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Biomedical subjects

J D Rainhorn

Publications and source records attributed to J D Rainhorn.

11 recordsLinked to original sources
PubMed1994

Priorities for pharmaceutical policies in developing countries: results of a Delphi survey.

The use of the Delphi method as a systematic and logical approach to establishing consensus among international experts on the priorities for interventions in national drug policies in developing countries is described. The Delphi survey showed a high degree of reliability, as evidenced by the high response rate, the quality of respondents, and the high standard for consensus. In addition to creating consensus on key issues and key components for priority intervention, the study identified six components that could constitute a basic framework for designing drug policy in developing countries. The study's conclusions have important implications for decision-makers within international development agencies and national governments.

Delphi Technique↗
PubMed1989

Phase I clinical trial of monoclonal anti-human chorionic gonadotropin antibody in women with an ectopic pregnancy.

A phase-I clinical trial of a mouse monoclonal anti-human chorionic gonadotropin (hCG) antibody designated as HT13 was conducted in three patients treated for ectopic pregnancy. Doses of 5 and 25 mg of purified antibody were injected into patients. Monoclonal antibody serum levels dropped to 0 within 1 to 5 days. Human antibodies directed against mouse immunoglobulins were not detected at up to 41 days after injection. In one patient, the tubal pregnancy resolved, as confirmed by hCG levels of less than 10 mUl/mL and by tubal patency at hysterosalpingography. The time of resolution was 30 days. In two patients, salpingectomy was performed because of persistence of elevated hCG levels, whereas HT13 had a striking effect on progesterone (P) and estradiol (E2) serum levels. The injection of anti-hCG antibody did not appear to interfere with the subsequent fertility of patients, and two out of three patients later developed a successful pregnancy. While the precise role of antibody injection in the interruption of ectopic pregnancy remains speculative, the injection of monoclonal anti-hCG antibody appears to induce a dramatic decrease in the production of both P and E2.

Antibodies, Monoclonal↗
PubMed1988

Improvements in ovarian stimulation for in vitro fertilization.

What are the major improvements in stimulation over recent years? The stimulated cycle has completely superseded the natural cycle since this is the only method of obtaining several embryos. In conventional stimulation, despite an enormous body of literature, no single treatment modality has emerged as superior to other forms of therapy. Undoubtedly it is the experience and habits of individual IVF teams that determine the success of one or another method. Therefore programmed stimulation is an improvement in that it introduces the factors of convenience and simplicity while retaining the clinical efficacy of stimulation by conventional treatment. The analogues of LHRH are still in an early phase of development, but they appear to be associated with a low cancellation rate even in previous poor-responders. Furthermore, preliminary results seem to indicate that this is the first development since the widespread adoption of follicular stimulation, which is associated with an increased pregnancy rate. We are currently involved in trying to associate programmed stimulation and analogue treatment in a bid to combine the advantages of both therapies. Finally, embryo cryopreservation must be mentioned. There is no point in refining our stimulation protocols to obtain many embryos if those surplus to immediate requirement are disposed of. Cryopreservation offers the means of maximizing the pregnancy potential of a single IVF cycle while reducing the possibility of multiple pregnancy.

Embryo, Mammalian↗
PubMed1988

Spontaneous resolution of ectopic pregnancy.

Fourteen patients with ampullary tubal pregnancy confirmed by laparoscopy were initially managed conservatively. Serum human chorionic gonadotropin (hCG) levels were measured daily and strict clinical monitoring performed. In nine patients (64%), the tubal pregnancy spontaneously resolved. In four cases (29%), surgery was ultimately necessary. One patient with a coexistent intra- and extrauterine pregnancy was also successfully managed conservatively. There was a high probability of spontaneous resolution of the pregnancy when the serum hCG level at diagnosis was less than 1000 mIU/mL. Hysterosalpingography was performed after the spontaneous resolution of the tubal pregnancies. Tubal patency was demonstrated in all six patients, and three are currently pregnant. We conclude that conservative therapy allows spontaneous resolution of certain types of ectopic pregnancy.

Abortion, Spontaneous↗
PubMed1987

Factors influencing the success rate of human embryo freezing in an in vitro fertilization and embryo transfer program.

