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Biomedical subjects

J Stanger

Publications and source records attributed to J Stanger.

11 recordsLinked to original sources
PubMed1998

Ultrasound tracking of the movement of embryo-associated air bubbles on standing after transfer.

The aim of this study was to investigate whether standing upright shortly after embryo transfer has any potential to affect the position of embryos transferred to the uterine cavity during treatment with in-vitro fertilization (IVF). This was assessed by ultrasound-guided tracking of embryo-associated air within the uterine cavity. A prospective study of 93 patients undergoing 101 consecutive embryo transfers in an IVF programme was carried out. Transvaginal ultrasound guided embryo transfer was performed with a second ultrasound in standing position immediately after transfer, allowing the movement of embryo-associated air to be assessed. No movement occurred in 94.1% (95/101) of transfers, movement of <1 cm in 4.0% (4/101) of transfers and movement of 1-5 cm in 2.0% (2/101) transfers. No movement of embryo-associated air out of the uterine cavity, either into the cervix or the intramural portion of the Fallopian tube, was seen. Standing shortly after embryo transfer does not play a significant role in the final position of embryo-associated air and is unlikely to be a factor in determining the position of embryos transferred to the uterine cavity during treatment with IVF.

Air↗
PubMed1997

Potentially important variables identified by transvaginal ultrasound-guided embryo transfer.

Transvaginal ultrasound-guided embryo transfer was performed on 121 consecutive patients. Observation was made of guiding cannula and transfer catheter placement in relation to the endometrial surface and uterine fundus during embryo transfer. The position and movement of a transfer-associated air bubble and the impact of subendometrial myometrial contraction leading to endometrial movement was observed. Results indicate that tactile assessment of embryo transfer catheter placement is unreliable: in 17.4% of transfers the outer guiding catheter inadvertently abutted the fundal endometrium. The outer guiding cannula indented the endometrium in 24.8% and the transfer catheter embedded in the endometrium in 33.1%. Unavoidable sub-endometrial transfers occurred in 22.3% of transfers. Ultrasound-guided transfer avoided accidental tubal transfer in 7.4% of transfers. Transfer catheter withdrawal did not significantly affect embryo transfer-associated air bubble position. Endometrial movement due to sub-endometrial myometrial contraction was obvious in 36.4% of cases, with active motion of the transfer-associated air bubble occurring in 28.1%. Pregnancies occurred in 45.5% of transfers with endometrial movement compared to 15.6% (P < 0.001) without.

Adult↗
PubMed1995

Differential impact on pregnancy rate of selective salpingography, tubal catheterization and wire-guide recanalization in the treatment of proximal fallopian tube obstruction.

A total of 66 patients with proximal Fallopian tube (113 tubes) obstruction, as diagnosed by both laparoscopy and hysterosalpingogram, were each subjected to a transcervical recanalization procedure sequentially using selective salpingography followed, if necessary, by tubal catheterization with a soft Teflon 2-French catheter and finally, if needed, wire-guide cannulation. Each procedure were terminated once patency had been achieved without recourse to the next technique. Bilateral obstruction was present in 47 patients and unilateral in 19 patients. Patency was achieved in 39 (34.5%) Fallopian tubes by selective salpingography alone, in 52 (46.0%) by tubal catheterization and in 10 (8.9%) by wire guide, with 12 (10.6%) tubes remaining obstructed. Pregnancy occurred in 24 (36.4%) patients without recourse to other treatment (mean follow-up, 17 months). Where patency was achieved (59 patients), 19 out of 43 (44.1%) of those treated for bilateral obstruction and five out of 16 (31.3%) of those treated for unilateral obstruction achieved a pregnancy. Pregnancy occurred in six out of 22 patients (27.3%) where selective salpingography was used to produce tubal patency, in 17 out of 30 patients (56.7%) where tubal catheterization was used and in one out of seven (14.3%) where a wire guide was used, which was an ectopic pregnancy. The difference between the ongoing pregnancy rates following tubal catheterization (50.0%) and wire-guide cannulation (0.0%) was significant (P = 0.033). While wire-guide cannulation is the most effective method used to achieve tubal patency, these results indicate that when it is truly necessary, as opposed to electively used by clinicians, the prognosis with regard to pregnancy is poor and alternative therapy such as microsurgery or in-vitro fertilization should be considered early.

Adult↗
PubMed1995

Custom versus standardized patient satisfaction surveys: a Pacific Telesis case study.

With the increased interest in and use of patient satisfaction surveys has come the search for the ideal survey that could be used as a definitive tool to measure satisfaction. This article overviews the advantages and disadvantages of custom versus standardized patient satisfaction surveys. A disenrollment survey conducted by Pacific Telesis in 1994 and 1995 serves as a case study of a useful custom survey.

California↗
PubMed1994

Refinements in the methodology of injection for transvaginal gamete intra-fallopian transfer.

