PubMed Health⌕ Search

Biomedical subjects

M Germond

Publications and source records attributed to M Germond.

At least 19 recordsLinked to original sources
PubMed1999

[Assisted fertilization in azoospermic men: results of CHUV from 1994 to 1997].

In vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) have revolutionised the treatment and prognosis of oligo-terato-asthenozoospermia (OTA). Sperm extraction in the vas deferens, the epididymis (MESA: with epididymal sperm aspiration) or the testicles (TESE: with testicular sperm extraction), associated with ICSI, can achieve pregnancy in cases of excretory or secretory azoospermia. We report the results of the use of MESA and TESE in 42 patients with an average age of 37 (age range 24 to 58). Of these, 26 have excretory azoospermia, 11 secretory azoospermia and 5 a problem linked to ejaculation. Of the 506 oocytes that were inseminated, 270 zygotes were obtained, giving a fertilisation rate of 53.4%. 85 embryo transfers were carried out (55 with fresh embryos and 30 with cryo-preserved embryos). Three spontaneous abortions and one extrauterine pregnancy were reported. Six pregnancies are developing normally. To date, 13 children have been born (9 boys and 4 girls) in 10 deliveries (7 single children and 3 sets of twins). The limits of male infertility need to be revised to take these new forms of therapy into account and patients should be advised on the new possibilities available.

Adult↗
PubMed1999

Does growth hormone-releasing factor assist follicular development in poor responder patients undergoing ovarian stimulation for in-vitro fertilization?

Treatment with growth hormone-releasing factor (GRF) has been reported to improve the ovarian response to gonadotrophins in women who respond poorly to ovarian stimulation during in-vitro fertilization (IVF). The efficacy and tolerability of GRF were studied in a randomized, double-blind, placebo-controlled trial involving 196 patients. Following down-regulation with a gonadotrophin-releasing hormone agonist (GnRHa), patients were randomized to receive GRF (500 microg twice daily; n = 96) or placebo (n = 100) in addition to follicle stimulating hormone (FSH); treatment was continued until human chorionic gonadotrophin was given, or for a maximum of 14 days. GRF had no significant effect on the mean number of follicles with a diameter of >/=16 mm (GRF: 3.26 +/- 2.29; placebo: 3.27 +/- 2.30; P = 0.95), the number of FSH ampoules required to achieve ovarian stimulation (GRF: 55.2 +/- 16. 4; placebo: 54.9 +/- 17.2; P = 0.50), or on secondary measures of ovarian response and treatment outcome. There were, however, significant increases in circulating growth hormone (GH) and insulin-like growth factor (IGF)-1 concentrations. GRF was well tolerated. It is concluded that, despite producing significant increases in GH and IGF-1, concomitant treatment with GRF does not improve the ovarian response to FSH in poorly responsive women undergoing IVF.

Adolescent↗
PubMed1997

[Diagnostic and therapeutic approach to male sterility].

The new techniques of medically assisted procreation allow to approach most of the male infertilities. Their complexity and cost call for a precise diagnosis prior to treatment initiation and a multidisciplinary investigation of the sterile couple is mandatory. We demonstrate the urological side of these investigations.

Diagnosis, Differential↗
PubMed1996

Non-contact microdrilling of mouse zona pellucida with an objective-delivered 1.48-microns diode laser.

BACKGROUND AND OBJECTIVE: A non-touch laser-induced microdrilling procedure is studied on mouse zona pellucida (ZP). STUDY DESIGN/MATERIALS AND METHODS: A 1.48-microns diode laser beam is focused in a 8-microns spot through a 45x objective of an inverted microscope. Mouse zygotes, suspended in a culture medium, are microdrilled by exposing their ZP to a short laser irradiation and allowed to develop in vitro. RESULTS: Various sharp-edged holes can be generated in the ZP with a single laser irradiation. Sizes can be varied by changing irradiation time (3-100 ms) or laser power (22-55 mW). Drilled zygotes present no signs of thermal damage under light and scanning electron microscopy and develop as expected in vitro, except for a distinct eight-shaped hatching behavior. CONCLUSION: The microdrilling procedure can generate standardized holes in mouse ZP, without any visible side effects. The hole formation can be explained by a local photothermolysis of the protein matrix.