Certain factors influencing the success of embryo cryopreservation were analyzed from 124 cycles of in vitro fertilization and embryo transfer (IVF-ET) program in which 193 1- or 2-day embryos were frozen and had already been thawed. There were 100 transfers of one or two surviving embryos from which 26 pregnancies were initiated. Several factors significantly influenced embryo survival after thawing. They were: the developmental stage of frozen embryos; the appearance of the embryo at the time of freezing; and the mode of ovarian stimulation in the IVF cycle. The pregnancy rate after frozen-thawed embryo transfer was higher with 4-cell frozen embryos than with embryos at all other stages combined. There were also tendencies for the pregnancy rate to be higher if a spontaneous luteinizing hormone surge occurred in the transfer cycle or if the duration of embryo storage did not exceed 1 to 2 months. The results obtained support a new policy in IVF-ET programs: it should be advantageous for the sterile couple if the immediate fresh embryo transfer is only performed with the categories of embryos that demonstrate a poor aptitude for survival following cryopreservation procedures.

Embryo Transfer↗
PubMed1987

One year's experience with programmed oocyte retrieval for IVF.

We have previously described a simplified form of ovulation stimulation for IVF in which the day of presumed oocyte retrieval is determined several weeks in advance. This paper retrospectively analyses this technique in 296 unselected patients over a one year period to assess if the method is suitable for routine use in an IVF programme. Oocyte retrieval was performed on the predetermined day in 70% of patients commencing stimulation. In the remainder, the presumptive day of oocyte retrieval was modified, or the cycle was cancelled. Compared with 356 patients undergoing a comparable classically monitored IVF stimulation during the same period, there was no significant difference in the cancellation rate of cycles prior to oocyte recovery, in the numbers of oocytes or embryos obtained or in the pregnancy rate between the two populations. It is concluded that programmed oocyte retrieval does not have a deleterious effect on the success rate of IVF compared with classical clomiphene citrate/HMG stimulation and it considerably facilitates the administration of an IVF programme.

Clomiphene↗
PubMed1986

Programmed oocyte retrieval during routine laparoscopy and embryo cryopreservation for later transfer.

Fixed-schedule ovulation induction and cryopreservation of the obtained embryos was performed in women undergoing a preliminary laparoscopy for infertility investigation before possible inclusion in an in vitro fertilization program. The cycle before follicular stimulation was modified by a progestogen or an estrogen-progestogen contraceptive pill. Ovarian inaccessibility precluded follicular aspiration in four of 34 patients but at least one oocyte was obtained in 29 of the remaining 30. Although fewer oocytes were obtained in these patients than in a control group undergoing in vitro fertilization treatment, one or more embryos were obtained in 22 patients in the study group. All embryos were frozen and to date 25 embryos from 17 patients have been thawed. Embryos have been placed in 16 of the 17 patients and six pregnancies have been initiated. Three are currently ongoing, one ectopic pregnancy was recorded, and two pregnancies were classified as "chemical." Programmed oocyte retrieval and embryo cryopreservation resulted in an extra chance of pregnancy in patients undergoing a laparoscopy for infertility investigation.

Adult↗
PubMed1986

High pregnancy rate after early human embryo freezing.

Human embryos produced by in vitro fertilization (IVF) were frozen with 1,2-propanediol as a cryoprotectant. Embryo survival after thawing was related to the presence of a nucleus in frozen cells and decreased with the increasing number of cells in the frozen embryo. None of five embryos frozen 3 or 4 days after IVF survived when thawed. Of 48 early embryos (35 patients) frozen 1 or 2 days after IVF, 42 (87.5%) were transferred in 32 patients. Ten pregnancies were initiated after frozen embryo transfer (ET). If we exclude the three infertile patients who had sexual intercourse in the fertile period, the pregnancy rate for each patient who had 1- or 2-day frozen embryo(s) was 22% (7 of 32). One of the pregnancies was obtained after ET of a 1-cell pronucleated frozen and thawed embryo. The rate of ongoing pregnancies after triple fresh ET was 23%. In patients having four embryos obtained in a single IVF cycle, the expected overall liveborn rate in an IVF-ET program including embryo cryopreservation could theoretically equal that of natural human fertility.

Cell Survival↗
PubMed1986

A new approach to follicular stimulation for in vitro fertilization: programed oocyte retrieval.

Programed oocyte retrieval was performed in a group of 35 patients undergoing in vitro fertilization (IVF) treatment. The date of follicular aspiration was decided several months in advance and the cycle prior to oocyte recovery was modified with a progestagen or an estrogen-progestagen contraceptive pill. This was followed by a fixed-schedule ovulation stimulation and induction regimen. Follicular growth was not monitored. Thirty-four of the 35 patients had follicular aspiration, and at least one embryo was obtained in 30 of them. The clinical pregnancy rate (excluding cryopreserved embryos) was 20% per IVF cycle, 21% per attempted oocyte retrieval procedure, and 23% per embryo transfer cycle. Programmed oocyte retrieval is a realistic option for follicular stimulation for IVF treatment and is associated with significant practical and economic benefits.

Contraceptives, Oral, Combined↗