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Biomedical subjects

M Bustillo

Publications and source records attributed to M Bustillo.

At least 37 records · Page 2Linked to original sources
PubMed1995

Comparison of pulsatility indices on the day of oocyte retrieval and embryo transfer.

Transvaginal ultrasonography with colour blood flow imaging and analysis of impedance to uterine arterial blood flow has been used to provide an index of uterine receptivity for implantation after IVF/embryo transfer. A mean uterine arterial pulsatility index (PI) > 3.0 at the time of embryo transfer predicted 35% of failures to become pregnant. Cryopreserving embryos in non-receptive cycles and transferring them in receptive cycles would be expected to improve pregnancy rates. Earlier decisions regarding embryo cryopreservation can be made if receptive cycles can be predicted at the time of oocyte retrieval rather than at embryo transfer. To assess differences in uterine artery impedance, PI were measured serially in 107 women on both the day of oocyte retrieval and the day of embryo transfer. Mean PI on the day of oocyte retrieval was 2.52 +/- 0.59, and on the day of embryo transfer was 2.78 +/- 0.45. No significant difference was observed when PI determined on the day of oocyte retrieval were compared with PI on the day of embryo transfer. These data suggest that the PI measurement done on the day of oocyte retrieval could substitute for the measurement done on the day of embryo transfer. This would allow prediction of non-receptive endometria earlier in the cycle. Further studies are needed to evaluate whether cryopreservation of embryos and transfer when the uterus is more receptive will increase the implantation rates.

Adult↗
PubMed1995

Serum progesterone at the time of human chorionic gonadotrophin does not predict pregnancy in in-vitro fertilization and embryo transfer.

Controversy exists as to whether the serum concentration of progesterone on the day of human chorionic gonadotrophin (HCG) administration following ovarian stimulation for in-vitro fertilization (IVF) and embryo transfer can be used to predict the likelihood of success. This retrospective study was undertaken to answer this question by analysing a large population of IVF and embryo transfer cycles (n = 756). In addition to the concentration of progesterone on the day of HCG administration, all variables known to impact on IVF and embryo transfer success (such as patient age), indication for IVF and embryo transfer, number of oocytes retrieved and the number of embryos generated and transferred were examined. There was a significant increase in the number of oocytes retrieved with increasing progesterone concentration at the time of HCG administration. However, there was no correlation of progesterone concentration at HCG administration with pregnancy and implantation rates. It is concluded that previous reports associating a slight elevation of progesterone in gonadotrophin-releasing hormone agonist ovarian stimulation cycles for IVF and embryo transfer may be misleading because of a small sample size or the presence of confounding variables that affect IVF and embryo transfer success.

Adult↗
PubMed1995

Uterine receptivity in an oocyte donation programme.

Oocyte donation is a useful model for the assessment of potential factors affecting implantation since embryos generated are from younger oocytes than in in-vitro fertilization programmes and are therefore expected to have higher and more consistent implantation rates. Transvaginal sonographic measurement of endometrial thickness, echogenic pattern and uterine artery impedance, measured as pulsatility index (PI) and resistance index (RI), were retrospectively compared in 99 recipient women following 117 fresh embryo transfers that resulted in 51 conception cycles and 66 non-conception cycles. The prevalence of a multilayered echogenic pattern was significantly greater (91.2%) in conception than in non-conception (44.4%) cycles. No differences in endometrial thickness, PI or RI were observed between conception and non-conception cycles. However, no pregnancy occurred when the PI was > or = 3.4 (sensitivity 100%). The number of days or cumulative dose of oestrogen intake and the serum oestradiol concentration prior to progesterone administration were not different in the multilayered pattern versus other echogenic pattern groups. The data show that it may be beneficial to await achievement of a PI < 3.4 and a multilayered pattern endometrium prior to embryo transfer in an oocyte donation programme.

Adult↗
PubMed1995

Intravenous immunoglobulin for treatment of recurrent pregnancy loss.

