The Pretoria academic complex--embracing the future.
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Academic Medical Centers↗
Biomedical subjects
J V van der Merwe
Publications and source records attributed to J V van der Merwe.
Pregnancy outcome after in vitro fertilisation at the Pretoria unit.
This retrospective study was conducted to ascertain the success rate of a university-based in vitro fertilisation (IVF) programme. Over a 4-year period a total of 881 patients was aspirated with an 81.8% embryo transfer (ET) rate. This resulted in 150 biochemical pregnancies (20.8% per ET), and 92 births that produced 100 babies were recorded (12.8% per ET). Multiple pregnancies accounted for 8.7% of births and 6.5% of the 100 babies presented with minor congenital abnormalities. Delivery took place by caesarean section in 46% of cases. Birth mass of babies ranged from 1.06 to 4 kg with a mean of 2.944 +/- 0.629 kg. Mean gestational age was 260 +/- 18.2 days. Twenty-three percent of babies born were preterm, 13.8% of these were twins and presented with a low birth mass. It was concluded that the conception rate of patients did not differ with regard to the number of IVF attempts but that those who conceived during the first two attempts had a significantly better chance (P < 0.05) of carrying to term.
Abortion, Spontaneous↗
Successful pregnancy despite retrograde ejaculation. A case report.
In retrograde ejaculation sperm is passed into the bladder causing infertility. Among patients seen at the Reproductive Biology Research Unit of the University of Pretoria retrograde ejaculation is relatively uncommon (0.004%), but is a potentially treatable cause of infertility. The technique for collecting sperm, sperm processing and recovery described was successful and resulted in a pregnancy after transfer of 1 four-cell embryo.
Ejaculation↗
In vitro culture of mouse embryos in human amniotic fluid.
Human amniotic fluid was compared with Ham's F-10 culture medium as a possible alternative for use in in vitro fertilisation. The cleavage success of mouse embryos in human amniotic fluid (experimental group) was 92% compared with 86% in Ham's F-10 medium. It is concluded that human amniotic fluid is a viable alternative culture medium for mouse embryos.
Amniotic Fluid↗
Cost analysis study of an in vitro fertilisation programme.
In vitro fertilisation (IVF) and embryo transfer has established itself as a modality in the treatment of infertile patients. Estimates of the cost of this relatively new procedure were investigated with specific assumptions. The maximum cost per (first) cycle totalled R1611.16. Laboratory expenses were the single most expensive entity, accounting for 39.2% of the total cost. Patient contribution was established at 32.6% of total cost and the approximate breakdown of cost for an IVF and embryo transfer programme for a university-based unit is given.
Female↗
Wet-smear diagnosis of genital schistosomiasis.
The diagnosis of genital schistosomiasis can be made only on the presence of ova on histological or cytological material. In 7 out of 8 consecutive cases of genital schistosomiasis we were able to make the diagnosis on a wet-smear preparation in an outpatient clinic.
Adolescent↗
The incidence of polyspermy during in vitro fertilisation. A study at the H. F. Verwoerd Hospital, Pretoria.
Results from 1249 in vitro-fertilised human oocytes were analysed to identify the incidence of polyspermy. In this study polyspermy occurred in 23 oocytes (1.8%). The effects of the various ovulation induction protocols employed, maturation of oocytes, incubation time before insemination and anaesthesia exposure were examined in order to identify a cause for polyspermy. Early diagnosis of polyspermy is important because the polyspermic embryo may appear morphologically normal at a later stage but should not be transferred since this nearly always results in a spontaneous abortion.
Fertilization↗
The hormonal and morphological events of stimulated cycles in an in vitro fertilisation programme.
