PubMed Health⌕ Search

Biomedical subjects

J A Goldman

Publications and source records attributed to J A Goldman.

At least 19 recordsLinked to original sources
PubMed1992

The impact of long-term gonadotropin-releasing hormone analogue treatment on preclinical abortions in patients with severe endometriosis undergoing in vitro fertilization-embryo transfer.

OBJECTIVE: To examine the relationship between endometriosis and preclinical abortions and to evaluate the effect of gonadotropin-releasing hormone analogue (GnRH-a) therapy on these pregnancies. DESIGN AND PATIENTS: Of 67 women with severe endometriosis referred to us for in vitro fertilization-embryo transfer (IVF-ET), 32 underwent ovarian stimulation for oocyte retrieval with menotropins (protocol A), whereas the other 35 were admitted for the procedure after a 6-month period of hormonal suppression with a GnRH agonist (protocol B). The clinical impact of the preclinical and clinical pregnancies in both treatment protocols were evaluated on the basis of oocyte classification and embryo quality score. SETTING: All patients were treated in our IVF Unit. MAIN OUTCOME MEASURE: Clinical pregnancy was used as our main outcome measure of success. RESULTS: A significantly higher number of preclinical pregnancies (P less than 0.0001) occurred in patients treated by protocol A. After GnRH-a treatment, the preclinical pregnancy rate declined significantly (P less than 0.0001), whereas the clinical pregnancy rate per cycle and per transfer rose significantly (P less than 0.0001 and P less than 0.0001, respectively). Furthermore, clinical pregnancies had a significantly better mean embryo quality score in comparison with preclinical pregnancies (P less than 0.0001). CONCLUSIONS: It is concluded that combining GnRH-a therapy before IVF-ET provides an improved treatment modality for preclinical abortions and infertility associated with severe endometriosis.

Abortion, Spontaneous↗
PubMed1991

Fresh versus frozen thawed semen for initial and late insemination in IVF cycles.

Frozen thawed semen has been associated with reduced semen quality and as a result diminished pregnancy rates. In vitro fertilization (IVF) can supply the true measure of the functional fertilizing capacity of fresh versus frozen-thawed semen. One hundred and six patients in an IVF program who underwent donor insemination were divided into two groups. Group I included 51 women in whom initial insemination with donor fresh or frozen semen was performed. They were compared to 65 group II women in whom late insemination with donor fresh or frozen semen was performed after initial insemination with husband semen had failed to fertilize the eggs. There was no statistically significant difference between groups I and II on initial insemination; however, statistically significant difference in fertilization (P less than 0.006) and pregnancy rates (P less than 0.001) between the two groups were achieved when late insemination was carried out. Consequently, we prefer initial insemination with frozen-thawed donor semen in cases indicated.

Adult↗
PubMed1991

GnRH agonist increases pregnancy potential of retrieved oocytes given adequate preincubation before insemination: a comparative study.

Preincubation of oocytes aspirated from follicles in IVF-ET programs is a controversial approach. While some investigators recommend this technique others doubt its necessity. We have studied the embryo quality in 100 women, undergoing IVF-ET, in whom ovulation was induced by the combination of GnRH agonists (GnRHa) and menotropins and compared to a control group in whom ovulation was induced with menotropins alone. No statistically significant difference was noted with regard to the fertilization and cleavage rates as well as to the preincubation period. Significantly higher pregnancy rates (P less than 0.001) were encountered in the first group in comparison with the control group.

Female↗
PubMed1991

The impact of the refractory period to gonadotropin therapy in IVF-ET cycles post longacting gonadotropin-releasing hormone (GNRH) analogue.

