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Biomedical subjects

D Dicker

Publications and source records attributed to D Dicker.

At least 109 records · Page 6Linked to original sources
PubMed1988

Comparison of a fixed and dynamic protocol for embryo replacement in an IVF/ET programme.

Implantation after embryo transfer is considered a major obstacle in terms of pregnancy rates after in-vitro fertilization. A flexible approach to the date of replacement, based on the fact that the most suitable embryonic structure for proper implantation is the four- to eight-cell embryo, has been studied. One-hundred-and-twenty patients with various aetiologies of infertility were stimulated with HMG or combined HMG and FSH, then treated by three different methods of embryo replacement. In group I embryos were replaced in mothers 48 h after ovum retrieval; in group II replacements were carried out 72 h after retrieval; and in group III replacements were related to embryonic cleavage development. Mean levels of oestradiol when HCG was given averaged 1301 +/- 121 pg/ml, 1016 +/- 96 pg/ml and 1182 +/- 101 pg/ml in the three groups, respectively. There was no significant difference in the average number of embryos transferred among the various groups. The pregnancy rates per transfer were 21.8, 24.2 and 38.7%, respectively (P less than 0.001). Although more investigation is required, a dynamic approach to embryo replacement might significantly improve pregnancy rates, because of improved interactions between the embryos and the uterus.

Chorionic Gonadotropin↗
PubMed1988

First trimester bleeding in clinical IVF pregnancies.

First trimester bleeding has been investigated in 72 pregnant women undergoing in-vitro fertilization and embryo transfer and was compared to 70 pregnant patients in whom ovulation was induced, in addition to 70 spontaneous pregnancies. Abortion rates did not differ significantly between the first two groups but were significantly higher in comparison to normal pregnancies. Furthermore, among IVF pregnancies that continued, a high incidence of first trimester bleeding occurred (P less than 0.01). This complication was mainly related to luteal insufficiency and multiple pregnancies, whereas hyperstimulation was the major risk factor for bleeding in pregnancies arising from HMG-induced ovulation. Other currently unknown, aetiological factors for first trimester bleeding in IVF pregnancies remain to be investigated.

17 alpha-Hydroxyprogesterone Caproate↗
PubMed1988

Pregnancy outcome in maturity onset diabetes at young age (MODY).

Diabetes mellitus is not a single disease, but rather a syndrome comprised of a variety of diseases characterized by hyperglycaemia. Indeed it has a heterogeneous nature. Maturity Onset Diabetes of the Young or MODY is an unusual, mild type of hyperglycaemia, which develops in young women, (below the age of 25), who do not require insulin. This study describes 10 pregnancies in MODY women, who are compared to a group of patients with insulin-dependent diabetes mellitus (IDDM), a group with gestational diabetes, and a control group of normal, healthy pregnant women. Our group of pregnant MODY patients proved to have an intermediate form of diabetes, more severe than gestational diabetes and yet not as severe as insulin-dependent diabetes mellitus. Mean duration of diabetes was shorter and mean daily insulin requirement (during pregnancy) was lower among MODY patients in comparison to IDDM gestants. Moreover the frequency of maternal complications and Caesarean deliveries in MODY patients were lower than in the IDDM group, but higher when compared to the gestational diabetes group.

Adolescent↗
PubMed1988

Transvaginal oocyte retrieval controlled by vaginal probe for in vitro fertilization: a comparative study.

Of 142 patients who initiated in vitro fertilization cycles, 52 underwent oocyte collection by laparoscopy, 58 by the ultrasonically guided transvesical route, both under general or local anesthesia and 36 by the ultrasonically transvaginal route under local anesthesia. When the three methods were compared the results did not differ significantly. An average of 6.4, 6.2, and 5.7 oocytes, respectively, were retrieved. Cleavage rates were 82.6, 79.4, and 81.6%, respectively, while 20.2, 22.6, and 21.1% clinical pregnancies per cycle were obtained. Complications with this procedure such as exacerbation of previous pelvic inflammatory disease, urinary tract infections, transient hematuria, and mild hemoperitoneum were rare. In general, patients greatly preferred the transvaginal method. In addition to providing greater comfort for the patient, this method requires no general anesthesia and is less expensive than other methods. Our initial experience demonstrates that in vitro fertilization can be performed successfully through this simplified alternative to oocyte retrieval.

Adult↗
PubMed1988

Intrapartum management of insulin-dependent diabetes mellitus (IDDM) gestants. A comparative study of constant intravenous insulin infusion and continuous subcutaneous insulin infusion pump (CSIIP).

Two groups of insulin-dependent diabetes mellitus (IDDM) parturients were managed according to different intrapartum protocols and compared with a control group of normal women in labor. Thirty-seven patients received conventional intensified insulin therapy during pregnancy and intravenous continuous insulin infusion during labor. Twenty-eight women were managed by continuous subcutaneous insulin infusion pump (CSIIP) throughout gestation and this therapeutic approach was continued during labor. When the two glucose control techniques were compared, CSIIP was superior to achieving and maintaining intrapartum optimal metabolic control, reducing significantly the incidence of acute fetal distress, thus lowering the cesarean section rate and neonatal hypoglycemia. Consequently we concur with the recommendation that firm prepartum as well as intrapartum diabetic control is mandatory for successful management of labor in IDDM patients.

Blood Glucose↗
PubMed1987

Abdominal complications following ultrasonically guided percutaneous transvesical collection of oocytes for in vitro fertilization.

