Viability of in vitro-developed human embryos.
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Blastomeres↗
Biomedical subjects
F Leroy
Publications and source records attributed to F Leroy.
Dihydroergotamine-erythromycin-induced ergotism.
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Aged↗
Laminin and type III procollagen peptide in human preovulatory follicular fluid.
The levels of laminin P1 fragment, a marker of basement membrane, and of the aminoterminal sequence of type III procollagen, a marker of interstitial connective tissue, were measured in human preovulatory follicular fluids. The concentrations of these peptides correlated with progesterone levels but not with those of estradiol or testosterone. Immunocytochemical studies confirmed the remodeling of the perifollicular basement membrane and interstitial matrix during oocyte maturation. The studies suggest that monitoring of the ovarian connective tissue macromolecules could be useful for estimating follicular maturation.
Basement Membrane↗
Early pregnancy loss and obstetrical risk after in-vitro fertilization and embryo replacement.
Between March 1983 and March 1986, 108 pregnancies were obtained at the IVF clinic of St Pierre Hospital in Brussels. There were 29 chemical pregnancies (26.8%), five ectopic pregnancies (4.6%), 15 abortions (14%) and 59 ongoing pregnancies of over 20 weeks (54%). Patients who had experienced a chemical pregnancy at first trial displayed a significantly higher rate of ongoing pregnancy at their second attempt. Among the 15 cases of abortion, a chromosomal anomaly was detected in two cases and suspected in a third. Four of the five ectopic pregnancies occurred in patients with previously documented tubal pathology. The ongoing pregnancies were distributed as 44 singletons, 13 pairs of twins, one set of triplets and one set of quadruplets. The Caesarian section rates were 21 and 40% for single and multiple pregnancies, respectively. The prematurity rate was low for singletons (4.5%) but reached 46.6% in multiple pregnancies. Two minor malformations were observed and five perinatal deaths occurred; among these latter, four cases were twins. It appears that perinatal pathology is substantially higher among IVF pregnancies than in the normal population. It is clear, however, that most of this difference is accounted for by the considerably higher rate of twin pregnancy displayed by the former group.
Abortion, Spontaneous↗
Clinical and morphologic aspects of the vanishing twin phenomenon.
The pathologic findings in placentas from ten multiple gestations complicated by the so-called vanishing twin phenomenon were studied to confirm the ultrasonographic evidence. Five pregnancies resulted from in vitro fertilization and embryo transfer, and five conceptions were spontaneous. The pregnancies were studied by repeat ultrasound examinations between five and 12 weeks' gestation. First-trimester bleeding was the only clinical sign of this phenomenon. Postpartum evidence of the vanishing twin phenomenon was found in five cases. Morphologically, the lesions were characterized by well-delineated plaques of perivillous fibrin deposition, associated in one case with embryonic remnants. This focal degenerative change of the placental mass, which also exists in about 25% of placentas from uncomplicated term pregnancies, may be the only clue to the disappearance of one conceptus.
Female↗
[Anatomo-clinical aspects of papyraceus fetus syndrome].
Three cases of twin pregnancies where one of the twins died in the second trimester of the pregnancy are described together with a review of the literature. This pathological condition is found in 1/12,000 births according to the figures reported by Ottolenghi-Preti; but in our series presented as a complication of pregnancy in 1/2,500 deliveries. When there are vascular connections between the dead twin and the survivor in cases of monovular twin pregnancy it is possible that cerebral, renal and skin lesions can occur in the surviving twin; as often as not without any maternal complication. The management of the surviving twin depends therefore on the type of placenta that exists. This can only be determined if an early ultrasound is taken in the first trimester of the pregnancy.
Adult↗
[New inotropic drugs in chronic cardiac insufficiency: progress or wrong track].
The first results of the long-term treatment of chronic heart failure with inotrope positive medications are disappointing, especially in that survival is not prolonged and even a greater mortality is suggested. Is it because of the regular failure of specific medications, of a class of medications or because the overall concept of inotropism stimulation during chronic heart failure should be condemned? The mechanisms of inotropism of normal muscles or muscles in human chronic heart failure are reviewed as well as the various pharmacological means available to stimulate inotropism.
Cardiotonic Agents↗
[Late ventricular potentials. Clinical applications and relation to severe ventricular arrhythmias].
The recording of late ventricular potentials with high amplification cardiography (HAC) permits to identify patients presenting a risk of sudden death and ventricular tachycardia, especially in the later stage of myocardial infarction. Few authors have studied the prevalence of these potentials in other heart diseases presenting a risk of sudden death. Most series in the literature are too small to specify variations in the prevalence of these potentials according to the severity of the coronary disease. For this purpose, 835 patients including 535 coronary patients were evaluated with HAC compared to data from coronary angiography and Holter test. An automatic quantification method of the late potentials was used on 131 healthy subjects. The prevalence of late potentials is 32 p. cent after infarction, and 75 p. cent when a chronic ventricular tachycardia is present. These potentials retain their significance of tracers of ventricular arrhythmias in primary dilated myocardiopathies, with a prevalence of 25 p. cent reaching 50 p. cent in case of ventricular tachycardia. Their recording in the presence of idiopathic ventricular extrasystoles must be an indication to look for an underlying cardiopathy. It is possible to record them in other diseases especially in advanced valvular cardiopathies, as well as in right ventricular dysplasias with arrhythmia where their presence has a great diagnostic value.
