Biomedical subjects

D Lurie

Publications and source records attributed to D Lurie.

At least 19 recordsLinked to original sources

PubMed2001

Transfer of refrozen twice-thawed embryos do not decrease the implantation rate.

PURPOSE: To assess the ability of twice frozen/thawed multi-cell embryos to implant in the human uterus. METHOD: Fourteen frozen embryo transfer (ET) cycles, in which at least one twice-frozen embryo was thawed for transfer, were matched to frozen ET cycles in which no twice-frozen embryos were thawed. The number of embryos thawed at the pronuclear stage and at the multi-cell stage were matched. RESULTS: Multi-cell embryos frozen once had a 76.3% survival rate after thaw and those frozen twice had a 74.0% survival rate. For frozen ET cycles that had no twice-frozen embryos, the viable pregnancy and implantation rates were 58.3% and 29.8%, respectively. The corresponding rates for cycles involving at least one twice-frozen embryo were 50.0% and 25.5%, respectively. CONCLUSION: The inclusion of twice-frozen embryos in the embryo pool did not reduce the implantation rate.

Adult↗

PubMed2001

Pregnancy rates (prs) according to embryo cell number at time of embryo transfer (ET).

PURPOSE: To evaluate pregnancy and implantation rates following fresh and frozen embryo transfer (ET) according to blastomere number. METHODS: A retrospective study from 1/1/97 to 9/30/98 including all cycles with ETs irrespective of age. RESULTS: 65% of fresh transfers had at least one 8-cell embryo vs only 39.6% for frozen ET. The clinical pregnancy and implantation rates were higher when one 8-cell embryo was transferred (64% and 24%) vs a 5-7 cell embryo (41% and 14.5%) for fresh transfers. There was less of a difference with frozen ETs (46% and 19% for 8-cell vs 38% and 17% for 5-7 cell). CONCLUSIONS: Since mostly only 8-cell embryos at day 3 reach the blastocyst stage, these data raise questions as to whether the quest to attain the highest pregnancy rate per transfer through blastocyst transfer, may be at the expense of overall pregnancy rate (fresh and frozen) from a given oocyte harvest.

Adult↗

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↗

PubMed2001

Cumulative pregnancy rates after four embryo transfers of either fresh or frozen embryos.

PURPOSE: To evaluate in the modern era of in vitro fertilization (IVF) cumulative probability of pregnancy for the first four embryo transfers (ET) irrespective of whether the embryos were fresh or frozen. METHODS: Retrospective review over a 2 1/2 year period. Cumulative probability of pregnancy for four consecutive cycles of either fresh or frozen ETs divided into four age groups. RESULTS: The cumulative clinical and viable pregnancy rates after four ETs were 92% and 88%; 87% and 82%; 83% and 69%; and 68% and 52% for age groups <30, 30-34, 35-39, and 40-44. The cumulative rates decline with age. CONCLUSIONS: Pregnancy rates per transfer for the first four ETs regardless of age are similar even in IVF centers that emphasize frozen ETs.

Adult↗

PubMed2000

Effects of pantothenic acid on postoperative adhesion formation in a rat uterine horn model.

This randomized blind study evaluated the effect of pantothenic acid on postoperative adhesion formation in euestrogenic and hypoestrogenic environment. We used the rat uterine horn model in a university-based laboratory setting. Thirty-six Sprague-Dawley rats were randomized into two estrogenic environments: euestrogenic and hypoestrogenic. The hypoestrogenic condition was achieved in 21 rats by either the administration of gonadotropin releasing hormone agonist or ovariectomy. The remaining 15 rats were untreated and remained in the regular estrogenic state. The left uterine horn was subjected to a lesion by serosal denudation at laparotomy. Following the uterine horn surgery, the rats within each environment were randomized into three treatment groups: saline (control), intraperitoneal pantothenic acid and intramuscular pantothenic acid. The degree of adhesions ten days following surgery was scored by an evaluated blinded to the rat's estrogenic condition and treatment. In the hypoestrogenic environment, there were no differences in the mean adhesions scores by treatment. In euestrogenic rats, the intraperitoneal pantothenic acid group had a higher mean adhesion score than intramuscular pantothenic acid, but neither treatment mean differed from that of the saline group. There was no difference in the mean adhesion scores of the saline groups by estrogenic environment. We concluded that pantothenic acid was not found to decrease adhesions formation when administered intraperitoneally or intramuscularly at these dosages. Contrary to previous reports, the hypoestrogenic condition alone was not found to be associated with decreased adhesion formation in our study.

Animals↗

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↗

PubMed1999

Effects of misoprostol on lipoprotein (a) levels of ovariectomized rats.

