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Biomedical subjects

M L Taymor

Publications and source records attributed to M L Taymor.

At least 19 recordsLinked to original sources
PubMed1996

The regulation of follicle growth: some clinical implications in reproductive endocrinology.

OBJECTIVE: To review the literature concerning the regulation of follicle growth, to describe a model for unifollicular ovulation based upon the information gleaned, and to discuss some clinical implications in reproductive endocrinology underscored by this expanding knowledge. DESIGN: Studies relating to follicular growth in lower animals and primates were reviewed. From the most pertinent articles the individual agents playing a significant role in the regulation of follicle growth were identified along with their mechanisms of action. A model for unifollicular development was proposed based upon the results of the review of these studies. Refinements in the management of some clinical problems in reproductive endocrinology were discussed based upon this model. RESULTS: From a review of these studies it appears that in the human and primate menstrual cycle one follicle is selected because it has adequate FSH receptors when plasma FSH levels are high. This follicle becomes dominant despite falling FSH levels because of increased sensitivity of the follicle to FSH brought about by intraovarian growth regulators. CONCLUSIONS: Improved care of patients requiring ovulation induction for differing indications should be possible with this more comprehensive knowledge of natural follicle growth.

Amenorrhea↗
PubMed1992

Natural oocyte retrieval with intravaginal fertilization: a simplified approach to in vitro fertilization.

To simplify in vitro fertilization (IVF), we have combined natural-cycle oocyte retrieval with intravaginal fertilization. Our subjects ranged in age from 28-40 years and were monitored by ultrasound and steroid hormone levels. Oocyte retrieval was carried out under vaginal ultrasound-guided aspiration 32-36 hours after the onset of the LH surge. The oocyte was identified and placed in a sealed capsule containing culture media and sperm. The capsule, in a sealed cryoflex envelope, was placed in the woman's vagina and removed 42-48 hours later. The embryo was then isolated and transferred to the woman's uterus. Fifty-one retrieval cycles were attempted in 45 patients. At least one oocyte was retrieved in 88% of cycles, and fertilization was achieved in 84% of oocytes. Of the five clinical pregnancies (10%), four have delivered and one is ongoing. The cost of this procedure is approximately one-third that of standard IVF. The advantages of our method are the elimination of the use of gonadotropins, the simplicity of monitoring and oocyte retrieval, and the lack of need for expensive laboratory equipment. Natural oocyte retrieval with intravaginal fertilization may prove appropriate for those women requiring IVF who fear multiple pregnancies, have side effects from controlled ovarian hyperstimulation, or cannot afford standard IVF.

Adult↗
PubMed1988

Efficacy of danazol treatment for minimal endometriosis in infertile women. A prospective, randomized study.

We compared pregnancy rates between a danazol-treated and an untreated group of infertile women with minimal endometriosis. After completion of a basic infertility workup and laparoscopy, women with minimal endometriosis were entered into the study and randomly selected to receive either a six-month course of danazol or no treatment at all. Those patients with other infertility factors were included in the study only if the factors were correctable and ultimately determined to be noncontributory. Life-table analysis was used to compare pregnancy rates between the two groups over a 12-month period that started immediately after laparoscopy in the untreated group and after completion of danazol therapy in the treated group. The cumulative pregnancy rate (+/- SEM) was 37.2 +/- 8.4% in the danazol group (n = 37) and 57.4 +/- 10.4% in the untreated group (n = 36) (NS, P greater than .10). This prospective, randomized study showed danazol to be ineffective in improving pregnancy rates over doing nothing at all in patients with minimal endometriosis.

Actuarial Analysis↗
PubMed1987

The impact of embryo quality and quantity on implantation and the establishment of viable pregnancies.