Sixty-nine women were treated with a long-acting gonadotropin-releasing hormone analogue (GnRHa), D-Trp-6-LH-RH (DTRP6) 3.2 mg (Decapeptyl, Ferring, Kiel, F.R.G.) prior to induction of ovulation for in vitro fertilization (IVF) with human menopausal gonadotropin (hMG; Pergonal; Serono Laboratories, Inc., Randolph MA). Three types of response were noted: Group I (18 patients) responded between days 1-3 of the treatment; Group II (30 patients) responded between days 4-6 of the therapy, and Group III (21 patients) responded after 7 days of treatment. Although a higher number of oocytes were encountered in Group I than in the latter two groups fertilization and clinical pregnancy rates were lower than in Group II (P less than 0.05), respectively, but higher than in Group III (P less than 0.07 and P less than 0.01), respectively. The best results were achieved by Group II patients, while Group III seemed to represent low responders as the number of embryos and pregnancy rate were significantly lower than in the other two groups. It seems that the level of ovarian suppression achieved by GnRH analogue results in a period of refraction of the ovary, and its duration has most probably an effect upon the results of the IVF cycles.

Adult↗
PubMed1991

Age and pregnancy rates in in vitro fertilization.

The influence of women's age on the results of in vitro fertilization (IVF) was analyzed in 1801 women undergoing the procedure. Advancing age was found to be related to significant reduced success rates from an average of 30.1% per transfer below the age of 36 years to 15.9% per transfer at 37 years or more (P less than 0.001). The decrease was related to a reduction in oocyte production (five at 25 years or less, four below the age of 40 years, three at 40 years or more, and two in the 43 to 47-year group) and probably due to reduced implantation. It is concluded that a woman's age must be considered an important prognostic factor when IVF is suggested.

Adult↗
PubMed1991

Very early pregnancy wastage in in vitro fertilization and embryo transfer (IVF-ET).

The occurrence and incidence of early pregnancy wastage in an in vitro fertilization and embryo transfer (IVF-ET) program have been studied in 750 patients. In 297 (39.6%) a pregnancy was diagnosed; of these, 14.8% were biochemical and 24.8% clinical pregnancies. In the latter group 23.6% aborted, while 75.8% had clinical ongoing pregnancies. The mean embryo quality score of the biochemical pregnancy group was similar to that of the clinical ongoing pregnancy group but statistically different from that of the clinical abortion group (P less than 0.005). Furthermore, the clinical ongoing pregnancy rate in women with previous biochemical pregnancy was 24.7%, a significantly higher percentage compared to clinical ongoing pregnancies achieved in IVF-ET cycles (P less than 0.05). It is possible that biochemical pregnancy does not represent an index for infertility but rather an intact stage of reproduction leading toward implantation. The high clinical pregnancy rate in subsequent cycles may probably serve as an encouraging sign or a marker for future clinical pregnancy.

Abortion, Incomplete↗
PubMed1991

Transvaginal ultrasonic needle-guided aspiration of endometriotic cysts before ovulation induction for in vitro fertilization.

Controversy still exists concerning the optimal treatment of endometriomata in endometriosis and its related infertility. Forty-one women with endometriomata who failed to conceive during previous in vitro fertilization and embryo transfer (IVF-ET) cycles (protocol A) were readmitted for ovum pickup following transvaginal ultrasonic needle-guided aspiration of the endometriomata (protocol B). Following aspiration a significantly higher number of oocytes was recovered (P less than 0.0006); subsequently, more embryos were transferred, and significantly higher clinical pregnancy rates per cycle (P less than 0.0001) were achieved. This difference may be directly related to the reduction of extensive ectopic endometrial tissue (endometriomata) with improved ovarian response, follicular accessibility, and, most probably, improved oocyte quality.

Cysts↗
PubMed1991

Giant diverticulum of the bladder simulating ovarian cyst.

A patient was admitted for investigation of a giant ovarian cyst, confirmed by physical examination. At laparotomy the genital organs appeared normal. Ultrasonic reexamination affirmed the preliminary findings of a pelvic cystic mass. A urinary bladder diverticulum was suspected and confirmed by cystography and found to be nonobstructive in nature. Although extremely rare, bladder diverticulum should be considered in the differential diagnosis of a cystic pelvic mass.

Adult↗
PubMed1991

The prognostic value and significance of preclinical abortions in in vitro fertilization-embryo transfer programs.