OBJECTIVE: To determine the effects of misoprostol on plasma lipoprotein (a) concentrations of ovariectomized rats. DESIGN: Controlled prospective study. SETTING: Animal research laboratory. ANIMAL(S): Four-month-old female Sprague-Dawley rats. INTERVENTION(S): Blood samples were obtained before and 60 days after ovariectomy, and the rats were divided into three groups. Group I (five rats) was treated with vehicle (water); groups II and III (nine and eight rats, respectively) were treated with oral misoprostol at 100 and 200 microg/kg/d, respectively, for 60 days, after which blood was drawn again. MAIN OUTCOME MEASURE(S): Serum lipoprotein (a) levels. RESULT(S): The median lipoprotein (a) level before ovariectomy was 10.8 mg/dL (range, 10.6-46.5 mg/dL). Sixty days after ovariectomy, the level increased significantly to 15.9 mg/dL (range, 10.6-36.9 mg/dL). After treatment, there was no change in lipoprotein (a) levels in the vehicle-treated group (range, 16.3-21.1 mg/dL); however, the lipoprotein (a) levels decreased significantly in the group treated with 100 microg/kg/d of misoprostol, from 15.4 mg/dL to 10.8 mg/dL, and in the group treated with 200 microg/kg/d of misoprostol, from 17.1 mg/dL to 10.6 mg/dL. CONCLUSION(S): Misoprostol caused a significant decrease in lipoprotein (a) levels.

Animals↗

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↗

PubMed1998

Effect of age on pregnancy outcome without assisted reproductive technology in women with elevated early follicular phase serum follicle-stimulating hormone levels.

There are data suggesting that patients with elevated early follicular phase serum follicle-stimulating hormone (FSH) levels have a poor fertility outcome. This has been attributed to a high rate of aneuploidy in the oocytes. It is not clear whether the spindle defects leading to nondisjunction are related to the high FSH levels or the age of the oocyte. The study presented herein retrospectively evaluated 6-month pregnancy rates in women with elevated early follicular phase serum FSH levels according to age. Only cases without in vitro fertilization were used, since the elevated FSH levels were deemed likely to interfere with multiple egg recruitment needed for assisted reproductive technology. The 6-month clinical and ongoing pregnancy rates were significantly higher in the women <40 years of age (46.1 and 34.6%, respectively) than in those aged 40 or older (10.5 and 5.3%). These data suggest that women with elevated follicular-phase serum FSH levels have a better fertility prognosis when they are younger.

Adult↗

PubMed1997

Clinical outcome of cryopreserved human pronuclear stage embryos resulting from intracytoplasmic sperm injection.

OBJECTIVE: To compare the survival rate and pregnancy rate (PR) of embryos from intracytoplasmic sperm injection (ICSI) or conventional IVF, which were cryopreserved at the pronuclear stage in cycles where fresh transfer was deferred. DESIGN: Comparative observational study. SETTING: University-associated IVF center. PATIENT(S): Ninety-nine patients who deferred ET and had all their embryos cryopreserved at the pronuclear stage after 153 oocyte retrievals. Thirty-nine patients had their oocytes inseminated by ICSI and 60 patients had conventional IVF insemination. INTERVENTION(S): All embryos were frozen-thawed at the two pronuclear stage and allowed to cleave for 2 days before transfer. MAIN OUTCOME MEASURE(S): Survival rate (morphologically intact after thaw), cleavage rate (cleaved by time of transfer), and the clinical PR after frozen ET. RESULT(S): In the ICSI group, 205 embryos were thawed for use in 57 frozen ETs; in the IVF group, there were 527 embryos thawed for use in 149 frozen ETs. There was no significant difference in any of the outcome measures by insemination method: survival rates (ICSI, 93.2%; IVF, 94.8%); cleavage rates (ICSI, 95.2%; IVF, 94.7%), and clinical PR (ICSI, 14.0%; IVF, 17.4%). CONCLUSION(S): Pronuclear embryos resulting from ICSI can be cryopreserved successfully, thawed, and the survival rate and PR are comparable to conventional IVF.

Adult↗

PubMed1997

11 beta-Hydroxysteroid dehydrogenase enzyme activity in granulosa cells derived from ovarian follicles of in vitro fertilization patients.

11 beta-Hydroxysteroid dehydrogenase (HSD) activity was measured in freshly frozen granulosa cells isolated from follicles of twenty-one infertility patients undergoing in vitro fertilization-embryo transfer (IVF-ET). A total of 213 follicles were analyzed for 11 beta-HSD activity. Both nicotinamide-adenine dinucleotide (NAD) and nicotinamide-adenine dinucleotide phosphate (NADP) dependent 11 beta-dehydrogenase activities were measured in granulosa cells. The activity in reductive direction (11-oxoreductase activity) was not measurable either with NADH or NADPH as cofactors. NAD- and NADP-dependent dehydrogenase activities are in comparable levels at 100 nmol/l and 1 mumol/l corticosteroid concentrations. For comparing enzyme activities of individual follicles, significant enzyme activity was considered to be a level of > 2 nmol/l/min/mg. 41.3% of the follicles demonstrated enzyme activity, 58.7% did not. The mean 11 beta-dehydrogenase (11 beta-DH) activity was calculated for each patient. Those patients with levels > 2 nmol/l/min/mg were considered enzyme positive; those with mean levels < 2 nmol/l/min/mg were considered negative. No significant association was noted between follicle size, oocyte maturity or fertilization rates and 11 beta-DH activity. This study noted the presence of 11 beta-DH activity in granulosa cells, however, no association with oocyte maturity and fertilization was found.

