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Biomedical subjects

F R Batzer

Publications and source records attributed to F R Batzer.

At least 37 records · Page 2Linked to original sources
PubMed1993

Predicting success of gamete intrafallopian transfer.

OBJECTIVES: To examine seminal parameters predictive for success in a cycle of GIFT and to construct an algorithm using pertinent seminal data as well as easily obtained historical data to predict pregnancy and viable pregnancy rates. DESIGN: A retrospective study of 544 cycles in 376 couples. SETTING: A private IVF-ET and GIFT center. PATIENTS: Couples in a GIFT program with a mean of 53.6 months of infertility who had failed to conceive with other therapies. INTERVENTIONS: Gamete intrafallopian transfer. MAIN OUTCOME MEASURES: Pregnancy as a function of laboratory historical data with emphasis on seminal parameters. RESULTS: Motility was the only seminal parameter that was predictive. Success was correlated with the number of oocytes returned and inversely related to female age. An algorithm to predict pregnancy in a GIFT cycle as well as viable pregnancy was constructed. CONCLUSIONS: Motility is the only seminal parameter predictive for success in a GIFT cycle. An easily programmable algorithm can be constructed to help patient and physician decide on the appropriateness of GIFT for each couple.

Adult↗
PubMed1992

Genetic offspring in patients with vaginal agenesis: specific medical and legal issues.

OBJECTIVE: There are new options for genetic offspring in patients with vaginal agenesis (Mayer-Rokitansky-Küster-Hauser syndrome). The reported world experience to date with genetic offspring of patients with vaginal agenesis consists of five pregnancies (including two reported here and two frozen embryos). The specifics of these cases are presented for discussion. STUDY DESIGN: We present a retrospective description of two women with vaginal agenesis and their matched gestational carriers with positive outcome of two live births. Care was delivered in a private in vitro fertilization and gamete intrafallopian transfer program. RESULTS: In vitro fertilization of oocytes gathered from the genetic mother with vaginal agenesis and sperm from the genetic father were transferred to a gestational carrier. Two live births and one blighted ovum pregnancy resulted. CONCLUSION: Until recently, treatment for patients with vaginal agenesis (Mayer-Rokitansky-Küster-Hauser syndrome) has centered on the creation of a functional vagina. The technology of in vitro fertilization and embryo transfer, allowing for collection of oocytes from the genetic mother, fertilization by the genetic father, and placement into a gestational carrier, enables a woman without a uterus to have her own genetic children. The specific medical and legal issues involved in facilitating genetic offspring in these instances must be considered; these include the initial matching of the genetic parents with the gestational carrier, cycle synchronization for in vitro fertilization and embryo transfer, anatomic difficulties of oocyte retrieval, birth certificate documentation, and the current legal status of a gestational carrier.

Adult↗
PubMed1992

Leuprolide acetate-prepared in vitro fertilization-gamete intrafallopian transfer cycles: efficacy versus controls and cost analysis.

OBJECTIVE: To evaluate the effect of gonadotropin-releasing hormone agonist (GnRH-a) when given through stimulation with gonadotropins versus stopping it as stimulation was initiated versus a control group unprepared in this manner. Also, to construct a cost analysis for this type of therapy in an in vitro fertilization-gamete intrafallopian transfer program (IVF-GIFT). DESIGN: Prospective, consecutive, randomized, with a control group. SETTING: An out-patient IVF-GIFT program. PATIENTS: One hundred new patients entering an IVF-GIFT program. INTERVENTIONS: In vitro fertilization or GIFT cycles with or without preparation (pituitary suppression) by GnRH-a administration in which suppression was continued or halted as gonadotropins were begun. MAIN OUTCOME MEASURES: Cancellation rates, ampules, and days of gonadotropin use, costs, estradiol (E2) level, egg numbers and quality, and pregnancy rates. RESULTS: Stopping GnRH-a (leuprolide acetate) therapy as stimulation was begun did not lessen the suppressive effect in reduction of spontaneous luteinizing hormone surge as seen with continued use of agonist. In contrast, the control group had a 30.3% cancellation rate before ovum retrieval. The E2 and egg data among the groups were similar, but as expected, agonist use led to the need for more and longer duration of gonadotropin stimulation. Pregnancy rates were not different by group. Costs were approximately even by the third initiated cycle.

Adult↗
PubMed1992

Insemination data on men with varicoceles.

