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J Testart

Publications and source records attributed to J Testart.

At least 163 records · Page 9Linked to original sources
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 The stimulated cycle has completely superseded the natural cycle since this is the only method of obtaining several embryos.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

[Endoluminal angioplasty of iliac obstruction. Immediate results and cumulative patency at 2 years in 23 patients].

23 patients with obstruction of one or both main iliac arteries underwent one or more transluminal angioplasties by catheterization via the obstructed vessel. 26 iliac arteries were thus reopened. The length of obstructions varied from 1 to 10 cm. The majority of the obstructions were of recent onset whilst in 6 cases the presumed date was more than 6 months previously. In all cases potency was obtained with normal follow-up angiograms in 20 cases, and a residual though not hemodynamically significant stenosis in 6 cases. All patients were followed up by Doppler and in the majority of cases by venous digital angiography, with a follow-up at the present time of 6 months to 2 years. 2 patients underwent surgery because of reobstruction occurring 2 and 13 months after dilatation. Cumulative patency is 79% in 2 years, similar to results obtained by surgery. These results show that iliac angioplasty, a simple procedure, may avoid or delay surgery, and that it should be widely used in this precise anatomical indication.

Adult↗
PubMed1988

[Bronchial resection-anastomosis for cicatricial stenosis. Physiopathologic and therapeutic considerations].

The exploration of a stenosis of an intermediate bronchus in a 50 year-old woman showed it to be severe, limited, and non-malignant. Pre-operative angiography showed hypovascularization of the right lower and middle pulmonary lobes. A short resection of the stenosis, with termino-terminal bronchial anastomosis was performed. Post-operative evaluation showed normal bronchography and angiography. This suggests that bronchial stenosis plays a role in the hypovascularization observed before its surgical correction, the most likely hypothesis being vasoconstriction.

Anastomosis, Surgical↗
PubMed1988

[In vivo and in vitro fertilizing ability of immature human epididymal spermatozoa].

In cases of congenital absence of vas deferens (9 patients) or after failure of previous epididymovasostomy (2 patients), in vitro fertilization (IVF) was attempted with spermatozoa surgically obtained at the epididymal caput level. These sperm populations showed little progressive motility (5.9 +/- 6.5%) and an marked necrozoospermia (19.3 +/- 17.4%). Stimulation by caffeine (4.5 mM) alone or associated with heterologue normal seminal fluid resulted in most of the cases in an initiation of motility with an improvement of the progressive velocity. In 9 IVF attempts, 31 mature oocytes were inseminated with 5.10(3) to 1.5.10(6) motile spermatozoa. The dynamic characteristics in 3 inseminated sperm populations were Vp (24.2 +/- 8.3 microns/s), Ah (8.6 +/- 2.0 microns) at room temperature. Sperm binding to zona pellucida was decreased (0 to about 20 spermatozoa per oocyte) and there was no fertilization. In the same period, 21 attempts of intra uterine insemination and 14 attempts of intracervical inseminations were made in 5 couples who remained infertile after patent high epididymovasostomy (4) or vasovasostomy (1) and having immature spermatozoa stimulated as previously described. Antisperm antibodies were detected on the ejaculated spermatozoa in four men. No pregnancy was obtained with these immature stimulated spermatozoa. The fertility of the female partners was confirmed in 3 women after insemination with donor sperm.

Adult↗
PubMed1988

[Search for specific factors in culture media of embryos].

Mitogenic activity of culture media having contained either unfertilized or cleaved embryos have been studied. In these media human eggs have been cultured for one day, beginning 20 hours following in vitro insemination. B-lymphocyte proliferation was estimated by thymidine incorporation following 3 day culture in the presence of eggs or embryo culture media. No reproducible effect on B lymphocyte proliferation was observed. Therefore the viability of embryos could not be ascertained by the mitogenic activity of their culture media.

B-Lymphocytes↗
PubMed1988

[Reoperations for early thromboses of femoropopliteal and tibial artery bypass. Apropos of 50 cases].

The mechanism of thrombosis early after subinguinal bypass and outcome after revision surgery have been rarely analyzed. Results are reported of revision surgery for early thrombosis in 50 cases (10% of subinguinal bypass operations during the same period). Initial indication in the 40 men and 9 women (mean age 66.9 +/- 1.74 (SEM) years), was severe chronic or acute ischemia in 82%. The 50 thrombosed bypasses included 40 femoropopliteal, 8 femorotibial and 2 short bypasses. The bypass was by saphenous in situ (21 times), an inversed saphenous (9 times), a mixed bypass (12 times) and a prosthesis (8 times). The distal arterial bed was evaluated as good in 50% of cases. Analysis of cause of thrombosis, of the operative procedure and of the time before surgery enabled a technical cause to be determined in 31 of the 50 cases. Corrective surgery produced 16 permeable bypasses and 34 definitive thromboses complicated by 21 amputations and a 10% mortality. Improved results were related to a venous bypass (p less than 0.05), to a time before operation of less than 24 hours (p less than 0.02) and to a good distal bed. The 1 year actuarial permeability for the 50 bypass operations was 35%. Mixed bypass procedures and technical problems during surgery appear to be the principal predisposing factors of early thrombosis. In this series, the preoperative distal pressure index and intraoperative flowmetric recordings were not reliable predictive elements.

