PubMed Health⌕ Search

Biomedical subjects

F Leroy

Publications and source records attributed to F Leroy.

At least 91 records · Page 5Linked to original sources
PubMed1991

Predictive value of classical and automated sperm analysis for in-vitro fertilization.

The fertilization rates observed in 122 attempts at in-vitro fertilization were examined in relation to sperm characteristics assessed by visual and automated screening. Using linear regression analysis, a significant correlation was found between the fertilization rate and (i) evaluations in fresh semen sperm concentration, percentages of sperm motility, vitality and normal morphology and velocity, (ii) measurements in swim-up preparations of percentages of sperm motility, vitality and morphology, velocity and amplitude of lateral head displacement. No significant correlation was found between the fertilization rate and any of the parameters studied in 24-h-old swim-up suspensions. Analysis by multiple variable stepwise linear regression showed an optimal correlation (R6 = 0.62) between the observed fertilization rate and theoretical calculation obtained from the following predictive function: fertilization rate = -0.3 + (0.008 x swim-up motility) + (0.004 x normal sperm morphology in fresh semen). Introduction of kinematic characteristics studied by automated screening improved the multiple correlation between the calculated and observed fertilization rate in cases of normal or mildly defective semen. Because of the limited availability of motile spermatozoa, automated analysis could not supersede classical sperm analysis in cases of more severe sperm defects.

Autoanalysis↗
PubMed1991

[Prevention of iatrogenic multiple pregnancies].

A significant increase of twin and multiple pregnancies induced by infertility treatment has been observed. These high-risk pregnancies should be efficiently prevented. Gonadotrophin treatment for anovulation being the main culprit, it should be undertaken: 1) if other induction methods have failed. 2) under strict echographic and hormonal monitoring. After in vitro fertilization, number of embryos replaced should be selectively limited (to 2 or 3) on the basis of their vitality scores. Partial reduction of a multiple pregnancy should remain an exceptional solution.

Anovulation↗
PubMed1991

[Prevention of complications of ovarian stimulation in in-vitro fertilization].

The ovarian hyperstimulation syndrome which is the most severe iatrogenic complication of ovulation induction, may range from mere abdominal discomfort to lethal thromboembolism. It is therefore, mandatory to be able to evaluate the risk of such complications. In in vitro fertilization treatment, maximal level and growth rate of oestradiol and also the number of oocytes retrieved, are significantly higher among patients who will develop an hyperstimulation syndrome than in a group of healthy controls. However, due to the large distribution of individual values, none of these variables can be predictive by itself. Only multiple discriminant analysis effected within the frame of a multicentric study might be able to define a specific and sensitive predictive function.

Adult↗
PubMed1991

[Prolonged mechanical nasal ventilation. Apropos of 27 case of myopathy].

We report the results of a retrospective study of a group of 27 patients with a myopathy who were ventilated at home using a nasal mask over a period of 5 years. Twelve patients were ventilated in a preventive fashion before any orthopaedic surgical intervention and 15 out of necessity because of respiratory failure and/or hypercapnia. There was a statistically significant improvement in the PaO2 while the PaCO2 remained stable. The vital capacity (CV) was unaltered. Side effects were relatively frequent but did not lead to this method of ventilation being stopped. One patient died from a very advanced cardio-myopathy after having stopped his own assisted ventilation. Another patient died at home of bronchial congestion. One patient had a tracheotomy after 3 years of ventilation. The treatment was judged overall as positive amongst the 19 patients who responded to a questionnaire anonymously. We are able to confirm the efficacy of this mode of ventilation by the nasal route as much therapeutically as prophylactically, which is against the recently reported results in a multi-centre study.

Adolescent↗
PubMed1991

[Vasomotor activity and coronary insufficiency].

Provocative testing has provided a method of evaluating the important role of vasomotor tone in coronary artery disease. The most sensitive test is the ergonovine (Methergin) test. This is a specific and reliable method of defining the clinical situations in which coronary spasm is common: --focal coronary artery spasm is mainly observed in resting angina alone or in association with effort angina. The prognosis of spasm is excellent with calcium antagonist therapy provided there is no other associated pathology such as left ventricular failure or triple vessel disease; --in the six weeks following myocardial infarction, focal coronary artery spasm is a common event: 20% of coronary angiographies. After six weeks, spasm is much less frequent. It does not influence the prognosis. This type of spasm is probably related to the scarring process; --coronary artery spasm is frequently associated with restenosis after coronary angioplasty, a process which is histologically related to proliferation of smooth muscle; --diffuse increase in coronary vasomotor tone is a much rarer pathology, perhaps related to global changes in vascular tone as its association with the Raynaud syndrome and with migraine would suggest. It presents clinically with resting angina and sometimes by typical Prinzmetal angina; --finally, vosomotor tone plays an important role in the daily life of coronary patients. Holter recordings for the detection of silent myocardial ischemia have shown episodes of myocardial ischemia at lower myocardial oxygen consumption levels than those usually recorded during exercise stress testing, which suggests a reduction in oxygen supply, that is to say coronary vasoconstriction. Changes in coronary vasomotor tone can modify the diameter of healthy coronary arteries by 100%.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗
PubMed1991