OBJECTIVE: To determine possible benefits of sperm processing and intrauterine insemination (IUI) for a group of men with a varicocele history who had not achieved a pregnancy by natural coitus (mean duration of infertility 42.2 months). DESIGN: A retrospective study including infertile men with varicoceles who were classified by their semen analyses and sperm penetration assays (SPAs). SETTING: Private practice of infertility. PATIENTS: Seventy-one infertile couples. The husbands had a varicocele history and were grouped into four clinical categories (14 untreated, 5 medical treatment, 34 varicocelectomies, and 18 varicocelectomies plus medical treatment). The wives were studied or treated before IUI. INTERVENTIONS: Varicocelectomies were performed on the males when indicated. Female studies included laparoscopies as indicated intrauterine insemination with Tomcat catheter (Sherwood Medical, St. Louis, MO) was performed in all cases. MAIN OUTCOME MEASURES: Overall pregnancy rates (PRs) and fecundity rates with sperm processing and IUI. RESULTS: Six pregnancies occurred with 66 cycles of sperm processing and IUI among 28 men with normal SPAs (PR 21%, fecundity rate = 0.09). In contrast, there were no pregnancies with 121 cycles among 43 varicocele patients with abnormal SPA results or with low values for all three semen parameters. CONCLUSIONS: Sperm processing and IUI may be beneficial for selected patients with varicoceles who had not achieved a pregnancy by coitus.

Adult↗
PubMed1991

Surgical treatment of endometriosis at the time of gamete intrafallopian transfer.

Gamete intrafallopian transfer (GIFT) was performed on 77 women with endometriosis in 92 cycles with or without concomitant laser therapy or electrofulguration of endometriosis. The pregnancy rates were 45% for laser cases, 25% for electrofulguration cases and 36.4% for GIFT only. The pregnancy rate for stage III endometriosis was 53% versus 14% and 47% for stages II and I, respectively. Although there was a trend toward an increased pregnancy yield with active therapy, no statistically significant difference was achieved. The postoperative fecundity in patients not conceiving with GIFT was poor for all the groups.

Adult↗
PubMed1989

Laparoscopic laser treatment of endometriosis with the Nd:YAG sapphire probe.

Laparoscopic surgery with the Nd:YAG laser generator and a sapphire probe was performed in 43 women for relief of pain and/or infertility associated with endometriosis and in two other women for treatment of an asymptomatic adnexal enlargement. More than half of the patients had American Fertility Society endometriosis scores of stage III or IV. Results of uterosacral denervation for pain relief were excellent, and eight of 17 patients who were attempting pregnancy with follow-up for 6 months conceived. A touch technique, reduced smoke production, and delivery via a flexible fiber constitute advantages to the surgeon compared with carbon dioxide systems.

Adult↗
PubMed1989

Outcome in 242 in vitro fertilization-embryo replacement or gamete intrafallopian transfer-induced pregnancies.

Two centers combined data on 152 in vitro fertilization embryo replacement and 90 gamete intrafallopian transfer generated pregnancies. The outcomes of the pregnancies with respect to abortion, ectopic gestation, and multiple gestation were evaluated independently by method and by center. Only with multiple gestation by center was a difference seen. Variables examined included estradiol levels, luteal phase support, maternal age, and prior reproductive history, and the number of eggs or embryos replaced.

Abortion, Spontaneous↗
PubMed1989

Intrauterine insemination and ovulation stimulation as treatment of infertility.

Fecundity rates were measured for 302 patient-couples in 991 cycles of intrauterine insemination (IUI) between January 1984 and December 1986 in terms of the diagnoses and whether human menopausal gonadotropin (hMG) was also employed. Those rates were compared with the fecundity rates in 255 of the couples followed in 2,668 untreated cycles. IUI was most beneficial for cervical factor infertility, with a monthly yield of 0.11 in conjunction with hMG and for poor postcoital tests in general but was less impressive when seminal parameters were abnormal. The addition of hMG when ovulation was normal (as an independent variable) did not yield results statistically superior to those of IUI alone (fecundity = 0.06 versus 0.03), but the addition of hMG to the regimen gave an improvement over IUI alone when endometriosis had been diagnosed and in the presence of cervical factor infertility. One serious side effect of therapy was a pelvic abscess, which required hospitalization but not surgery.

Adult↗
PubMed1989

Measurement of the force necessary for laparoscopic trocar entry.

A study was designed to measure the force necessary for trocar insertion before laparoscopy. A strain gauge was used to measure the force used with a reusable, pyramid-tipped trocar system sharpened at regular intervals and a disposable trocar system also with a pyramidal point and of equal diameter (10 mm). Variables studied for both groups, 50 patients each, included the type of incision made at the umbilicus; the opening and closing laparoscopic gas source pressure; the volume of gas delivered to create the pneumoperitoneum; the age, weight and height of the patient; and whether the laparoscopy was the first or a repeat. The variables were matched for both groups. The disposable device required half the force for entry required with the reusable device. Since many gynecologists are now women and thus may have less upper body strength than men do, this finding could be important for them. Further, the disposable trocar affords an operator of any size and strength greater control over the potentially dangerous trocar insertion into the abdomen since less force is required.