The role of cleavage rates, number of embryos transferred, and some other variables in pregnancy outcome in 222 human embryo transfers was studied. Pregnancy rates were significantly higher in a group of 117 patients receiving at least one embryo that had reached the four-cell stage at 40 hr postinsemination (26% total pregnancies/transfer and 18% ongoing pregnancies/transfer) than in the 105 patients receiving embryos developing at a slower rate (7% total pregnancies/transfer and 2% ongoing pregnancies/transfer). Of the 23 ongoing or term pregnancies produced, 21 came from transfers of at least one embryo that had reached four-cell stage by 40 hr postinsemination. Pregnancy rates were unaffected in either the fast-cleaving or the slower-cleaving embryos by culturing in vitro for an additional 24 hr. The presence of anucleate cell fragments also had no effect on pregnancy rates. Pregnancy rates increased progressively with the transfer of more embryos per transfer. These results suggest that procedures to improve ovulation induction and in vitro embryo culture technique may better the success of in vitro fertilization by providing a high number of rapidly cleaving embryos for transfer.

Cleavage Stage, Ovum↗
PubMed1987

Comparison of follicular fluid hormones in patients with one or two ovaries participating in a program of in vitro fertilization.

The authors recently reported on the follicular response to clomiphene citrate (CC) and human menopausal gonadotropins (hMG) in patients with one or two ovaries participating in a program of in vitro fertilization. This study was designed to analyze the follicular fluid hormones in patients with one or two ovaries in order to elucidate the compensatory mechanisms by which a single ovary achieves folliculogenesis equal to that of two ovaries. Twenty-one follicles from ten patients with one ovary were compared to 30 follicles from eight patients with two ovaries present. Ovulation induction was achieved using a standard protocol with sequential CC and hMG. Human chorionic gonadotropin (hCG) was administered after appropriate estradiol (E2) values and ultrasonic findings, and oocyte aspiration by laparoscopy was performed 33 hours later. Follicular fluid (FF) hormones were assayed by standard radioimmunoassay techniques and no differences were found in the levels of progesterone (P), testosterone, estradiol/testosterone ratio, prolactin, follicle-stimulating hormone, and luteinizing hormone. However, follicles from patients with one ovary had a lower mean concentration of E2 (286 versus 542 ng/ml, P = 0.001) and a lower mean E2/P ratio (0.055 versus 0.107, P = 0.016). Also, the mean follicular diameters and volumes were similar in both groups. In view of the authors' previous finding of a comparable number of mature oocytes from patients with either one or two ovaries, these data suggest that follicles from patients with a single ovary may achieve comparable oocyte maturity despite less efficient production of E2. Although FF E2 levels were lower in patients with one ovary, this dysynchrony between oocyte maturity and FF E2 values does not appear to affect outcome adversely.

Estradiol↗
PubMed1987

The influence of exogenous human chorionic gonadotropin cycles with spontaneous luteinizing hormone surges on the outcome of in vitro fertilization.

Thirty consecutive patients who displayed endogenous luteinizing hormone (LH) surges and reached oocyte recovery for the purpose of in vitro fertilization were reviewed (LH surge group). Another 37 patients receiving human chorionic gonadotropin (hCG) in the absence of an LH surge served as a control group (no surge-hCG group). All patients underwent ovulation induction using clomiphene citrate (CC) plus human menopausal gonadotropin (hMG). The numbers of oocytes recovered and embryos transferred were significantly lower in the LH surge group compared with the no surge-hCG group (P less than 0.05). Nevertheless, the pregnancy rate per oocyte recovery between the two groups appeared similar (20 versus 16%). Among the 30 patients with a LH surge, 9 received hCG after a LH surge was verified, whereas the others did not. Addition of hCG to the LH surge increased the numbers of oocytes recovered, embryos transferred, and the pregnancy rate (3 out of 9 versus 3 out of 21); however, this difference is not statistically significant. Furthermore, the addition of exogenous hCG to a spontaneous LH surge appears to be necessary to maximize the number of oocytes recovered, embryos transferred, and pregnancies obtained.

Adult↗
PubMed1986

Comparison of intermediate-dose purified urinary follicle-stimulating hormone with and without human chorionic gonadotropin for ovulation induction in polycystic ovarian disease.