[Long-term prognosis after myocardial infarction. Value of exercise test compared to clinical features and coronarography].

The aim of this study was to identify the parameters of exercise stress testing with a predictive value of cardiac death after myocardial infarction and to determine their importance with respect to clinical and coronary angiographic data. Three hundred and three patients, average age 48.9 +/- 9.2 years, surviving primary myocardial infarction, underwent a symptoms-limited exercise stress test and coronary angiography four to seven weeks after infarction. The average follow-up period was 48 +/- 22 months. Eighteen patients (5.9%) were lost to follow-up. Global mortality was 11.6% (33/285) and cardiac mortality was 8.8% (25/285) including 14 sudden deaths (56%) and 17 deaths during the first three years of follow-up (68%). A univariable analysis identified the following parameters of exercise stress testing as predictive of cardiac mortality. The duration of exercise, the maximal rate-pressure product, inconclusive test, the maximal heart rate, and occurrence of supraventricular arrhythmias. Only the last two parameters remained significant after a discriminant analysis and their combination with clinical variables (age and ventricular fibrillation during the hospital phase) enabled accurate classification of 79% of patients, which was significantly better than when clinical features were used alone (p 0.01). On the other hand, adding the data of coronary angiography (number of diseases vessels, absence of an Ergometrine test) only moderately improved this score (82%, NS). This study suggests that the results of the post-infarction exercise stress test enables identification of patients with a low or, on the contrary, with a high risk of cardiac death. The prognostic value of this investigation is better than simple clinical evaluation, especially in stable or asymptomatic patients. In this selected group of patients, coronary angiography did not provide additional prognostic information.

Adult↗
PubMed1990

[Other techniques of arterial recanalization].

During the last few years several new instruments have been added to the armentarium of endovascular procedures. They are aimed at destroying atheromatous plaques and recalibrating the arteries. The plaque destruction techniques include atherectomy which may be directional (as with Simpson's Atherocath) and applicable only to very proximal vascular segments, or rotational, pulverizing the plaques with a bur. In this category are the flexible Auth's rotablator and Stack's transluminal extraction catheter (TEC) where planning is combined with extraction. To traverse complete occlusions, Kaltenbach's rotating guide increases the success rate, but its use must always be completed by conventional angioplasty. Vascular recalibration can be achieved by stents or heating balloons. Numerous types of stent are now available. The best known are the Medivent stent which is self-expansive and stents with expanding balloons, such as the Palmaz Schatz stent or the radio-opaque Wiktor stent made of tantalum. These stents require an important anticoagulant therapy. These technique have widened the limits of angioplasty by tackling stenoses that have long been regarded as inaccessible. They have also made it possible to treat a number of acute occlusions. On the other hand, none of them has yet proved effective in the prevention of restenosis.

Arterial Occlusive Diseases↗
PubMed1990

Use of buserelin acetate in an in vitro fertilization program: a comparison with classical clomiphene citrate-human menopausal gonadotropin treatment.

A comparison has been established retrospectively between clomiphene citrate-human menopausal gonadotropin (CC-hMG) and buserelin acetate-hMG treatments in in vitro fertilization trials performed over a 3-year period. The analysis of 466 CC-hMG and 319 buserelin acetate-hMG trials shows that buserelin acetate-hMG stimulation generates a greater ovarian response resulting in higher numbers of oocytes being retrieved (6.2 + 3.8 versus 9.3 + 5.2) and fertilized (2.8 + 2.7 versus 4.3 + 3.8). More embryos are thus obtained, allowing a wider choice for intrauterine replacement and cryopreservation. Mean embryonic vitality scores do not differ (4.33 + 1.51 versus 4.44 + 1.54), implying that the embryonic quality remains similar in both treatments. A premature demise of the corpus luteum occurs in a large proportion of buserelin acetate-hMG cycles. However, when suppletive progesterone treatment is given, there is a trend toward a better implantation rate per embryo, and a significantly higher ongoing pregnancy rate is observed in relation to buserelin acetate-hMG treatment (20%) as compared with CC-hMG cycles (14%).