Animals↗
PubMed1996

Normogonadotropic primary amenorrhea in a growth hormone-deficient woman with ectopic posterior pituitary: gonadotropin pulsatility and follicle-stimulating hormone bioactivity.

We studied the gonadotropic function in a 25-year-old woman suffering from congenital GH deficiency, complaining of primary amenorrhea and wishing to become pregnant. She disclosed a hypoplasic anterior pituitary within a small sella turcica and an ectopic posterior pituitary lobe located below the median eminence. Immunoreactive LH and FSH plasma levels were normal, basal and in response to a GnRH iv bolus but estradiol was low. LH pulse frequency was elevated and FSH bioactivity was low in a granulosa cell aromatase bioassay. Pulsatile administration of iv GnRH at a slower, normal pace, failed to induce ovulation or to increase FSH bioactivity, with or without concomitant GH replacement. However treatment with exogenous im gonadotropins, when preceeded by GH replacement, succeeded in inducing mature oocytes and pregnancy. We concluded that the hypogonadism observed in this patient was due to rapid GnRH pulsatility and poor biological activity of endogenous FSH.

Adult↗
PubMed1996

Improved fertilization and implantation rates after non-touch zona pellucida microdrilling of mouse oocytes with a 1.48 microm diode laser beam.

The safety of microdrilling the zona pellucida of mouse oocytes with a 1.48 microm diode laser has been investigated by determining the ability of mouse oocytes to fertilize in vitro and develop in vivo. Mice born after transfer of control and zona pellucida-microdrilled embryos into foster mothers were submitted to anatomical and immunohistochemical investigations, and their aptitude to breed was assessed in two subsequent generations. Decoronization of the oocytes with hyaluronidase induced a reduction of the fertilization and implantation rates, which was attributed to a zona hardening phenomenon. After laser zona pellucida microdrilling, these rates were restored to those obtained with embryos derived from untreated oocyte-cumulus complexes. Pups derived from zona pellucida microdrilled embryos were comparable with those obtained from control embryos, confirming the lack of deleterious effects of the laser treatment. In conclusion, the 1.48 microm diode laser allows safe microdrilling of the zona pellucida of mouse oocytes after decoronization with hyaluronidase. Based on the health of the F2 generation and the lack of neuroanatomical and neurochemical differences, we concluded that this technology may be investigated in the human, particularly when the zona pellucida represents the main impediment for fertilization or embryo hatching.

Animals↗
PubMed1996

Aorto-subclavian thromboembolism: a rare complication associated with moderate ovarian hyperstimulation syndrome.

The case of an arterial aorto-subclavian thromboembolism associated with a moderate ovarian hyperstimulation syndrome (OHSS) and following ovulation induction for in-vitro fertilization in a young woman is reported. Because of the lack of response to systemic thrombolysis, a left postero-lateral thoracotomy was performed on day 8 after embryo transfer. A fibrinocruoric embolus situated at the junction of the left subclavian artery from the aorta was removed through a left subclavian arteriotomy. The distal axillary embolus was removed by a retrograde balloon catheter embolectomy. A moderate OHSS was observed. The ovarian stimulation and OHSS-related risks of thromboembolism are discussed. We conclude that, in the absence of risk factors, counselling about possible complications resulting from stimulation must be emphasized.

Adult↗
PubMed1995

Microdissection of mouse and human zona pellucida using a 1.48-microns diode laser beam: efficacy and safety of the procedure.

OBJECTIVE: To investigate the efficacy and safety of a small and affordable 1.48-microns continuous wave diode laser for zona pellucida (ZP) microdissection. DESIGN: Mouse and human oocytes and zygotes were submitted to ZP drilling. The hole characteristics and possible laser-induced structural alterations of the neighboring cytoplasm were investigated with scanning and transmission electron microscopy. The safety of the procedure was checked on control and drilled zygotes by determining their ability to develop in vitro and in vivo. SETTING: Collaborative study between three Swiss academic centers. INTERVENTIONS: The collimated diode laser beam was delivered through a 45x objective of an inverted microscope and focused through the culture dish and culture medium in 1- to 3-microns spots. MAIN OUTCOME MEASURE: Safety assessment of the laser drilling procedure. RESULTS: The 1.48-microns radiation achieves a rapid, precise, and easily controlled lysis of the ZP without any micromanipulative handling of the eggs. Different shapes of holes can be produced by varying the laser beam intersection site on the ZP, laser power, and irradiation time. The energy needed to drill holes of a given diameter is greater for zygotes than for oocytes. Safety of the drilling procedure is confirmed by the lack of damage at the ultrastructural and biologic levels. CONCLUSIONS: The low-cost 1.48-microns diode laser allows an easy, objective-driven, nontouch microdissection of the ZP. The procedure is safe, as drilled embryos give rise to normal and fertile offspring.