Urinary FSH is capable of inducing ovulation in PCOD. The duration of treatment can be reduced by administering an intermediate dose. However, it appears that prospective monitoring with E2 assays and ultrasound, combined with hCG, is required to optimize outcome and minimize complications. Studies comparing urinary FSH with similar doses of hMG with and without hCG are needed to determine the most effective form of gonadotropin therapy in PCOD.

Chorionic Gonadotropin↗
PubMed1986

Luteal phase serum progesterone levels after follicle aspiration with and without clomiphene citrate treatment.

Peripheral serum progesterone (P) levels were studied on random days after the spontaneous luteinizing hormone (LH) surge in women who underwent follicle aspiration. Comparisons were made with ovulatory women treated with clomiphene citrate (CC) undergoing follicle aspiration and women undergoing midcycle general anesthesia and laparoscopy without follicle aspiration. There were no differences in mean P levels in the group of women who underwent follicle aspiration, compared with the group who did not. Women treated with CC showed higher P levels during the first week of the luteal phase. During the second week of the luteal phase P levels were similar, regardless of follicle aspiration alone or in combination with CC use. In the groups not using CC, more individual women had P levels less than 10 ng/ml. Follicle aspiration does not appear to reduce luteal phase P levels in groups of patients in the natural menstrual cycle or receiving CC. Some individual patients, however, appear to be at risk for lower P levels, particularly after follicle aspiration or general anesthesia, in the natural cycle.

Clomiphene↗
PubMed1986

Danazol therapy for proximal obstruction of the oviduct.

Danazol therapy for proximal tubal obstruction and associated endometriosis has been suggested to be highly effective. Of 12 women treated with danazol for two to nine months, 5 had resolution of their proximal tubal obstruction after three to eight months of therapy. Two of the five had no associated pelvic endometriosis, and one of them became pregnant. Due to the heterogeneity of the patient population studied, it is difficult to make a definitive statement about the efficacy of danazol in patients with proximal tubal obstruction. However, the data suggest that danazol is effective in the treatment of some patients with proximal tubal obstruction and should be considered prior to surgery.

Danazol↗
PubMed1985

In vitro fertilization and embryo transfer: an individualized approach to ovulation induction.

Because of the inherent marked individual responsiveness to ovulatory stimulating agents, a highly individualized approach to ovulation induction for in vitro fertilization has been utilized. The starting time for medication was varied according to the previous mean cycle length. The dose of clomiphene citrate was adjusted to the body weight. The dose and duration of both clomiphene and human menopausal gonadotropin (hMG) were adjusted as early as treatment day 5 in accordance with the ultrasonic findings. The day of human chorionic gonadotropin (hCG) administration was varied according to a combination of ultrasonic findings and plasma estradiol levels. This approach resulted in a mean retrieval of four oocytes per laparoscopy, 75% of which were mature, a fertilization rate of 78%, and a pregnancy rate of 14% of laparoscopies.

Adult↗
PubMed1985

The relationship of semen parameters to fertilization in patients participating in a program of in vitro fertilization.

Approximately 80% of the patients in a program of in vitro fertilization (IVF) will fertilize an oocyte. The purpose of this study was to determine which parameters of the semen analysis influence fertilization in vitro. Of 120 patients participating in an in vitro fertilization program, 98 achieved fertilization of at least one mature oocyte and 22 did not. Ovulation induction was standardized and patients whose sperm was exposed to at least one mature oocyte (by light microscopy) were included in the study. Semen washing was accomplished using a "swim-up" technique. Semen parameters were assessed both before (raw) and after washing. Following insemination with 100,000 motile sperm, fertilization was determined by the presence of pronuclei or cleavage. Mean sperm count and motility were higher in patients who fertilized. However, morphology was similar. Fertilization was more likely to occur with a raw density greater than 104 million/ml and a motility greater than 64%, as well as with a density greater than 18 million/ml and a motility greater than 86% following washing. Furthermore, washing lowered sperm counts by 75% and increased motility by 25% but had no effect on morphology. This study demonstrates that sperm count and motility, but not morphology, influence fertilization in a program of in vitro fertilization and that patients with higher counts and motility have a greater probability of fertilization.