Adult↗
PubMed1990

Guidelines for the prevention of multiple pregnancy in treatment by in vitro fertilization.

Within the same in vitro fertilization (IVF) program, treatment trials leading to single and multiple ongoing gestation were compared. Rates of cesarean delivery, prematurity and perinatal mortality were found much higher among twin and multiple IVF pregnancies. Our work thus attempts at defining characteristics of proneness to multiple gestation in IVF treatment, in order to try and avoid its occurrence. The mean vitality score of embryos replaced is the most reliable criterion for this purpose, enabling one to replace no more than two embryos when the average score is high. Age of the patient and cause of infertility are almost nondiscriminant in this respect. Ovarian stimulation parameters such as total dosage of gonadotropin treatment and level of estrogenic response, as well as numbers of oocytes and embryos obtained, may serve as secondary criteria for assessing the twinning risk.

Adult↗
PubMed1990

Fertilization failure in IVF: why and what next?

Among 297 couples who underwent 587 oocyte collection procedures, 95 (16%) total fertilization failures (FF) were observed. This frequency is similar in couples with either normal or only mildly deficient spermatozoa (16.2 and 13.7% respectively) but is almost doubled in cases of moderately and severely defective sperm (26.5%). However, this latter group accounts for only 19% of FF events. The fertilization rate per oocyte (FR) follows an inverse trend. FR was correlated with the final (i.e. after swim-up) sperm count and with initial and final motility of the sperm sample. If the final count and motility were less than 2 x 10(6)/ml and 40% respectively, the FF frequency in the group with partner's spermatozoa was significantly higher and FR significantly lower. FR was inversely correlated with the number of oocytes recovered but FF was found significantly more frequently only when fewer than three eggs were retrieved. No correlation was found between FF and either female causes of infertility, age or dosage of stimulation treatment. However, in the group with donor spermatozoa the FR was significantly lower amongst tubal, endocrinopathic and endometriotic patients (67.6, 67.2 and 56.6 respectively versus 79.7% in harvests from idiopathic cases). FR was decreased and FF increased when ovulation induction resulted from a spontaneous LH peak supplemented with human chorionic gonadotropin (HCG), as compared to induction by HCG alone. In the group using normal or mildly defective spermatozoa, if FF occurs at the first attempt, the frequency of recurrence in further trials is high (29%) and the probability of pregnancy after completed trials is low (12.5%).(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1990

Percutaneous coronary rotary ablation.

The rotablator is a high-speed rotating ablative system developed to grind obstructing atheromatous material into fine particles. It consists of a rotating burr attached to a long, flexible driving shaft with a central flexible guidewire. The device rotates with a speed of 190,000 r.p.m. In this study, after appropriate pretreatment, the atherectomy system was positioned over the guidewire, the steerable guidewire advanced to beyond the stenosis, the abrasive burr positioned at the stenosis and the rotation commenced. The abrasive burr was advanced until a resistance was experienced and then, with back and forth motion, further advanced until passage of the stenosis was achieved. The procedure was repeated six to eight times until no further mechanical resistance was encountered. Patients were maintained on aspirin and nifedipine. With a burr size between 1.5 and 2 mm, in 32 patients in the right coronary artery, twelve patients in the left anterior descending artery and eight patients in the circumflex artery, an average increase in diameter from 0.52 +/- 0.28 mm to 1.27 +/- 0.37 mm was achieved with respective reduction in the stenosis from 80 +/- 11% to 47 +/- 17%. Balloon dilatation was subsequently carried out in 19 patients in 15 of whom residual significant stenosis was due to the use of an inadequately large burr. There were no deaths. During ablation, in six patients evanescent (of few seconds in duration), spontaneously-reversible AV-block developed probably due to embolization of particles into the sinus node artery. Two patients developed coronary spasm, three had acute occlusion with subsequent myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Human rights and procreation].

Assisted procreation raises several problems in relation to Human Rights. The first owes to gamete donation which introduces foreign genetic material into the family. In this respect, conflicting rights of the child, the parents and the donor, are diversely perceived in different cultures. Another difficulty concerns the status of the human embryo cultured in vitro. An analysis based on a relational definition of the human person indicates that the embryo cannot reasonably become endowed with legal rights, if it does not represent the project of having a child. Assisted procreation, moreover, raises the question of the right to parenthood, not only of sterile couples but also of female homosexuals and women without partners. It also reactivates the debate on Human Rights in relation to technocratic power.

Child Advocacy↗
PubMed1990

[Human rights and procreation].