Arrhythmias, Cardiac↗
Higher pregnancy rates after in vitro fertilization and embryo transfer in cases with sperm defects.
One hundred thirty-three couples were classified into four groups according to previous sperm analyses. These couples underwent 237 in vitro fertilization trials that led to 46 clinical pregnancies (19.4%/trial). Clinical pregnancy rate per laparoscopy of the group with male defects was significantly higher than that of the normospermic couples (25 versus 14%, P less than 0.05). The fertilization rate was significantly reduced only if two sperm anomalies were present (P less than 0.05). However, the mean number of embryos transferred did not differ significantly among the four groups, but the proportion of trials without transfer was increased with regard to the severity of sperm defect. Implantation rate per embryo in cases of triple transfer was significantly higher in the group with sperm anomalies as compared with the normospermic cases (18 versus 10%, P less than 0.02). Correction of the male problem through IVF treatment allows higher female fertility to be disclosed in these cases.
Adult↗
Endometrial morphology in stimulated in vitro fertilization cycles and after steroid replacement therapy in cases of primary ovarian failure.
Endometrial morphology and ultrastructure are studied in 17 spontaneous, 23 stimulated, and 18 artificial cycles in cases of primary ovarian failure. Normal light-microscopic aspect was found, but impaired development of nucleolar channel system and stronger intercellular junction have been observed by electron-microscopic studies in stimulated cycles with relative excess of luteal estrogen. Normal glandular maturation can be obtained in patients with premature menopause, given adequate steroid replacement, but an abnormally dense fibrocytic aspect of the stroma is characteristic of the first treatment cycles.
Biopsy↗
Morphological anomalies in the placentae of IVF pregnancies: preliminary report of a multicentric study.
Macroscopic characteristics of 100 fetal adnexae from pregnancies obtained by in-vitro fertilization and embryo transfer (IVF-ET) were compared with data for normal pregnancies taken from the literature. Material was obtained from 63 singleton, 15 twin, one triplet and one quadruplet pregnancies. The fetal and placental weights as well as the fetal:placental weight ratio were within the normal range for gestational age. Whilst placental morphology was normal, the insertion of the umbilical cord was frequently abnormal. Marginal (15%) and velamentous (14%) insertions of the umbilical cord were found more frequently than in a general obstetrical population (6% and 1% respectively). Excluding placentae from multiple pregnancies (which are known to have a higher incidence of abnormal cord insertion) the frequency did not decrease and remained significantly higher than in a normal population (P less than 0.01 and P less than 0.001, for marginal and velamentous insertion respectively). Abnormal insertion of the cord is of major clinical importance because of its association with vasa praevia and fetal haemorrhage (Benkiser Syndrome). Since this condition is thought to be caused by disturbed orientation of the blastocyst at implantation it is probably related to the IVF-ET procedure.
Embryo Implantation↗
Embryo scoring as a prognostic tool in IVF treatment.
A semi-quantitative and non-invasive method for scoring embryos obtained after in-vitro fertilization (IVF) has been defined, aiming at selection of embryos before transfer and at prognostic evaluation of IVF trials. Grading of embryos observed on the inverted microscope was essentially based on the amount of anucleate fragments expelled during early cleavage and on developmental speed. Embryos endowed with a high score were more often associated with pregnancy and in particular with the occurrence of multiple pregnancy. No difference was observed between scores attributed to embryos related to ongoing, aborted or chemical pregnancies. Average embryonic scores corresponding to double and triple transfers differed significantly in failures as well as pregnancies. The better quality of embryos replaced in triple transfers was also apparent from the significantly higher implantation rate per embryo observed in this group. From our results, five criteria including clinical data and embryonic scores can be derived for defining a high risk of multiple pregnancy prior to transfer. It might be warranted to replace only two embryos when these conditions are fulfilled.
Embryo Transfer↗
Problems related to the laboratory part of treatment by in vitro fertilization and embryo transfer.
The successive stages leading to fertilization in mammals are reviewed in this article. Methods of human sperm preparation for IVF are described and the "ideal" delay between oocyte pick-up and insemination time is discussed, as well as methods to reduce the incidence of polyspermy. Different culture media and their supplementation are mentioned, as well as a semi-quantitative embryonic scoring system, defined by the IVF team of the Saint-Pierre Hospital in Brussels. Finally the optimal transfer time, and the handling of embryos at replacement are discussed.