Eighty-seven volunteer patients with non-tubal infertility initially intending to undergo gamete intra-Fallopian tube transfer (GIFT) via a transabdominal route were re-scheduled for ultrasound-guided transvaginal GIFT which was performed using a Jansen-Anderson tubal transfer set. Emphasis was placed on (i) definite ultrasound confirmation of the transfer catheter within the Fallopian tube, (ii) low transfer volumes (50 microliters), (iii) high sperm transfer densities and (iv) slow injection of gametes. Transvaginal Fallopian tube catheterization was possible in 83 patients (95.4%). Twenty-three of 83 (27.7%) patients conceived (clinical pregnancy). The viable ongoing pregnancy rate was 20.5%. These results compare favourably to those previously reported for both transvaginal and transabdominal GIFT. This study suggested that the fluid dynamics of gamete injection following transvaginal Fallopian tube catheterization are different to those following transabdominal methods. Further study is necessary to define the optimal methodology for transvaginal GIFT and to enhance the ability of the procedure to produce pregnancy rates comparable to transabdominal GIFT.

Adult↗
PubMed1994

The fluid dynamics of injection: variables as they relate to transvaginal gamete intra-fallopian transfer and tubal embryo transfer.

Transvaginal gamete intra-Fallopian transfer (GIFT) and tubal embryo transfer have not, in most cases, produced pregnancy rates as high as the equivalent transabdominal methods. We postulated that two parameters, i.e. wide dispersion of the gametes and peritoneal spill of gametes or embryos, are of prime importance in explaining this difference. We designed this study to analyse the effect of varying the rate of injection (microliter/min) of radio-opaque contrast media and the distance the transfer catheter is placed into the tubal isthmus upon these two parameters. Selective salpingography was performed on 30 patients who were allocated to one of two experiments. In the first experiment (flow rate), 20 patients were divided into four groups so that we could analyse four sets of 10 Fallopian tubes. Each group was subjected to injection of contrast at different flow rates: 100, 50, 25 or 12.5 microliters/min. Peritoneal spill occurred from 4, 2, 0 and 0 tubes and wide dispersion (> 4 cm) of contrast occurred in 6, 5, 1 and 0 tubes at the respective injection rates of 100, 50, 25 and 12.5 microliters/min. At 12.5 microliters/min contrast was localized to < 2 cm of tubal ampulla in all cases. In the second experiment (catheter placement), the remaining 10 patients were divided to allow analysis of two groups of 10 Fallopian tubes. The transfer catheter was placed either 1.5 cm or 5 cm into the tube and the radio-opaque contrast was injected at 12.5 microliters/min. No difference in the degree of dispersion of contrast along the Fallopian tube was observed. No backflow of contrast into the uterine cavity was observed in any patient following removal of the catheter.(ABSTRACT TRUNCATED AT 250 WORDS)

Biophysical Phenomena↗
PubMed1991

Prolonged follicle stimulation decreases pregnancy rates after in vitro fertilization.

Ovarian stimulation with a GnRH-a and hMG for IVF treatment offers the potential to extend the period of follicle recruitment and growth free of the restriction imposed by a spontaneous midcycle LH surge. A randomized trial investigating the impact of extending follicle growth by 1 day resulted in a significantly reduced PR, despite an increase in the number of larger follicles (greater than or equal to 17 mm) at the time of hCG. The reason for a reduced PR was not related to the number of ova recovered or embryo quality. This suggests that follicular aging or the duration of estrogen rise may be important.

Adult↗
PubMed1989

A randomized trial of laparoscopy and transvaginal ultrasound-directed oocyte pickup for in vitro fertilization.

Ninety-four (94) couples undergoing IVF for the usual spectrum of clinical reasons and who were suitable for either laparoscopic or vaginal ovum pickup (OPU) were randomly assigned at the commencement of 166 treatment cycles to one of two OPU procedures. Both patient and clinician were informed of the allocation. If either wished to change this, then that cycle was eliminated from the trial. After a period of 15 months, 103 cycles were appropriate for analysis, of which 64 had been subject to ultrasound and 39 to laparoscopic OPU. Patients in the two groups did not differ significantly in terms of age or diagnosis, and the treatment cycles did not differ significantly in terms of stimulation used, commencing or maximum estradiol (E2) concentrations, E2 per follicle aspirated, or characteristics of the semen used for IVF. The rate of oocyte recovery (number of oocytes obtained per follicle aspirated), the average number of embryos available for transfer, and the pregnancy rate per oocyte recovery procedure did not differ significantly in the two groups. Ovum recovery for IVF using vaginal aspirations and ultrasound guidance is as efficacious as that which uses laparoscopy.

Female↗
PubMed1986

Demographic and personality characteristics of couples undergoing in vitro fertilisation.

Two hundred and fifty-eight (258) couples requesting in vitro fertilisation (IVF) were interviewed by a social worker prior to commencing treatment. At the time of admission to hospital 147 women and 134 men completed a questionnaire which incorporated the Eysenck Personality Inventory and the Spielberger State-Trait Anxiety Inventory. Forty-three women conceived and 26 couples (14.2%) required extra counselling or support after their involvement in the programme. Couples seeking IVF did not differ significantly from the rest of the population with respect to occupation, education, alcohol, cigarette and medication use. The personality characteristics of couples seeking IVF did not differ significantly from a local comparison group. Personality and psychosocial characteristics did not identify those couples who were more likely to become pregnant by IVF. However, couples who required extra counselling were more likely to have required similar help in the past. Women requiring counselling also scored significantly higher on the Eysenck neuroticism scale and the Spielberger State-Trait anxiety scales compared to those women who did not require extra counselling or support. The male partners scored significantly lower on the Eysenck scale of extroversion compared to male partners of couples who did not require support or counselling. We conclude that these inventories may be of value in identifying certain couples who require extra care during attempted conception by IVF.

Adult↗