The impact of procreation on freedom, health and welfare of human beings, is considerable. This relationship, however, is not mirrored in texts devoted to Human Rights. This omission obviously implies a neglect of women's and children's rights. The history of anticonceptive methods exemplifies the struggle for these rights. This conquest, which has lasted two hundred years, is far from completed. Because of the demographic outbreak in Third World countries, an ideological conflict has appeared between first generation Human Rights concerned with individual freedom ("rights of") and those of second generation aiming at social fairness ("rights to"). Adequate political and economic adjustment between North and South is a prerequisite to any balanced compromise that would resolve this conflict through democratic, albeit intensive, birth control.

Contraception↗
PubMed1989

Is fresh or frozen semen to be used in in vitro fertilization with donor sperm?

Sixty-six partners of either severely oligoasthenospermic or azoospermic men were treated by in vitro fertilization with donor sperm (IVF-D), usually (86%) after failure of artificial insemination with donor sperm. One hundred twenty-nine IVF trials were performed with either fresh (59%) or frozen-thawed (41%) donor sperm. Characteristics of sperm preparations were significantly lower in the frozen-thawed group (P less than 0.001). In the latter group, fertilization rates had slightly decreased (but without statistical significance); embryonic vitality scores and cryopreservable spare embryos had significantly decreased (P less than 0.05). However, cumulative ongoing pregnancy rates were strictly equivalent in both groups (40% after three trials). Frozen-thawed sperm thus can be substituted for fresh donor sperm without entailing impairment of the outcome of IVF, and this method must be preferred for its greater safety regarding transmission of human immunodeficiency virus.

Female↗
PubMed1989

Fertility prognosis in IVF treatment of patients with cancelled cycles.

Among 429 patients admitted in our in-vitro fertilization (IVF) programme during the last 3 years, 106 experienced cancellation of one or more treatment cycles. A low oestrogen (E2) response represented by far the main reason for cancellation (144/184). Significantly lower clinical pregnancy rates were found in the group of patients with low E2-cancelled cycles (E2CC) as compared to the rest of the IVF population (13 versus 37%). Further comparison between these groups showed only little or no difference in the mean age of patients, basal FSH levels, number of egg collections, rate of oocytes obtained and fertilized per trial and mean embryonic vitality score. A large majority of E2CC patients were found to belong to the tubal infertility group (75%) as opposed to a lower proportion of tubal cases among other IVF patients (56%). E2CC tubal patients showed a lower pregnancy rate than other cases with abandoned cycles and also than other tubal patients (8.9 versus 25 and 35%, respectively). Mean numbers of previous laparotomies, of attempts at oocyte retrieval and of oocytes recovered per trial were similar in tubal patients with or without E2CC. However, in the E2CC tubal group mean age and basal FSH levels were somewhat higher, whereas E2 peak values and fertilization rates were lower, leading to a greater proportion of trials without embryo transfer. Embryonic scores and the E2/P ratio at day 3 of the luteal phase did not differ significantly. It may be concluded that cancelling of a cycle because of a low E2 response in a patient with tubal infertility is indicative of a poor prognosis in further IVF trials.

Adult↗
PubMed1989

[Should one use fresh or frozen sperm in in-vitro fertilization with donors?].

Between 1984 and 1987, 66 women whose partner had severe oligo-asthenoteratospermia or azoospermia underwent in vitro fertilization (IVF) with donor sperm. The mean duration of sterility was 7.5 +/- 3.2 years. Investigations performed in the women showed no abnormality in 30%, pure endocrinopathies in 21% or tubal diseases isolated or associated with other pathologies in 40%. Most of these women (86%) had had previous unsuccessful inseminations with donor sperm. Our study involves 129 attempts of IVF with donor sperm (1 to 3 attempts per patient); the sperm was fresh in 59% of the cases and cryopreserved in 41%. Initial and final motility and sperm density are significantly lower for cryopreserved sperm (p less than 0.001). The fertilization rate is lower with cryo-preserved sperm but the difference is not statistically significant. Moreover, the score of embryonal vitality and the number of embryos that can be cryopreserved are lower with cryopreserved sperm (p +/- 0.05). However the number of pregnancies is identical with one or another type of sperm (40% of the women after 3 IVF). To conclude, cryopreserved sperm may be used for IVF without lowering the percentage of success. In fact, the fertilization rate, the embryonal score and the number of embryos to deep freeze are slightly less with cryopreserved sperm and this difference could reveal to be significant with a larger cohort of patients. But the advantage of fresh sperm must be balanced by the risk of AIDS contamination, avoided with cryopreserved sperm.

Acquired Immunodeficiency Syndrome↗