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Biomedical subjects

J M Yovich

Publications and source records attributed to J M Yovich.

At least 19 recordsLinked to original sources
PubMed1995

Sperm stimulants can improve fertilization rates in male-factor cases undergoing IVF to the same extent as micromanipulation by partial zona dissection (PZD) or subzonal sperm insemination (SUZI): a randomized controlled study.

PURPOSE: Our purpose was to evaluate the efficacy of direct insemination (IVF), micromanipulation by partial zona dissection (PZD), and subzonal sperm insemination (SUZI) using sperm-treated with pentoxifylline (PF) +/- 2-deoxyadenosine (2DA). RESULTS: The overall fertilization rate achieved was similar for all three fertilization techniques (33.1, 30.2, and 26.9% for IVF, SUZI, and PZD, respectively). Patients who had reduced fertilization in previous IVF attempts showed improved fertilization with sperm stimulants, either PF alone or PF in combination with 2DA in standard IVF. In certain cases, SUZI or PZD gave significantly improved fertilization rates in comparison to IVF. CONCLUSION: Selective use of sperm stimulants in IVF can achieve fertilization for the majority of male-factor cases. However, PZD and SUZI techniques are useful, especially when sperm stimulants fail to achieve fertilization or achieve poor fertilization in direct insemination.

Deoxyadenosines↗
PubMed1995

An argument for the past and continued use of pentoxifylline in assisted reproductive technology.

Pentoxifylline was first used within an in-vitro fertilization (IVF) programme before the advent of alternative treatment strategies such as oocyte micromanipulation. Over the years, it has continued to be useful in aiding fertilization in selected IVF cases, with a beneficial effect also being seen in certain cases treated by intrauterine insemination. In both instances, the acrosome reaction to ionophore challenge test appears to have been invaluable in identifying suitable patients. The stimulation of spermatozoa by pentoxifylline should remain a therapeutic option in the treatment of couples with a male factor present. As an adjunct to IVF, it has the advantage of being simpler and less costly to perform compared with micromanipulation. However, its use should be restricted to selected cases, and the merits over and above those of invasive procedures such as intracytoplasmic sperm injection should be discussed with the individual patients. The pretreatment of spermatozoa prior to intrauterine insemination in selected cases gives an alternative therapeutic strategy to those patients not wishing or unable to undertake IVF.

Fertilization↗
PubMed1994

Use of the acrosome reaction to ionophore challenge test in managing patients in an assisted reproduction program: a prospective, double-blind, randomized controlled study.

OBJECTIVE: To assess the utility of the acrosome reaction (AR) to ionophore challenge test in determining the sperm treatment protocols for patients undergoing assisted reproduction. DESIGN, SETTING, PATIENTS: One hundred twenty-one couples undergoing an IVF-ET or GIFT procedure from January to July 1992 were included in this prospective study. All cases had a preliminary semen analysis within the previous 3 months and an AR to ionophore challenge test was carried out unless an acceptable fertilization rate occurred on previous IVF. For those patients whose AR to ionophore challenge score was below the accepted fertile range of > or = 10%, a second AR to ionophore challenge test was performed after exposure of sperm to the stimulant pentoxifylline. Couples then were managed by assisted reproduction with randomized allocation of oocytes for fertilization with a standard sperm preparation or with added sperm stimulants, either 3.6 mM pentoxifylline alone or combined with 3.0 mM 2-deoxyadenosine. The study was double-blind with neither the patients nor the embryologist knowing the AR to ionophore challenge result at the time of the IVF procedure. MAIN OUTCOME MEASURES: Data from the preliminary semen analyses and AR to ionophore challenge scores were correlated with the fertilization rates achieved using control and treated sperm preparations. The rates of total fertilization failure and the numbers of clinical pregnancies occurring in each subgroup were also recorded. RESULTS: All AR to ionophore challenge groups showed normal sperm counts except the groups with poor AR to ionophore challenge, which demonstrated reduced sperm counts. The group with normal AR to ionophore challenge scores or previous normal fertilization showed satisfactory fertilization rates with either control or treated sperm, although some individual cases showed reduced fertilization with treated sperm. The fertilization rate for the group with low AR to ionophore challenge scores improved significantly with pentoxifylline, and the benefit was greatest when this had been predicted from the AR to ionophore challenge studies. Cases with persisting poor AR to ionophore challenge despite pentoxifylline showed no significant improvement in fertilization rates with sperm exposed to either sperm stimulant regimens. Poor AR to ionophore challenge scores were also predictive of total fertilization failure, but this problem was reduced by sperm stimulation. The AR to ionophore challenge score at 10% cutoff level showed optimal levels of sensitivity (82.1%), highest negative predictive value (82.1%), and lowest false negative rate (17.9%). CONCLUSIONS: The AR to ionophore challenge test is useful in the assessment and management of the male factor in assisted reproduction. It can be used to identify the majority of cases who will benefit from the use of sperm stimulants.