Animals↗
PubMed1995

Timing of hCG administration in cycles stimulated for in vitro fertilization: specific impact of heterogeneous follicle sizes and steroid concentrations in plasma and follicle fluid on decision procedures.

The timing of ovulation induction is usually decided according to estradiol plasma concentrations and follicle size. We administered human chorionic gonadotropin (hCG) when at least three follicles of 16 mm or more in diameter and adequate estradiol plasma concentrations were detected. We studied the percentage of mature oocyte-cumulus-corona radiata complexes, estradiol and progesterone concentrations in a heterogeneous sized follicle population (range 10-20 mm, n = 90) to perform a retrospective analysis of the adequacy of criteria adopted for the timing of ovulation induction. Plasma and follicular fluid were obtained from 20 normo-ovulating women (aged 28-37 years) treated with gonadotropin releasing hormone analogs (GnRH-a) and human menopausal gonadotropin (hMG) for in vitro fertilization (IVF). No correlation was found between the mean individual follicular fluid estradiol concentration (500-5640 nmol/l) and the respective maximum concentration in plasma (2-16 nmol/l). The estradiol concentration was similar in all follicles. Total follicular fluid estradiol concentration was found to be correlated with follicular fluid volume (r = 0.771, p < 0.01). On the day of hCG administration, the concentration of estradiol in the plasma but not the follicular fluid was correlated with the number of oocyte-cumulus-corona radiata complexes collected (p < 0.01) and the number of mature complexes (p < 0.01). At oocyte pick-up, the plasma concentration of progesterone was correlated (p < 0.01) with number of complexes collected and the number of mature complexes. The percentage of mature complexes collected (77.5%) was higher than suggested by the number of leading follicles. This indicates that our criteria for administering hCG were adequate and that heterogeneous follicle size does not exclude a high rate of mature oocyte-cumulus-corona radiata complexes.

Adult↗
PubMed1995

[Midazolam versus placebo before spinal anesthesia].

The goal of this randomized, double blind and multicentric study was to compare the effects of midazolam (M) and placebo (P) administered by titration before puncture for spinal anaesthesia on the comfort of 211 patients scheduled for elective surgery after oral premedication with hydroxyzine. The administered dose of midazolam was 3.4 +/- 1.3 mg (mean +/- SD). Anxiety was nil in 92% of the patients of the M group and in 64% of the patients of the P group (p < 0.001) and memorization of the pain of the puncture was reported in 34% of the patients of the M group and in 66% of the patients of the P group (p < 0.001). However cooperation of the patient and easiness of the puncture were similar in both groups. In conclusion titrated sedation with midazolam before puncture for spinal anaesthesia increases the comfort of the patient.

Adjuvants, Anesthesia↗
PubMed1994

[Diprivan and full stomach].

On the basis of published data and our own experience, the procedure to be followed for general anaesthesia in a patient with a full stomach is that of a rapid sequence induction (induction-intubation) or "crash-induction". This technique which consists of the administration of atropine, a hypnotic and suxamethonium together with Sellick's manoeuvre, will provide the best conditions for intubation. In view of the characteristics of propofol (rapid effect, deep depression of pharyngo-laryngeal reflexes) it seems possible to use it as a first choice induction agent in patients who are haemodynamically stable. However, it should be noted, that there is, as yet, no evidence of the superiority of propofol over other induction agents.

Anesthesia, Intravenous↗
PubMed1993

[A traditional anesthesia consultation or a "telephone interview" within the framework of ambulatory surgery?].