A better understanding of the physiological processes involved in the stimulated cycle for successful harvesting of mature eggs in an in vitro fertilisation programme is a prerequisite for obtaining good pregnancy results. The hormonal levels of oestradiol, luteinising hormone (LH) and follicle-stimulating hormone correlated with ultrasonographic studies of follicular growth, were followed during an in vitro fertilisation cycle giving an overall pregnancy rate of 32% per transfer procedure. The combined use of clomiphene citrate (Clomid; Mer-National) and human post-menopausal gonadotrophin (Pergonal; Script Intal) produces an average of 5.96 follicles per patient. Human chorionic gonadotrophin (HCG) was given prior to the oestrogen peak and no spontaneous LH peak occurred before the day of the HCG injection. Timing of this injection needs to be synchronised with definite hormonal and ultrasonography values.
Adult↗
Phase II of a successful university-based in vitro fertilisation programme. Changes incorporated.
the ultimate goal of any clinical programme treating infertility by means of in vitro fertilisation and embryo replacement is to maximise the number of patients who become pregnant in a treatment cycle. A 12% pregnancy rate was previously reported from this unit. Following the instigation of changes and further modifications, an overall success rate of 27% per patient was obtained in phase II. The reasons for this improved success are hard to pinpoint, but experience and changes in methodology probably play a role. These changes are described and the results discussed.
Adult↗
Transverse myelitis caused by schistosomiasis during pregnancy. A case report.
A rare case of transverse myelitis caused by schistosomiasis of the spinal cord during pregnancy is presented. The diagnosis and treatment are discussed.
Adult↗
Diagnostic laparoscopy v. combined screening laparoscopy and timed follicle aspiration for in vitro fertilisation.
Results from ovulation induction and laparoscopic oocyte retrieval for in vitro fertilisation and embryo transfer were compared in two groups of patients to determine whether oocyte retrieval subsequent to diagnostic laparoscopy had specific advantages over combined screening laparoscopy and timed follicle aspiration. There were no statistically significant differences in any of the factors investigated in the two groups. This study was useful in demonstrating firstly that there are no absolute criteria for selection of patients for either diagnostic or combination laparoscopy. Secondly, the procedure of choice is a combined screening laparoscopy and timed follicle aspiration if a patient is willing to accept a failure rate of 7.4% (2/27 in this study) due to ovarian inaccessibility.
Embryo Transfer↗
Primate in vitro fertilization research: preliminary results on the folliculogenic effects of three different ovulatory induction agents on the chacma baboon, Papio ursinus.
1. A study was conducted on the chacma baboon, Papio ursinus with three ovulation induction agents in an effort to define a preferential stimulatory protocol with regards to the number and quality of oocytes obtained. 2. Three folliculogenic agents applied in four stimulatory protocol regimens comprised clomiphene citrate in a high (100 mg/day) and low (50 mg/day) dosage, a combination of clomiphene citrate and pregnant mare serum, and human menopausal gonadotropin. 3. A total of 159 oocytes were aspirated by laparotomy from 10 baboon females in 20 induced cycles with an average of 8.0 +/- 5.4 oocytes per aspiration. 4. The highest mean number of oocytes (11.3 +/- 6.7) were obtained with the clomiphene/pregnant mare serum gonadotropin combination. 5. The best fertilization rate was obtained with clomiphene 50 mg. 6. The highest incidence of oocytic cleavage and embryo transfer were achieved with human menopausal gonadotropin (14.8%).
Animals↗
Supplementation of Ham's F10 culture medium with three different sera in the culturing of baboon oocytes.
1. Ten female baboons (Papio ursinus) were stimulated for a total of 20 cycles with 3 ovulation induction agents. 2. Oocytes obtained were randomly allocated to Ham's F10 culture medium supplemented with human fetal cord serum, primate serum or commercial fetal bovine serum respectively. 3. Fertilization occurred (38.1-45.5%) in all 3 supplements, but cleavage and embryo development was more successful in culture medium supplemented with fetal bovine serum. 4. Eight embryos were cultured and 6 (75%) of these were cultured in fetal bovine serum supplemented medium.
Animals↗
Premature closure of the ductus arteriosus causing intra-uterine death. A case report.