PROBLEM: Efficacy of immunotherapy for treatment of recurrent spontaneous abortion (SA) has been controversial. The low treatment effect of white blood cell immunization lead to investigations of alternative treatments including intravenous (i.v.) immunoglobulin (Ig). To evaluate the efficacy of IVIg for treatment of recurrent SA, a prospective, randomized, double blinded, placebo-controlled trial was performed. METHODS: Ninety-five women experiencing two or more consecutive spontaneous abortions, with no known cause were randomized and received either IVIg 500 mg/kg/month or placebo (albumin). RESULTS: Of 95 women participating in the study, 47 received IVIg and 48 received placebo. Medication was discontinued in 34 women who failed to conceive within four cycles. The remaining 61 women achieved pregnancy. Pregnancy outcomes included 29 deliveries and 32 recurrent SA. Among women delivering live births 18 (62%) received IVIg and 11 (38%) received placebo. By contrast, 21 (66%) women experiencing recurrent SAs received placebo and 11 (34%) received IVIg. Among 61 women who conceived, 29 received IVIg and 32 received placebo. Of the 29 women who conceived and received IVIg, 18 (62%) delivered live births and 11 (38%) experienced recurrent SA. Of 32 women who conceived and received placebo 11 (34%) delivered live births and 21 (66%) had recurrent SA. The difference in live birth rates between women receiving IVIg and placebo was significant (P = 0.04, odds ratio 3.1). CONCLUSION: IVIg is effective in enhancing the percentage of live births among women experiencing unexplained recurrent SA.

Abortion, Habitual↗
PubMed1995

Cumulative number and morphological score of embryos resulting in success: realistic expectations from in vitro fertilization-embryo transfer.

OBJECTIVE: To define statistical thresholds for the number and morphological score of embryos transferred that would be predictive of reproductive success in an IVF program. DESIGN: A retrospective review of patient records. SETTING: The Mount Sinai Medical Center Assisted Reproductive Technologies Program. PARTICIPANTS: One hundred women who underwent IVF-ET for a diagnosis of tubal occlusion and later delivered viable infants. RESULTS: The mean number of embryos transferred before achieving live birth was 10.7 +/- 7.9 (mean +/- SD), with one half of patients achieving success within the first seven embryos transferred, and 95% achieving success within 25 embryos. For high quality embryos, the numbers were 7.5 +/- 6.3, 5, and 17, respectively, and, for the cumulative embryo score, a measure of both embryo morphology and metabolic activity, were 114.2 +/- 86.0, 83, and 280, respectively. Greater than 50% of live births occurred within the first two ET attempts. CONCLUSIONS: Although more than half of patients achieved reproductive success within the first two ETs and the first five high quality embryos transferred, after this threshold, fecundity declined rapidly. The calculation of cumulative embryo scores offered additional prognostic information. While all prior attempts to define IVF-ET failure have done so by including patients who did not become pregnant, we have found an analysis of our successes to be a useful adjunct in counseling patients.

Adult↗
PubMed1994

Ultrasonographic findings of pregnancy losses after treatment for recurrent pregnancy loss: intravenous immunoglobulin versus placebo.

OBJECTIVE: To describe the ultrasonographic findings of pregnancies that terminated in repeat abortion in women participating in an ongoing randomized placebo-controlled clinical trial evaluating the efficacy of intravenous (IV) immunoglobulin (Ig) in the treatment of recurrent spontaneous abortion (SA). DESIGN: A prospective descriptive study of ultrasonographic findings of pregnancies from 27 women experiencing repeated recurrent SAs after entry into a clinical trial. SETTING: Clinical practice at the Genetics & IVF Institute in Fairfax, Virginia. PATIENTS: Women experiencing two or more consecutive recurrent SAs received either 500 mg/kg per mo IV Ig or placebo (albumin). To date 90 women have been enrolled in the clinical trial and 52 have achieved pregnancy. The outcome of the 52 pregnancies include 16 deliveries, 9 ongoing pregnancies, and 27 losses. INTERVENTIONS: Ultrasonographic examinations performed in 27 women experiencing pregnancy loss are the subject of this study. MAIN OUTCOME MEASURES: The frequency of ultrasonographic findings of empty gestation sac (blighted ovum) and intrauterine fetal demise (IUFD) is compared between patients receiving IV Ig and placebo. RESULTS: Ultrasonographic findings of the 27 pregnancies losses included 11 blighted ova and 16 IUFDs. Of 11 blighted ova, 8 (73%) were in women receiving IV Ig and 3 (27%) were receiving placebo. Sixteen IUFDs were observed: 3 (19%) in women receiving IV Ig and 13 (81%) in women receiving placebo. Of 11 pregnancy losses occurring in women receiving IV Ig, 8 (73%) were blighted ova, 3 (27%) were IUFDs. Sixteen pregnancy losses occurred in women receiving placebo: 3 (19%) were blighted ova and 13 (81%) were IUFDs. The differences in frequency of blighted ova between IV Ig- and placebo-treated women was significant. CONCLUSION: IV Ig is not effective in preventing blighted ova and may be effective in preventing IUFDs.