Acrosome↗
PubMed1990

Influence of pentoxifylline in severe male factor infertility.

Two in vitro fertilization sperm preparation protocols using pentoxifylline (long and short exposure before insemination) were studied in 57 couples (61 cycles) with male factor infertility. For each cycle, oocytes were divided into two groups for insemination using either pentoxifylline-treated or control semen. Fertilization rates improved over controls in the short protocol (P less than 0.001) and fewer couples experienced fertilization failure (P = 0.02). Sixteen pregnancies ensued (30% per collection with the short protocol), and 4 were from cases with less than 1.0 X 10(6) progressively motile sperm count per milliliter, 1 being as low as 0.2 X 10(6) progressively motile count per milliliter. Seventeen healthy infants have now delivered and pregnancy wastage is not increased. Pentoxifylline is thus a useful sperm treatment for cases of male factor infertility.

Clinical Trials as Topic↗
PubMed1989

Pituitary down-regulation using leuprolide for the intensive ovulation management of poor prognosis patients having in vitro fertilization (IVF)-related treatments.

A review of 118 treatment cycles in 115 women under prolonged GnRH analogue (GnRHa; leuprolide) treatment is presented. Patients were selected for treatment primarily on the grounds of poor previous response to stimulation (n = 40), advanced age (greater than 35 years; n = 29), previous premature luteinizing hormone (LH) surge (n = 30), polycystic ovarian disease (PCO; n = 12), and elevated androgens without evidence of PCO (n = 5). An overall pregnancy rate of 28.8% per treatment cycle was attained, compared with a pregnancy rate of 6.2% (6/97, of which none went to term) in the previous completed treatment cycle for the same patients. Ovarian response, as measured by oocytes recovered and maximum estradiol levels observed, was significantly improved in all groups and this was associated with a prolonged follicular phase, significantly more human menopausal gonadotropin (hMG) stimulation and a relatively high incidence of ovarian hyperstimulation, particularly in pregnant patients. Of specific techniques in the GnRHa cycle, GIFT produced a pregnancy rate per treatment of 50% (10/20); IVF-ET, 22% (8/36); PROST, 28% (13/46); and TEST, 19% (3/16). No cycles were abandoned, compared with a cancellation rate of 24% in previous cycles without GnRHa. Patients with PCO performed particularly well on GnRHa management, with a pregnancy rate per treatment of 58% (7/12). Pregnancy rates per treatment for the other groups were as follows: elevated age, 27% (9/33), high androgens, 40% (2/5); premature LH surges, 32% (9/28); and poor responders, 17.5% (7/40).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

The relative chance of pregnancy following tubal or uterine transfer procedures.

In a 7-month study period, a total of 113 pregnancies were generated in 380 women (30%) undergoing transfers in one of four assisted conception procedures: gamete intrafallopian transfer (GIFT), pronuclear stage tubal transfer (PROST), tubal embryo stage transfer (TEST), and in vitro fertilization and embryo transfer (IVF-ET). It was shown that both the pregnancy rate per transfer procedure and the number of pregnancy sacs arising per embryo transferred were significantly higher among the groups having tubal transfer (P less than 0.001). There were no significant differences in the pregnancy or implantation rates among the three groups having tubal transfer procedures when the GIFT results were adjusted for a 72% fertilization rate noted in the combined IVF-ET and PROST groups. Early pregnancy wastage showed a similar pattern among the four groups and, overall, 67% of pregnancies advanced beyond 20 weeks.

Adult↗
PubMed1988

Preliminary results using pentoxifylline in a pronuclear stage tubal transfer (PROST) program for severe male factor infertility.

In vitro trials with washed spermatozoa incubated in medium containing 1 mg/ml of the methyl xanthine phosphodiesterase inhibitor PF showed improved counts of total motile and total progressively motile spermatozoa in cases of oligospermia/asthenospermia. Application of this agent in a PROST program for a series of nine couples presenting for treatment with histories of failed fertilization in vitro resulted in five pregnancies (four singleton, one triplet) and the subsequent delivery of normal infants. The results warrant further evaluation of this sperm treatment for cases of severe male factor infertility.

Embryo Transfer↗
PubMed1988

Methods of water purification for the preparation of culture media in an IVF-ET programme.