11-beta-Hydroxysteroid Dehydrogenases↗

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↗

PubMed1996

Pregnancy achieved with pronuclear-stage embryos that were cryopreserved and thawed twice: a case report.

PURPOSE: Our purpose was to determine if pronuclear-stage embryos (2PN) could be thawed, then frozen again with subsequent survival and cleavage after thawing. METHODS: A simplified cryopreservation protocol was used in which a slow cooling program is started at the seeding temperature of -6 degrees C in an alcohol-bath controlled-rate freezer. 1,2-Propanediol (1.5 M) was added to embryos before cooling. A fast thawing technique at room temperature was used. The cryoprotectant was removed in one step using a 1 M sucrose solution. RESULTS: Three months after refreezing, the three 2PN embryos were thawed and all three cleaved after 24 hr in culture. Following embryo transfer a pregnancy was achieved and a healthy full-term baby girl was born. CONCLUSIONS: This is the third case reported of successful pregnancies after transfer of human embryos that were frozen twice before transfer and the first case where the second freeze occurred at the pronuclear stage. This is also the first successful refreezing of human embryos using a simplified freezing and thawing technique with one-step addition and removal of cryoprotectant.

Adult↗

PubMed1996

The relationship of early follicular phase serum LH and pregnancy rates in women with regular menses.

OBJECTIVE: To investigate the relationship of early follicular phase serum LH levels and pregnancy rates in ovulatory women with regular menstrual cycles. METHODS: One hundred consecutive couples seeking help for infertility who had bilateral tubal patency, a minimum motile sperm-density-of 2.5 million/mL, and regular menstrual cycles were enrolled in the study. Baseline serum measurements of LH, FSH, and testosterone were obtained before treatment. Patients were treated with clomiphene citrate, human menopausal gonadotropin, or progesterone supplementation, as needed. Treatment continued for 6 months or until conception occurred. The 6-month pregnancy rates were correlated with baseline early follicular phase serum levels and age. RESULTS: The 6-month viable pregnancy rates did not decrease with an increase in baseline LH serum levels; they were 50% if LH was 10 mIU/L or less, 15.3% if LH was 11-20 mIU/mL, and 71.4% if LH was more than 20 mIU/mL. The 16.7% pregnancy rate in women whose baseline FSH exceeded 25 mIU/mL was significantly lower than the 56.3% rate in women whose FSH was 25 mIU/mL or lower. The pregnancy rates also declined significantly with age. When we controlled for age, FSH did not have an independent effect on conception rates. CONCLUSION: Early follicular phase serum levels of LH were not associated with pregnancy rates in infertile ovulatory women who were treated with progesterone in the luteal phase when needed. However, early follicular levels of FSH and age at treatment were found to be related to pregnancy rates.

Adult↗

PubMed1996

Transfer of cryopreserved embryos improved pregnancy rates in patients with damage to the functional integrity of the sperm membrane as measured by the hypo-osmotic swelling test.

OBJECTIVE: To compare the pregnancy rates (PRs) after transfer of cryopreserved embryos in patients who have damage to the functional integrity of the sperm membrane as measured by the hypo-osmotic swelling test to those without this defect. DESIGN: Prospective clinical study. SETTING: University-associated IVF center. PATIENTS: Fifty-four patients enrolled in a matched prospective study to evaluate the effects of low HOS scores (<50%) on PRs after IVF-ET were followed to determine the PR after transfer of cryopreserved embryos. MAIN OUTCOME MEASURE: Clinical PRs and implantation rates. RESULTS: Fourteen patients with low hypo-osmotic swelling test scores underwent 21 frozen ET cycles, achieved for clinical pregnancies for a PR per cycle of 19.0% and an implantation rate of 7.1%. Twelve patients with normal hypo-osmotic swelling test scores underwent 21 frozen ET cycles, achieved five preganancies for a clinical PR per cycle of 23.8% and an implantation rate of 9.3%. CONCLUSION: Previous studies have demonstrated an adverse effect of low hypo-osmotic swelling test scores on PRs after IVF-ET despite normal fertilization. This adverse effect was not found in the transfer of cryopreserved embryos from males with hypo-osmotic swelling test scores. Further investigation is required to determine how cryopreservation improves the chances of implantation of these embryos.

Cell Membrane↗