Disposable Equipment↗
PubMed1988

Sulfasalazine-induced abnormal sperm penetration assay reversed on changing to 5-aminosalicylic acid enemas.

Sulfasalazine, a drug used in the treatment of inflammatory bowel disease, has been associated with male infertility, an effect attributed to sulfapyridine rather than to 5-aminosalicylic acid (5-ASA), the presumed therapeutically active component of sulfasalazine. Recently, the sperm penetration assay (SPA) has been found to be an accurate method of quantitating male fertilization potential. We report the case of a man with ulcerative colitis in whom infertility and a markedly abnormal SPA were demonstrated while he was taking sulfasalazine. Shortly after discontinuing sulfasalazine and initiating treatment with 5-ASA enemas, his SPA became normal and his wife became pregnant. The SPA is a useful screening test for sulfasalazine-induced male infertility. On the other hand, 5-ASA enemas do not appear to be associated with an abnormal SPA.

Adult↗
PubMed1988

The human sperm-hamster egg penetration assay: prognostic value.

Males from 227 infertile couples were evaluated using the human sperm-hamster egg penetration assay (SPA). Indications for the SPA were abnormal semen analyses, poor postcoital tests, documented autologous sperm antibodies, and long-term unexplained infertility. Normal results defined as greater than or equal to 11% penetration were seen in 58.6% of couples. Penetration rates of 1% to 10% were observed in 25.6%, and 15.9% failed to penetrate any of the oocytes. During the follow-up period, with a mean of 17.9 months, 26.9% conceived at least once with or without treatment. Monthly fecundity was 0.014 for normal SPA patients and 0.007 for the abnormal SPA group when calculated by the Kaplan-Meier survival curve with Cox correction for unequal follow-up. The monthly fecundity rate at any time during the 30-month interval of follow-up was twice as great for men with normal SPA values as for those with abnormal values, regardless of male or female diagnosis or therapy indicating the prognostic value of the SPA in an infertile population.

Animals↗
PubMed1988

Correlations between results of the immunobead test and the sperm penetration assay.

Immunobead testing (IBT) and human sperm-hamster egg penetration assay (SPA) were performed in 233 infertile men. Positive immunologic results were recorded in 31 (13.3%). Significant reduction in SPA scores was found in patients with IgG antisperm antibodies alone but not in patients with IgA alone or in combination with IgG. Normal SPA scores were seen in 56% of immunonegative patients (n = 113) vs. 32% of immunopositive patients (n = 10). Therefore, a normal SPA does not rule out the presence of significant levels of antisperm antibodies.

Animals↗
PubMed1987

Correlations between the human sperm-hamster egg penetration assay and in vitro fertilization results.

The human sperm-hamster egg penetration assay (SPA) has been used to evaluate male fertility under in vivo conditions. The test is not only unstandardized, but agreement does not exist as to the lower limits of normal penetration rates. Therefore, it is not surprising that there is considerable doubt as to whether any correlation exists between SPA results and the behavior of sperm in an in vitro laboratory situation. We investigated this question by examining the SPA results and the subsequent fertilization and cleavage rates in the in vitro fertilization program at Pennsylvania Hospital. The sperm from men whose SPA results were 11% or more fertilized 86% of the morphologically normal and mature human oocytes to which they were exposed. Men whose SPA scores ranged from 1% through 10% fertilized 65% of human oocytes, and men whose sperm failed to penetrate hamster eggs still were able to fertilize 41% of the human oocytes. The differences between these groups are statistically significant. This information can be of practical prognostic value during in vitro fertilization cycles in which the number of mature oocytes seen ultrasonographically appears to be at a minimum.

Animals↗
PubMed1986

The "vanishing twin": ultrasonographic assessment of fetal disappearance in the first trimester.

Review of the sonographic findings of 1000 pregnancies with viable gestations in the first trimester revealed a minimum incidence of twinning of 3.29%. Of these, 21.2% demonstrated the "vanishing twin" phenomenon, often with associated bleeding, but with a good prognosis for the remaining fetus. Ovulation induction did not appear to alter these data. The sonographic criteria for "vanishing twin" are discussed. The incidence of multiple gestation is 3.29% to 5.39%, higher than previously believed.

Diagnostic Errors↗
PubMed1986

Diagnostic techniques used for ectopic pregnancy.

Though all diagnostic techniques used for ectopic pregnancy yield false-negative and false-positive results, prospective serial studies using hormonal and sonographic testing are quite accurate when appropriately applied.

Adult↗