Five methods of water purification for culture media preparation have been described. The quality of media thus prepared has been assessed retrospectively by relating to the fertilization and pregnancy rates of a total of 646 treatment cycles in an in-vitro fertilization and embryo transfer (IVF-ET) programme. All media for human use was subjected to quality control assessment in a mouse embryo culture system. Although no differences were seen in the fertilization rates or the proportion of women proceeding to embryo transfer, significant differences were seen in the pregnancy rates. The highest pregnancy rates were obtained using rainwater distilled six times (22/100, 22%) or eight times (40/184, 21.7%), and water polished using a Milli-Q water purifying system (41/181, 22.7%). Significantly lower pregnancy rates were obtained when the water was purified using an alternative Milli-Q system (9/89, 10.1%) or dam water distilled six times (6/63, 9.5%). These findings may reflect contamination of local dam water supplies but demonstrate the difficulty in purifying water for the preparation of culture medium.

Culture Media↗
PubMed1988

The treatment of normospermic infertility by gamete intrafallopian transfer (GIFT).

Gamete intrafallopian transfer (GIFT) was applied in 207 treatment cycles in 73 couples. The pregnancy rate in cycles with only one (2/21, 9.5%) or two (2/29, 6.9%) oocytes transferred was significantly less than that in which four oocytes (36/116, 31.0%) were replaced. The collection of more than four oocytes did not influence the pregnancy rate in that treatment cycle. The overall pregnancy rate was 24.2% (50 of 207) and was similar in the four infertility groups studied (non-occlusive tubal disorders, endometriosis, cervical factor and unexplained infertility) with 28 (56%) of the pregnancies delivered at greater than or equal to 20 weeks. The pregnancy wastage included 4 (8%) ectopic pregnancies and 3 (6%) late pregnancy losses. The 12 multiple pregnancies occurred following the transfer of three and four oocytes.

Fallopian Tubes↗
PubMed1987

The in vitro fertilization of supernumerary oocytes in a gamete intrafallopian transfer program.

Gamete intrafallopian transfer (GIFT) was performed on a series of 42 couples in whom four oocytes were replaced into the fallopian tubes and the remaining oocytes were inseminated with 100,000 motile spermatozoa. Fertilization in vitro was assessed 16 to 20 hours later. An overall pregnancy rate after GIFT of 40.0% (12/30) in normospermic couples and 16.7% (2/12) in oligospermic couples was seen. Supernumerary oocytes were submitted to in vitro fertilization (IVF) and the findings related to the likelihood of pregnancy. No correlation between IVF and the likelihood of GIFT pregnancies was found in either the oligospermic or normospermic couples. A similar proportion of pregnancies was seen in couples with or without evidence of fertilization of the supernumerary oocytes in both the oligospermic and normospermic couples. However, a high proportion of normospermic couples with no evidence of fertilization had only one oocyte remaining for insemination. These results suggest that the failure of low numbers of supernumerary oocytes to fertilize in vitro after GIFT relates to oocyte selection criteria and does not mean a reduced chance of conception in that treatment cycle.

Fallopian Tubes↗
PubMed1987

The role of gamete intrafallopian transfer (GIFT) in the treatment of oligospermic infertility.

Gamete intrafallopian transfer (GIFT) was used to treat 32 couples where the male partner was oligospermic (less than 12 X 10(6) motile spermatozoa per milliliter of semen). Initially, 100,000 motile spermatozoa were transferred per fallopian tube and no pregnancies were achieved in 11 cases. The technique was then modified so that a maximal number of motile spermatozoa were transferred (range, 0.11 to 0.90 X 10(6) spermatozoa) and 6 of 21 (29%) pregnancies resulted, with 325,000 spermatozoa being the lowest number associated with pregnancy. It appears that the modified GIFT technique, whereby an increased number of motile spermatozoa are replaced with the oocytes, is an effective therapy in the treatment of oligospermic infertility.

Fallopian Tubes↗
PubMed1986

The successful recovery and fertilization of oocytes from the pouch of Douglas.

Two groups of women were studied in whom a proportion of follicles had either ovulated spontaneously (7 women) or ruptured during manipulation at laparoscopy (30 women), and oocytes were recovered from the pouch of Douglas. There were no significant differences in the fertilization rates of oocytes collected in the pouch of Douglas from ovulated follicles, compared with those from the remaining intact follicles [15/20 (75%) vs 14/20 (70%)]. Also, there was no significant difference between the fertilization rate of oocytes from follicles ruptured at the time of oocyte collection and that of oocytes from intact follicles [25/38 (66%) vs 101/140 (72%)]. One woman became pregnant, following the transfer of four four-cell embryos, all derived from spontaneously ovulated oocytes found in the pouch of Douglas. She gave birth to a baby girl. The present study has shown that oocytes may still be retrieved from the pouch of Douglas, despite follicle dispersal; these oocytes can be fertilized; and the embryos derived from ovulated oocytes recovered from the pouch of Douglas may generate an ongoing pregnancy following in vitro fertilization and embryo transfer.

Cell Separation↗