Abortion, Habitual↗
PubMed1994

Ultrasonographic predictors of implantation after assisted reproduction.

OBJECTIVE: To assess the utility of endometrial thickness, echogenic endometrial pattern, and uterine artery impedance measured as pulsativity index in predicting implantation. DESIGN: Prospective case-controlled study of infertile patients undergoing assisted reproductive technologies (ARTs). PATIENTS: Four hundred five women undergoing ARTs were studied: 100 women after ET of thawed embryos in natural cycles (frozen ET), 107 women after standardized IVF-ET, 99 women receiving donor oocytes after controlled endometrial development with estrogen and P, and 99 women undergoing IUI with various ovarian stimulation regimens (none, 16; GnRH, 7; clomiphene citrate [CC], 29; hMG, 47). INTERVENTIONS: Transvaginal ultrasonographic examination performed on the day of hCG administration during stimulated cycles; on E2 day 15 during controlled endometrial cycles; and on the day of ovulation during natural, CC, and GnRH pump cycles. MAIN OUTCOME MEASURE: The endometrial thickness, echogenic pattern, and pulsativity index results in 170 conception cycles were compared with 235 nonconception cycles. RESULTS: When conception and nonconception cycles were compared, no difference in mean endometrial thickness and significant differences in the frequency of nonmultilayered pattern and pulsativity index > 3.3 were observed. Forty-seven percent of nonconception and 9% of conception cycles were associated with at least one of these factors. CONCLUSION: Ultrasonic measurements of pulsativity index, resistance index, and echogenic pattern are useful in predicting implantation after assisted reproduction.

Case-Control Studies↗
PubMed1994

Acrosome reaction inducibility predicts fertilization success at in-vitro fertilization.

We prospectively studied the ability of acrosome reaction (AR) inducibility to predict fertilization success in a group of 232 infertile patients presenting sequentially for in-vitro fertilization (IVF). The median percentage of eggs fertilized for the overall patient population was 25% (interquartile range 5-58%), with one to 29 oocytes available for insemination (median, five oocytes). The median percentage of eggs fertilized at IVF increased as the percentage of spermatozoa able to undergo AR became greater: spermatozoa with a failed AR (< or = 5%) fertilized only 12% of eggs, while spermatozoa with AR values > 9% fertilized 50% of eggs. The assay had a specificity of 0.75, a sensitivity of 0.55 and an odds ratio of 2.9; thus, AR-positive patients are 2.9 times more likely to achieve fertilization than patients with a failed AR. Receiver operator characteristic (ROC) curves were constructed for AR, sperm concentration and percentage of normal forms in semen. All three parameters proved to be potentially useful in predicting the occurrence of fertilization, although AR and morphology appeared to be better than sperm concentration by ROC analysis. Patients were divided into four clearly defined subgroups according to their traditional semen characteristics, including morphology. The median percentage of eggs fertilized decreased as traditional semen characteristics deteriorated, from a median of 46% for patients with excellent sperm concentration, motility and morphology, to a median of 29% for patients with suboptimal semen quality and a median of 0% for patients with severely impaired semen.(ABSTRACT TRUNCATED AT 250 WORDS)

Acrosome↗
PubMed1994

Intravenous immunoglobulin for in-vitro fertilization failure.