Aged↗
PubMed1987

In vitro fertilization of hamster and human oocytes by microinjection of human sperm.

In this study, swollen sperm heads were obtained after the injection of human sperm into the perivitelline space of hamster oocytes. The number of injected sperm and the sperm concentration in the preincubation medium were found to have an influence on the rate of penetrated hamster oocytes. The optimal injected sperm number was always between five to 12 to obtain 8, 37, and 36% penetration for donors A, B, and C, respectively. The optimal sperm concentration in preincubation medium was between 6 and 22 x 10(6) sperm/ml to obtain 16, 47, and 43% penetration for donors A, B, and C, respectively. The rate of polyspermic oocytes was related to the injected sperm number (0, 55, and 100% for one to four, five to 12, and more than 12 injected sperm respectively). Ten human mature oocytes were injected with the sperm from six normal donors. Five fertilized eggs were obtained, and of these four cleaved in in vitro culture.

Animals↗
PubMed1987

Human embryo viability related to freezing and thawing procedures.

Freezing and thawing procedures did not affect the chances of successful transfer of human embryos. The postimplantation viability of frozen-thawed embryos was equivalent to that of fresh, immediately transferred embryos. Selection of the embryos that were more suitable for freezing did influence the pregnancy rate after transfer of the remaining fresh embryos. The therapeutic efficacy of in vitro fertilization and embryo transfer programs will be greatly increased if only one embryo is transferred in the in vitro fertilization cycle, the others being separately frozen for further embryo transfer in subsequent cycles.

Embryo Transfer↗
PubMed1987

Importance of semen preparation in avoidance of reduced in vitro fertilization results attributable to bacteria.

Although the physical treatment of semen for IVF and related procedures is sufficient to remove most organisms present in semen, the pathogenic varieties tend to be more resistant. The supplementation of oocyte culture medium with both penicillin and streptomycin was associated with the eradication of 100% of organisms in the current study. In these circumstances, the presence of pathogenic organisms in the untreated semen is not associated with reduced oocyte fertilization in vitro.

Bacteria↗
PubMed1987

Evidence of uterine inadequacy to egg implantation in stimulated in vitro fertilization cycles.

From 104 IVF cycles 166 embryos were immediately transferred (63 embryo transfers, ET), whereas 151 embryos were frozen until later transfer (77 embryo transfers). There were 8 (12.7%) or 19 (24.7%) pregnancies after fresh or frozen-thawed ET, respectively. Sixteen pregnancies (29.1%) originated from 55 ETs of frozen-thawed embryos coming from IVF cycles in which pregnancy was not induced by fresh ET. The pregnancy rate after fresh ET (10.5%) was lower than that obtained when the same patients received frozen-thawed embryos (27.1%, P less than 0.02). It is concluded that a normal pregnancy rate may result if the embryos originating from an unsuccessful IVF-ET cycle are transferred in a favorable uterus.

Embryo Implantation↗
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

In situ versus reversed saphenous vein for femoropopliteal bypass: a prospective randomized study of 100 cases.

With the purpose of comparing results using the greater saphenous vein in situ or as a reversed conduit, 100 femoropopliteal bypasses, performed in 91 patients between October 1980 and January 1985, were randomized into two statistically comparable groups of 50 procedures of each type. Seventy-five percent of patients had cutaneous signs of ischemia and 20% had isolated rest pain. Average follow-up was 32 months for the in situ group and 33.4 months in the reversed bypass group. The quality of the vein was statistically better in the in situ group (p less than 0.01). There were six cases of early thrombosis in the in situ group compared to four in the reversed bypass group. In the in situ group, half of the thromboses could be attributed to inadequate valvular destruction. Seven delayed thromboses were noted in the in situ group whereas there were two in the reversed saphenous vein bypass group. The actuarial rates of bypass patency at three years in the reversed and in situ groups were 88.2 and 70.8%, respectively (chi 2 = 2.62; NS). Analysis of results suggests that: 1) the reversed saphenous vein bypass provides excellent results if vein harvest and preparation are as atraumatic as possible; 2) expertise in rendering the valves incompetent markedly increases patency in the in situ technique; 3) during the first 12 months, Doppler follow-up of measured distal pressures is necessary in order to detect pathologic changes of the bypass and adjacent arterial tree.

Aged↗
PubMed1987

The effect of dydrogesterone supplementation in an IVF programme.

Various treatments are given during the luteal phase by most IVF programmes, without any proof of their efficacy. We have performed a double-blind, randomized study with dydrogesterone (125 transfers) against placebo (133 transfers). The pregnancy rate was 21.6 versus 15.0% per transfer cycle with dydrogesterone or placebo, respectively. There was no significant difference between these figures, but taking into account the usual success rate in IVF programmes (15-20%) a difference of 5% would be significant only with two groups of 1500 subjects. This paper discusses the question of how we can come to a definite conclusion on the efficacy of hormonal supplementation during the luteal phase.

Adult↗
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↗