UNLABELLED: Preclinical abortions occur in natural conceptions as well as in in vitro fertilization-embryo transfer (IVF-ET) cycles. Nevertheless, although known, this entity is ill defined. OBJECTIVE: The purpose of this study was to propose a classification of these pregnancies on the basis of pathophysiological evidence and to evaluate their future clinical impact. DESIGN: Of 970 IVF-ET cycles, 114 cycles (11.7%) terminated in preclinical abortions. Abortions were divided according to peak beta human chorionic gonadotropin (beta-hCG) values into chemical abortions (52%) occurring 2 weeks after ET with beta-hCG values not higher than 21 mIU/mL and peri-implantation abortions (47%) terminating spontaneously 4 weeks after ET; the latter had higher beta-hCG values for a longer period of time but without any sonographic evidence of gestational sac. No woman in the two groups needed curettage. RESULTS: After a chemical abortion, the pregnancy outcome had better ongoing pregnancy rates (24.7%) in comparison with the 17% achieved in the total IVF-ET cycles. CONCLUSIONS: It is concluded that these two groups most probably have different pathophysiological backgrounds and concomitantly different future clinical impacts.

Abortion, Spontaneous↗
PubMed1991

Combination of long and short term GnRH analogue protocols: a new therapeutic approach to persistent high progesterone levels in IVF cycles.

Thirty-four patients who had had persistently high progesterone (P) levels during menotrophin therapy in previous in-vitro fertilization (IVF) cycles, despite pretreatment with a long acting gonadotrophin-releasing hormone analogue (GnRHa), were randomly divided into two groups according to the mode of ovulation induction used. In 16 women (group 1), induction of ovulation was performed with decapeptyl (DTRP6)/pure follicle-stimulating hormone (PFSH)/human menopausal gonadotrophin (HMG)/human chorionic gonadotrophin (HCG). In 18 patients (group II), the protocol was identical to the former group, except for the addition of a short-acting GnRHa (buserelin) that was started when P levels were persistently high. The combination of long and short acting GnRH analogues (group II) resulted in an improved follicular phase with significantly lower P levels on the day of HCG administration (P less than 0.001). Furthermore, a significantly higher number of oocytes was retrieved, fertilized and cleaved (P less than 0.005; P less than 0.001; P less than 0.005, respectively) and, as a consequence, significantly higher pregnancy rates were achieved (22.2 versus 12.5%; P less than 0.005). These results indicate that a combination of long- and short-acting GnRH agonists may be of value in cases of persistent high P levels during menotrophin therapy in IVF cycles. Further larger studies must be performed before the true efficacy of this mode of treatment can be determined.

Adult↗
PubMed1991

Hypermobility and deconditioning: important links to fibromyalgia/fibrositis.

In this study 210 patients who were identified as having fibromyalgia/fibrositis were evaluated for hypermobility of joints. The patients were then instructed to perform an exercise program, and thereafter their compliance with the program and its effect on their symptoms were evaluated. The data were then analyzed using the Student's t test and Pearson's correlation coefficient. Patients who exercised during the study had improvement. Because the hypermobile patients as a group exercised more than the nonhypermobile group, they showed greater improvement than the nonhypermobile group (58% versus 30%). Patients with fibromyalgia/fibrositis who have articular hypermobility are more likely to exercise, which will improve their symptoms. The ability to show the objective findings of hypermobility to a person with fibromyalgia/fibrositis, a diagnosis based on subjective symptoms and signs, facilitates management of the patient. These tangible signs help the patient accept and adjust to the diagnosis of fibromyalgia/fibrositis.

Adult↗
PubMed1990

The impact of embryo quality on pregnancy outcome in elderly women undergoing in vitro fertilization-embryo transfer (IVF-ET).