The aim of this study was to determine the effectiveness of intravenous (i.v.) immunoglobulin (Ig) for treatment of individuals experiencing failure after in-vitro fertilization (IVF) and embryo transfer. A total of 29 women with unexplained infertility who failed to become pregnant after IVF/embryo transfer were divided into two groups based on performance in previous IVF cycles: 16 women had fertilization of > or = 50% of oocytes retrieved and/or produced > or = 3 embryos each cycle and 13 had fertilization of < 50% of oocytes retrieved and/or produced < 3 embryos each cycle. Each woman had received at least 12 transferred embryos (95th percentile for successful IVF patients) or had experienced two or more biochemical pregnancies without ultrasonic confirmation of implantation during previous IVF/embryo transfer attempts. All women received i.v. Ig 500 mg/kg prior to the next embryo transfer. Only one of the 13 (8%) women with suboptimal fertilization and embryo yield became pregnant in the treatment cycle. Of 16 women who had previously had fertilization of at least 50% of oocytes retrieved and produced at least three embryos, nine (56%) became pregnant in the treatment cycle. The difference in pregnancy rates between the two groups is significant (P = 0.02). Intravenous Ig is useful in the treatment of unexplained IVF failure in women who have oocyte fertilization rates > or = 50% and generate at least three embryos per cycle.

Adult↗
PubMed1994

Very early (24-56 days from last menstrual period) embryonic heart rate in normal pregnancies.

To determine embryonic heart rate in early gestations, 426 ultrasonographic examinations from 24 to 56 days from onset of last menstrual period (LMP) were studied. All pregnancies had a subsequent successful outcome. Transvaginal ultrasonography was performed using an Acuson 128 10XP with a 5 MHz probe. Embryonic heart rate was determined by M-mode. No embryonic heart rate was observed prior to 34 days of gestation from onset of LMP (n = 65). At 35 days, two of 13 (15%) pregnancies had cardiac activity, and by 36 days 16 of 19 (82%) pregnancies had cardiac activity. By day 37 from onset of LMP all pregnancies demonstrated embryonic cardiac activity. From days 34 to 56, mean embryonic heart rate rose from 94 to 166 beats/min. We conclude that embryonic cardiac activity is first apparent at day 34 and should be visible by day 37 in normal pregnancies.

Female↗
PubMed1993

Serum progesterone and estradiol concentrations in the early diagnosis of ectopic pregnancy after in vitro fertilization-embryo transfer.

To determine if discriminatory P or E2 concentrations can be established for early diagnosis of EP after IVF, 282 pregnancies were studied 11, 13, 15, and 17 days after ET. Receiver-operator characteristic analysis of P and E2 indicated no clinically useful threshold value for EP. No significant differences in P or E2 was seen when intrauterine and extrauterine pregnancies or viable and nonviable pregnancies were compared. All EPs had P < 50 ng/mL and E2 < 500 pg/mL at 11 days after ET. Serum P and E2 cannot differentiate EPs from intrauterine pregnancies nor viable from nonviable pregnancies resulting from IVF.

Embryo Transfer↗
PubMed1993

Colour Doppler ultrasound guidance for transcervical wire tuboplasty.

To evaluate the usefulness of high-resolution ultrasound with colour Doppler mapping system in performing transcervical wire tuboplasty, 13 infertile women with bilateral proximal tubal obstruction demonstrated by X-ray or colour Doppler ultrasound hysterosalpingography and chromoperturbation at laparoscopy were treated by transcervical wire tuboplasty utilizing colour Doppler mapping ultrasound guidance. A co-axial catheter was used to introduce a 0.016-in. flexible wire to the occluded portion. Transcervical wire catheterization was accomplished in 25 of 26 tubes (96%), resulting in patency in 24 of 25 tubes (96%). At the end of the procedure all patients had at least one tube patent (100%). Five (38%) women achieved pregnancies within 1 year after the procedure. High-resolution ultrasound with colour Doppler mapping system is an efficacious way to perform transcervical wire tuboplasty, avoiding the risk of radiation and allergic reaction.

Adult↗
PubMed1993

Acrosome reaction inducing activity in follicular fluid correlates with progesterone concentration but not with oocyte maturity or fertilizability.