A case of hydrops fetalis with intra-uterine death after premature closure of the ductus arteriosus because of inhibition of premature labour by the administration of indomethacin is presented. The physiology of acute and chronic intra-uterine constriction of the ductus arteriosus and the effects of indomethacin on the fetal circulation are discussed. Mention is also made of the moral conflict confronting the doctor in the management of an affected fetus during the third trimester.
Adult↗
Combined extra- and intra-uterine pregnancies. A report of 3 cases.
Three cases of combined extra- and intra-uterine pregnancies are described. In 2 cases the diagnosis was made during laparotomy for ectopic pregnancy continued undisturbed. The third case proved to be a secondary abdominal pregnancy discovered 4 weeks after evacuation for abortion. The possibility of heterotopic pregnancy is more likely to occur in population groups with a high incidence of pelvic infections and in patients who receive ovulation-induction medication. Over the last decades the fetal and maternal prognosis has greatly improved because of better surgical and diagnostic techniques, efficient treatment of hypovolaemic shock and safer anaesthesia. Routine ultrasonographic examination in the first trimester of pregnancy would make early recognition of heterotopic pregnancy possible.
Adult↗
Sinusoidal fetal heart rate pattern associated with congenital hydrocephalus. A report of 2 cases.
Two cases of hydrocephalus with an intrapartum sinusoidal heart rate pattern are presented. In the first patient, the diagnosis of toxoplasmosis during pregnancy and congenital hydrocephalus was made antenatally. Intrapartum the fetal heart showed intermittent periods of a sinusoidal pattern, alternating with a normal heart rate pattern. At birth there were signs of congenital toxoplasmosis. In the second patient there was a sinusoidal heart rate pattern associated with late decelerations and a loss of beat-to-beat variation. A brief review of the literature shows that the debate still continues over the aetiology, pathogenesis and prognosis of this entity.
Adult↗
In vitro fertilization and embryo transfer in Pretoria.
Details of the in vitro fertilization and embryo transfer programme at the Department of Obstetrics and Gynaecology of the H. F. Verwoerd Hospital and the University of Pretoria are presented. From 1 March 1982 to 30 November 1983, 67 cycles in 47 patients were induced using clomiphene citrate and human chorionic gonadotrophin (hCG) (46 patients) and human postmenopausal gonadotrophin/hCG (1 patient). In 5 patients ovum recovery was unsuccessful owing to severe adhesions. In the remaining 42 patients 59 oocyte recoveries out of a total of 62 attempts were successful, a 95% recovery rate. One hundred and seventy-nine ova were recovered (2,9 per laparoscopy), of which 143 (80%) were viable. Forty-six per cent of fertilized ova cleaved actively. Forty-one transfers of 66 embryos (average 1,6 embryos per transfer) resulted in 5 pregnancies (12% pregnancy rate per transfer). Three preclinical pregnancies aborted spontaneously. Two pregnancies are ongoing at 30 and 32 weeks' gestation. Thus, the programme has so far led to 2 third-trimester pregnancies. Consolidation and refinement of techniques should lead to a steady increase in success at this centre.
Culture Media↗
A serum biochemical profile of normal pregnancy.
Serum sodium, potassium, chloride, magnesium, calcium, phosphate, urea, urate, creatinine, carbon dioxide, total alkaline phosphatase, total protein and albumin levels during pregnancy were studied in groups of subjects at less than 14 weeks' gestation, at 14-20 weeks, at 20-28 weeks and at 36-40 weeks. These were compared with levels in a nonpregnant control group matched for age and sex. Serum potassium, sodium and chloride levels remained within the normal range, while calcium, phosphate, total protein and albumin levels decreased progressively after the first trimester. Magnesium levels decreased progressively from early pregnancy to term, and urea, creatinine and carbon dioxide levels all decreased markedly throughout pregnancy. Urate levels were markedly decreased in early pregnancy but returned to normal at term, and the alkaline phosphatase values demonstrated the expected marked increase to term. The fact that all these values were not equally affected suggests that haemodilution cannot be held responsible for all serum changes during pregnancy. Individual results are discussed and a biochemical profile is suggested.
Alkaline Phosphatase↗