Female↗
PubMed1985

Ovulation induction in polycystic ovary syndrome with urinary follicle-stimulating hormone or human menopausal gonadotropin.

In patients with polycystic ovarian disease (PCOD) ovulation was induced with a combination of human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG) or with urinary follicle-stimulating hormone (uFSH; Metrodin, Serono Laboratories, Inc., Randolph, MA) alone. hMG/hCG and uFSH resulted in comparable rates of ovulation and conception in patients with PCOD. The incidence of hyperstimulation and the potential for multiple births appeared lower with uFSH. The fact that endogenous ovulation did not occur in hMG patients who had hCG withheld or in 3 of the 11 uFSH patients who had preovulatory levels of estradiol and follicles greater than 15 mm may imply that these similarly derived gonadotropins in some instances block endogenous ovulation.

Androstenedione↗
PubMed1985

Comparison of follicular response in patients with one or two ovaries in a program of in vitro fertilization.

Some patients undergoing in vitro fertilization have had a previous oophorectomy. The purpose of this study was to provide a preliminary comparison of the follicular response to ovulation induction with sequential clomiphene citrate and human menopausal gonadotropin (hMG) in patients with one (n = 14) or two (n = 14) ovaries. No statistically significant differences were detectable in the following parameters: mean number of ampules of hMG required, mean number of days of hMG therapy, mean number of follicles greater than 15 mm on ultrasound, mean number of mature or number of immature oocytes, mean number of embryos transferred, and number of pregnancies. Patients with both ovaries in situ demonstrated a trend for greater numbers of follicles greater than 15 mm aspirated at laparoscopy (5.9 versus 3.4, P = 0.03). We conclude that the presence of a single ovary does not appear to influence the outcome of in vitro fertilization.

Clomiphene↗
PubMed1984

Ovulation induction with subcutaneous pulsatile gonadotropin-releasing hormone: the role of supplemental human chorionic gonadotropin in the luteal phase.

Four subjects with hypothalamic amenorrhea were administered subcutaneous pulsatile gonadotropin-releasing hormone (GnRH) for ovulation induction. GnRH was discontinued at the time of presumed ovulation in all cases. In the first two patients the luteal phase was supported with human chorionic gonadotropin in the initial cycle but not in the second cycle. In patient 3, the reverse was true. Patient 4 had only one cycle on GnRH, and it was unsupported. Daily blood samples were obtained for luteinizing hormone, follicle-stimulating hormone, estradiol, and progesterone (P); and frequent pelvic ultrasound examinations were performed. Presumed ovulation as determined by ultrasound occurred in all seven cycles. The first three patients had short luteal phases with poor P production in the unsupported cycles. However, the fourth patient, who had shown pituitary response in GnRH testing, had a normal luteal phase with good P production without human chorionic gonadotropin support. These data support the notion that subcutaneous pulsatile GnRH can be used for the induction of ovulation. However, if the luteal phase is not supported, an inadequate corpus luteum may result.

Amenorrhea↗
PubMed1984

Treatment of polycystic ovary disease with chronic low-dose follicle stimulating hormone: biochemical changes and ultrasound correlation.

Pure follicle stimulating hormone (FSH) was administered during six cycles to five patients with "classical" polycystic ovary disease (PCO). Ovulation occurred in four of six cycles, and pregnancy occurred in three of six cycles studied. Luteinizing hormone (LH) levels initially declined slowly. Immediately prior to ovulation there was an exaggerated drop in LH coincidental with an estradiol (E2) rise. This was subsequently followed by a rise in LH above baseline consistent with a preovulatory LH surge. No more than a single dominant, preovulatory follicle was noted in the ovaries of any patient in whom pelvic ultrasound was performed. This study adds further in vivo evidence that FSH is capable of interrupting the self-perpetuating biochemical cycle of PCO in a safe and logical way.

Estradiol↗