Most IVF-ET units limit the procedure to women below age 38. Nevertheless, demands for infertility treatment, including IVF therapy, are more frequent nowadays. We compared 46 cycles for ovulation induction for IVF in 46 women aged 40 or more (Group I) to 51 induced cycles for this procedure in younger women of mean age 30.2 years (Group II). Cancellation rates due to early luteinization or ovulation were significantly higher in group I than in group II (28.2 and 17.6%, respectively) (P less than 0.001). Also, significantly higher abortion rates were observed in older women (62.5%), in comparison to the younger control group, (25%), (P less than 0.001). It is suggested that the high abortion rate considered to be due to genetic factors in older women, may possibly also be due to the aging uterine environment. Furthermore, while embryos with fragmentations may often produce clinical pregnancies in the young, the aging uterus in the elderly woman does not encourage the development of clinical pregnancies in such embryos. Consequently the higher abortion rate in the elderly woman.

Abortion, Spontaneous↗
PubMed1990

The value of hysteroscopy in elderly women prior to in vitro fertilization-embryo transfer (IVF-ET): a comparative study.

Two hundred eighty-four hysteroscopies were performed in 312 (91%) candidates for in vitro fertilization and embryo transfer (IVF-ET) who were divided into two groups. Group I consisted of elderly women over 40 years, and group II of women below this age. Although visualization revealed uterine abnormalities in 29.9% of all patients, abnormal findings were significantly increased in the former group in comparison to the latter (P less than 0.001). This difference was attributed mainly to uterine rather than cervical pathology. Furthermore, in elderly women age-related uterine pathology such as submucous myomata, endometrial hyperplasia, and polyps were more prominent, while in younger patients other uterine lesions such as adhesions and tubal ostia occlusion were more common. Moreover, treatment prior to IVF-ET resulted in 7 clinical pregnancies (8.9%) in group I and in 41 clinical pregnancies (19.9%) in group II, all of which failed in one to three cycles previously. It seems that hysteroscopic evaluation may reduce the IVF-ET failure rate due to intrauterine abnormalities in elderly as well as young patients, thus it becomes an absolute prerequisite for all patients scheduled for an IVF program.

Adult↗
PubMed1990

The value of pre-treatment with gonadotrophin releasing hormone (GnRH) analogue in IVF-ET therapy of severe endometriosis.

Controversy concerning the optimal treatment of endometriosis and its related infertility still exists. Thirty-one women with moderate and severe endometriosis, who failed to conceive during previous in-vitro fertilization and embryo transfer (IVF-ET) cycles (protocol A), were re-admitted for the procedure following a period of hormonal suppression with a gonadotrophin releasing-hormone (GnRH) agonist (protocol B). Following GnRH analogue treatment, a significantly higher number of oocytes were recovered (P less than 0.0006); consequently more embryos were transferred and significantly higher clinical pregnancy rates per cycle (P less than 0.0001) were achieved. This difference may be directly related to the beneficial effect of the GnRH analogue on pelvic endometriosis, converting severe cases into mild ones with improved ovarian accessibility and probably oocyte quality.

Buserelin↗
PubMed1990

Umbilical artery velocimetry in insulin dependent diabetes mellitus (IDDM) pregnancies.

Seven hundred and sixty seven Doppler umbilical artery velocity waveform analyses were performed in 108 pregnant insulin-dependent diabetes mellitus (IDDM) women. No significant correlation between mean third trimester systolic to diastolic (S/D) ratio and either mean blood glucose (r = 0.19) or glycosylated hemoglobin levels (r = 0.28) was found. Mean second and third trimester S/D ratios differed significantly in patients with or without vascular disease (P less than 0.05). Furthermore, women without vasculopathy who demonstrated an elevated S/D developed preeclampsia and delivered appropriate for gestational age infants while patients with vascular disease or chronic hypertension and elevated third trimester S/D (greater than 3) delivered intra uterine growth retarded (IUGR) infants. Moreover, in most of the latter group elevated S/D ratios were recorded in the second trimester prior to ultrasound documentation of IUGR. Our data suggest that in the absence of vasculopathy normal fetal placental resistance can be expected in most pregnancies complicated by diabetes. Patients with vasculopathy are at higher risk for fetal IUGR, which may be identified by early umbilical artery velocimetry.

Diabetes Mellitus, Type 1↗