measuring estradiol, progesterone, and luteinizing hormone (LH) levels. Two distinct types of LUF syndrome were identified: mature follicle LUF, in which release of an ovum was not demonstrated after a follicle attained maturity (serum estradiol reached 200 pg/mL while serum progesterone remained less than 2.5 ng/mL), versus premature luteinization LUF, where the serum progesterone increased above 2.5 ng/mL before follicular maturation was attained. The use of either hCG alone or hCG in combination with hMG in a single injection at the time of follicular maturation successfully corrected mature follicle LUF in 21 of 46 patients (46%), whereas ovulation-inducing drugs plus hCG or hCG and hMG corrected LUF in 24 of 25 patients (96%). Clomiphene citrate proved inferior to hMG in that it corrected LUF in 3 of 25 patients (12%) versus 12 of 22 patients (95%) who had undergone hMG therapy. Thus, hMG-hCG therapy is the most efficacious for mature follicle LUF, but because release can occur spontaneously on occasion by an appropriately timed single gonadotropin injection, one could offer the less costly options first. For premature luteinization, speeding up follicular maturation with gonadotropin therapy is effective. Upon failure of this technique, the more costly endogenous gonadotropin suppression followed by hMG can be employed.

Adult↗

PubMedDate not supplied

Evidence that difference in size of fraternal twins may originate during early gestation: a case report.

We describe a woman who conceived by in vitro fertilization (IVF) and embryo transfer (ET). Transvaginal ultrasound demonstrated at least 1 week's difference in size of twin gestations from 1 month post-transfer of embryos to delivery. Differences in sac size, crown-rump length, and gestational growth are discussed, as are implications of ultrasound in early pregnancy.

Adult↗

PubMedDate not supplied

Ovulation-inducing drugs versus specific mucus therapy for cervical factor.

Ovulation disorder as a possible cause of a cervical factor problem was evaluated in 30 patients with poor postcoital tests. The diagnosis of an ovulatory defect was based on follicular maturation studies included in serial pelvic ultrasonography and serial assays of serum estradiol and progesterone. Patients were divided into three groups with cervical factor presumably due to (1) immature follicular development, (2) premature luteinization, and (3) pure cervical factor. A higher pregnancy rate was achieved in the group with pure cervical factor when the therapy was directed exclusively toward improving the cervical mucus. However, a significant improvement in pregnancy rate was observed when therapy was aimed at correcting both abnormal follicular maturation and the cervical mucus problem. Combined use of pelvic sonography and quantitation of serum estradiol and progesterone allow the clinician to select the treatment for cervical factor that is most likely to achieve successful pregnancy.

Cervix Mucus↗

PubMedDate not supplied

The treatment of cervical factor with ethinyl estradiol and human menopausal gonadotropins.

Previously we have demonstrated that one can significantly improve the cervical factor in cases that have failed with conventional therapy by employing high doses of estrogen to stimulate the cervical mucus glands. The patients are concomitantly treated with human menopausal gonadotropins to stimulate ovulation, because of endogenous gonadotropin suppression by the estrogen. Monitoring of the hMG is accomplished by pelvic sonography. Unfortunately, the serum estradiol assay cannot also be used because it would measure not only endogenous estradiol but also exogenous estradiol from the conjugated estrogens employed. A modification of this technique is described wherein the estrogen now used is ethinyl estradiol. This estrogen has very little cross-reactivity in the 17-beta-estradiol assay. Thus, both ultrasound and serum estradiol monitoring can be used, resulting in a safer and more effective technique.

Adult↗

PubMedDate not supplied

Diagnosis and treatment of the cervical factor. I. Improvement with a short-course treatment of high-dose estrogen.

A new technique for improving cervical factor is described. This technique employs the use of high-dose estrogen at the time that a mature follicle is determined by ultrasound in patients who have inadequate postcoital tests despite the use of low-dose estrogen, guaifenesin, and tetracycline. Previously, a technique based on high-dose estrogen early in the follicular phase was employed; this suppressed pituitary gonadotropins, thus requiring the concomitant use of hMG. Seventy-three percent of the patients for whom this more expensive and intricate technique would have been necessary were able to achieve a good postcoital test through this modified technique of merely using high-dose estrogen when the follicle has already matured. Thirty-three percent achieved a pregnancy within 6 months on this therapy.

Cervix Mucus↗