Ultrasonically guided transvesical oocyte aspiration is a safe and efficient method in most in vitro fertilization (IVF) units. It entails very rare severe complications, even though transvesical punctures performed may unintentionally pierce the bowel or even major blood vessels. Nevertheless, mild complications are rarely noted and reported. During a 9-month period 140 ovum pickups were performed: 102 by transabdominal ultrasound-guided puncture and 38 by means of laparoscopy. In the former group, abdominal pain (11.6%), exacerbation of previous pelvic inflammatory disease (2.9%), mild hemoperitoneum (2.9%), urinary tract infections (5.8%) and transient macroscopic hematuria (5.8%) occurred following the procedure. In the latter group, abdominal pain followed in 7.8%; no urinary tract complications were noted in women undergoing laparoscopic ovum aspiration. In spite of the fact that ultrasonically guided transvesical oocyte collection is an atraumatic method with rare complications, they should be reported in order to draw attention to their not-so-rare occurrence and with the aim of their prevention.

Abdomen↗
PubMed1987

Multiple pregnancy after in-vitro fertilization and embryo transfer: report of a quadruplet pregnancy and delivery.

The first baby from in-vitro fertilization (IVF) was born in England in 1978 as a result of retrieval of a single preovulatory oocyte in the course of a natural cycle (Steptoe and Edwards, 1978). At present most programmes of IVF throughout the world do not use natural cycles producing only one oocyte, but rather multiple oocyte cycles produced by clomiphene citrate (CC), human menopausal gonadotrophin (HMG), or pure follicle stimulating hormone (FSH), either separately or in combination, sequentially or concomitantly, for the induction of multiple follicular maturation.

Adult↗
PubMed1987

Pregnancy outcome in gestational diabetes with preconceptional diabetes counselling.

One hundred and thirty-six women with known previous gestational diabetes and normal glucose tolerance between pregnancies attended a preconceptional clinic at least 2 months before conception, and were regularly consulted by a diabetological team. Evaluation consisted of oral glucose tolerance test (OGTT), mean blood glucose, glycosylated haemoglobin and management by self-blood-glucose monitoring (SBGM) and nutritional counselling. When these patients were compared to a group of 154 patients with gestational diabetes who attended our clinic at different stages of pregnancy, the former had improved glucose homeostasis whereas the latter had more frequent elevations of fasting and postprandial glucose levels throughout pregnancy. This group had also more maternal complications and higher Caesarean section rates. Congenital anomalies were 0.65% among offspring of nonattenders, while none occurred in those with preconceptional counselling. Macrosomia and hypoglycaemia were significant neonatal complications in infants of nonattending mothers. We concur with the recommendation that preconceptional counselling in gestational diabetics is required to improve glucose homeostasis throughout pregnancy, and that appropriate evaluation of glucose intolerance should be included as part of prospective family planning.

Adult↗
PubMed1987

Preconceptional diabetes control in insulin-dependent diabetes mellitus patients with continuous subcutaneous insulin infusion therapy.

Preconceptional diabetes management is an important prerequisite for pregnancy planning and its value has been well-documented. Glucose control and the outcome of pregnancy, managed in the preconceptional period, with continuous subcutaneous insulin infusion therapy to those receiving insulin injections are compared. Fifty-two juvenile onset insulin dependent diabetic women contemplating pregnancy were regularly consulted by a diabetology team starting at least two months before conception. Glucose control was achieved by continuous subcutaneous insulin infusion pumps (CSIIP) in 18 patients, and 34 women received intensive insulin therapy (IIT). In both groups, normal glucose levels and normal HbA1 were achieved at conception, maintained during the period of organogenesis and throughout pregnancy. In view of the fact that perinatal results, such as the occurrence of malformations, mean gestational age, mean birth weight and neonatal complications were not significantly different in both groups, we believe that both methods are equally effective. Consequently, the less costly and yet effective IIT may be the method of choice, while the more expensive pump should be used mainly in selected cases.

Diabetes Mellitus, Type 1↗
PubMed1986

Pregnancy outcome in patients with insulin-dependent diabetes mellitus with preconceptional diabetic control: a comparative study.

Forty-four of 75 pregnant women with juvenile-onset insulin-dependent diabetes, who attended a preconceptional clinic, were seen regularly by a diabetologic team. Glycemic control was obtained by intensified insulin therapy and monitored by blood glucose self-monitoring. When these patients were compared with a group of 31 nonattenders of the preconceptional clinic, in the former normoglycemia and normal hemoglobin A1 values were achieved before conception, whereas in the latter good control was reached by the second trimester. This group had also more maternal complications, such as preeclampsia, and higher cesarean section rates. Congenital anomalies were 9.6% among offspring of nonattenders, while none occurred in those with preconceptional counseling. We confirm the evidence accumulated in the recent literature that congenital malformations in pregnancy complicated by diabetes may be linked to disturbances in maternal metabolism during the period of embryogenesis. Consequently we concur with the recommendation that tight diabetic control is required before the patient attempts to conceive.

Adolescent↗
PubMed1986

Bilateral Sertoli-Leydig cell tumor with heterologous elements: report of an unusual case and review of the literature.

A case of bilateral ovarian Sertoli-Leydig cell tumor with heterologous elements is reported in an 18-yr-old girl with marked virilization. Panhysterectomy was performed, yet the tumor recurred shortly after the intervention. The microscopic picture was one of intermediate to poor differentiation. Despite chemotherapy, the postoperative course was rapidly malignant, and the patient died 4 wk later.

Abscess↗
PubMed1986

Quadruplet pregnancy in IVF.

The frequency of multiple pregnancy following IVF with the presently accepted methods is ten times higher than in natural cycles, and is identical to that following induction of ovulation with HMG. In spite of the fact that multifetal pregnancy exposes both fetus and mother to certain dangers, most couples joining IVF programs expose themselves to, and generally accept the risk of, multiple pregnancy, since this is their last resort for having a baby of their own. We report such a case of quadruplet pregnancy after the IVF procedure and review the literature.

Abortion, Induced↗