Animals↗
Clinical study on embryo transfer after human in vitro fertilization.
One hundred forty-six embryo transfers were carried out in the In Vitro Fertilization (IVF) Clinic at St. Pierre Hospital, Brussels, between November 1983 and February 1985. In each of these cases a series of characteristics of the replacement procedure was systematically recorded. Analysis of these data in relation to pregnancy rates indicated that no significant differences appeared among three different operators, the absence or occurrence of cervical bleeding and subjective evaluation of the procedure were related to the chances of establishing a pregnancy, and the duration of replacement had no influence on the outcome of trials. A prospective randomized study of 100 replacements showed that no better pregnancy rate was obtained by placing patients in the knee-to-chest rather than the dorsal position and the addition of a rigid external sleeve to the catheter did not provide any advantage. A simplified method of replacement is thus advocated.
Catheterization↗
Differences in the luteal phases after failed or successful in vitro fertilization and embryo replacement.
Luteal phases after in vitro fertilization (IVF) and embryo replacement have been studied in 241 cycles. A positive correlation was observed between the follicular estradiol (E2) peak and the progesterone (P) level on day 3 of the luteal phase, but no correlation was found between the E2-peak value and the luteal-phase duration or midluteal P concentration. When the trials were classified in relation to their outcome (i.e., clinical pregnancies, chemical pregnancies, or failures), the mean P level on day 3 of the luteal phase was significantly higher in clinical pregnancies than in chemical pregnancies and in failures. Mean E2 levels on day 3 were not significantly different among the three groups. Values of the E2/P ratio were significantly higher in chemical pregnancies than in the other groups. No significant differences were observed among the three groups on day 8. When comparing trials ending in failure to those leading to clinical pregnancy for the same patients, pregnancies were obtained in cycles in which early luteal P was higher and the early luteal E2/P ratio was lower than in failures cycles. These data suggest that high P levels and a low E2/P ratio in the early luteal phase might have a favorable influence on the implantation process in human IVF.
Embryo Implantation↗
In vitro fertilization and embryo transfer as related to endogenous luteinizing hormone rise or human chorionic gonadotropin administration.
After ovarian stimulation with clomiphene citrate combined with human menopausal gonadotropin for in vitro fertilization, the appearance of a spontaneous luteinizing hormone (LH) surge before fulfillment of the minimal criteria of follicular maturity (at least one follicle greater than 19 mm and serum estradiol [E2] greater than 400 pg/ml/follicle greater than 17 mm) is associated with reduced pregnancy rates. In these cases, follicles are smaller and serum E2 values are lower at the time of the LH surge. Oocyte recovery rate is reduced, embryonic anucleate fragments are more frequently observed, and the level of luteal progesterone on day 4 after oocyte retrieval is lower. Hyperandrogenic patients are more prone to display such premature spontaneous LH surge. We concluded that in case of an untimely LH rise, laparoscopy for oocyte retrieval should be cancelled.
Adult↗
Factors leading to tripronucleate eggs during human in-vitro fertilization.
Four-hundred-and-ninety-one oocytes were collected from 142 successive patients attending for in-vitro fertilization. The systematic observation of pronuclei between 14 and 18 h after insemination revealed 27 cases of tripronucleate eggs among 391 fertilized eggs (6.9%), which corresponds to rates generally reported in the literature. The following parameters were analysed in relation to the incidence of these eggs: aetiology of infertility, follicular response to hormonal stimulation, type of ovulatory stimulus, sperm count and motility and the incidence of fertilization. Only fertilization rates and concentration of motile spermatozoa in the insemination medium were found to be correlated with tripronucleate eggs, confirming that the condition is predominantly due to polyspermy. Comparisons with data from animals, and measures aimed at preventing polyspermy are suggested.
Cell Nucleus↗
A comparison between multiple and single pregnancies obtained by in-vitro fertilization.
Thirty-eight single and 10 multiple pregnancies obtained after in-vitro fertilization were compared. In the group of multiple gestations, maternal age was lower and the amounts of ovulatory drugs given were significantly smaller than in relation to single pregnancies. All multiple pregnancies arose from triple embryo transfers and the embryos from this group exhibited significantly higher vitality scores. In both groups, plasma levels of oestradiol and progesterone followed the same pattern until day 8 after oocyte retrieval. Following implantation, the secretion of these hormones increased more rapidly in multiple pregnancies pointing at greater luteal activity in this group. HCG levels became significantly higher in multiple gestation on day 25 after oocyte collection. Echographic examination showed that, compared to normal pregnancy, growth in both groups of IVF conceptuses was initially retarded but caught up with normal evolution at approximately 30 days after egg retrieval. The need for adjusting the number of embryos transferred not only to expected success rates but also to the risk of high rank multiples is emphasized.
Embryo Transfer↗