Follicular fluid is a potent mediator of sperm acrosome reaction (AR) in vitro. The aim of this study was to investigate whether individual follicular fluids vary quantitatively in their ability to stimulate an AR, and whether such variability relates to fertilizability of the corresponding egg, its maturational level and/or progesterone content. Individual follicular fluids were obtained from 24 women undergoing in-vitro fertilization and assayed for their ability to induce an AR in normal human spermatozoa. After incubation in capacitation medium for 18 h, spermatozoa were challenged with the individual follicular fluids for 30 min. AR was detected by immunofluorescence, using fluorescein-labelled Pisum sativum lectin. We found that individual follicular fluids varied markedly in their ability to induce AR. Acrosome reaction correlated linearly with progesterone concentration (Spearman's r = 0.735, P = 0.01) at constant protein level, but no correlation was found between AR and protein concentration at constant progesterone level. Progesterone concentrations were not only higher (ANOVA, P = 0.002) in fluids from mature oocytes compared to those from less mature or post-mature eggs but also in fluids from fertilized compared to unfertilized eggs (ANOVA, P = 0.015, n = 13 patients with both fertilized and unfertilized eggs). In contrast, AR-inducing ability of individual follicular fluids did not differ for fertilized and unfertilized eggs. While AR-inducing ability appeared to increase with maturational stage of the egg, this trend was not statistically significant, probably due to small sample size. Our data suggest that progesterone rather than protein is the principal mediator of acrosome reaction induced by follicular fluid in vitro.(ABSTRACT TRUNCATED AT 250 WORDS)

Acrosome↗
PubMed1991

Human preimplantation embryo cryopreservation: selected aspects.

This report describes the results of cryopreserving human preimplantation zygotes and cleaved embryos (2-4 cells) in our in-vitro fertilization programme. Cryopreserved zygotes and cleaved embryos resulted in similar post-thaw survival rates (74.8 versus 70.9%). Pregnancy rates per retrieval cycle (RC) and embryos transferred per pregnancy for frozen-thawed zygotes versus frozen-thawed cleaved embryos were 21.8 versus 11.5% (P less than 0.2) and 12.6 versus 17.5 (P less than 0.2), respectively. Pregnancy rates increased significantly for both fresh (P less than 0.0005) and frozen-thawed (P less than 0.05) embryos as the number of embryos replaced per transfer increased from one to three or more. Frozen-thawed embryos resulted in multiple implantation rates per transfer of 25 compared to 6.4% (P less than 0.1) for fresh embryos when two embryos were replaced. Pregnancy rates were reduced for fresh (P less than 0.05) and frozen-thawed (P less than 0.1) embryos obtained from patient retrieval cycle numbers greater than 3. The method of follicular stimulation during the retrieval cycle did not affect frozen-thawed embryo survival rates. There was no difference in pregnancy rates from frozen-thawed embryos replaced during natural or clomiphene citrate transfer cycles. Patients with cryopreserved embryos had cumulative pregnancy rates of 37.1% (66/178) compared to 23.5% (110/468) (P less than 0.01) for patients with no embryos cryopreserved; cryopreservation of preimplantation embryos is a reliable therapeutic procedure that enhances achievement of pregnancy through in-vitro fertilization.

Blastocyst↗
PubMed1990

Small increases in circulating luteinizing hormone (LH) concentrations shortly before human chorionic gonadotropin (hCG) are associated with reduced in vitro fertilization (IVF) pregnancy rate.

The effects of slight elevations in serum LH just before hCG administration on IVF cycle outcome were studied in 219 women undergoing retrieval. One hundred seven patients were stimulated using human menopausal gonadotropin (hMG), and 112 received clomiphene citrate and hMG. Serum LH, estradiol (E2), and progesterone concentrations were measured before and during controlled ovarian stimulation. Retrospectively the women were subdivided into three groups based on serum LH before hCG: Group I, less than 50% LH rise from baseline (BL) value (mean of day 2 and day 7); Group II, LH rise greater than or equal to 50% but less than 2 x BL; and, Group III, LH rise greater than or equal to 2 x BL. The fertilization and cleavage rates were similar in all groups. However, a greater than or equal to 50% rise in serum LH before hCG was associated with a significantly reduced IVF pregnancy rate.

Chorionic Gonadotropin↗