UNLABELLED: Preoperative assessment for anaesthesia must detect in the setting of ambulatory surgery both medical and sociopsychologic problems which may contraindicate the ambulatory aspect of the procedure. The goal of our prospective study was to assess the efficacy of a preoperative telephone interview in screening the medical and sociopsychologic problems of ambulatory patients. 1,000 consenting consecutive outpatients participated to the study and were randomly allocated to one of two groups: patients in the standard group (STD) had a consultation a few days before surgery whereas those in the telephonic group (TEL) called the anesthetist a few days before, the physical exam being performed on the day of surgery. The cancellation of the ambulatory procedure was decided upon either medical criterias (MC) or sociopsychologic criterias (from Waetchler). RESULTS: both groups were comparable regarding SPC and MC but prescription of preoperative tests was more frequent in the STD group (result statistically significant). In conclusion, this new approach is as reliable as the standard consultation in screening the SPC which remain the most frequent cause of cancellation in ambulatory surgery. Therefore this telephonic interview which is simple and reliable for screening outpatients may represent a suitable alternative to a standard consultation.

Ambulatory Surgical Procedures↗
PubMed1993

[Ovulation induction by pulsatile intravenous administration of Gn-RH to patients with hypothalamic amenorrhea].

Intravenous pump administration (Zyklomat, Ferring) of GnRH (Lutrelef, Ferring) has been used to induce ovulation in 16 patients suffering from hypothalamic amenorrhea between January 1989 and December 1991. One to 6 cycles were performed for a total of 47 cycles. GnRH pulses were set at 20 micrograms/pulse every 90 min up during the follicular phase and decreased to 1 pulse/120 min during the 3-5 days following ovulation. Thereafter, the luteal phase was supported by 1000 IU HCG/48 h up to the end of the 5th week. Response to the treatment was monitored with seriC E2, P and LH and vaginal echography. Cycles (N = 3) were cancelled when E2 did not reach at least 0.25 nmol/l after 30 days. An E2 level > 0.8 nmol/l, associated with a mature follicle (> 20 mm), and the presence of a LH peak or an increased progesterone level were used to determine the day of ovulation. In case of normozoospermy (N = 9), sexual intercourse was recommended to the patients (27 cycles), whereas an intrauterine insemination was performed in case of a male factor (N = 7, 20 cycles). Results can be summarized as follows: 39 (83%) cycles were ovulatory and led to 9 (19%) clinical and 6 (13%) biochemical pregnancies. Five (8.5%) pregnancies aborted and 5 (11%) came to full term. After exclusion of the male factors, the pregnancy rate reaches 26%/initiated cycle, 28%/ovulatory cycle and 56%/patient. No patient developed a hyperstimulation syndrome or a multiple pregnancy. Three cycles (6.3%) were interrupted due to 2 superficial phlebitis and 1 pump failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Follicle-stimulating hormone bioactivity in idiopathic normogonadotropic oligoasthenozoospermia: double-blind trial with gonadotropin-releasing hormone.

OBJECTIVE: To identify, among patients with idiopathic normogonadotropic oligoasthenozoospermia, those with low bioactive follicle-stimulating hormone (FSH), possibly because of inadequate gonadotropin-releasing hormone (GnRH) pulsatility, whose bioactive FSH and sperm could be improved by GnRH treatment. DESIGN: Randomized, double-blind, placebo-controlled trial with intranasal (IN) GnRH, followed by open GnRH treatment. SETTING: Outpatient endocrinology clinic. PATIENTS: Twenty-eight infertile men with idiopathic normogonadotropic oligoasthenozoospermia. INTERVENTIONS: Gonadotropin-releasing hormone or placebo was self-administered IN every 2 hours. MAIN OUTCOME MEASURES: Serum immunoreactive and bioactive FSH and semen analyses. RESULTS: Ten men showed a low basal FSH bioactive/immunoreactive ratio, which increased in 5 of them under GnRH without parallel sperm modification. Sperm improvements were observed in 10 patients with no parallel evolution of FSH bioactive/immunoreactive ratio. Unpredicted by sperm changes, three pregnancies developed on placebo and 5 on GnRH. CONCLUSIONS: Low bioactive FSH was not the cause of idiopathic normogonadotropic oligoasthenozoospermia in our patients and could not predict response to GnRH. Pulsatile GnRH did not improve sperm beyond random fluctuations.

Administration, Intranasal↗