Biomedical subjects
Publications and source records attributed to M M Alper.
Premature ovarian failure is not uncommon. It can occur at any age and has important implications for both patient and clinician. Various therapeutic options are available, including in vitro fertilization with donor oocytes.
Fertility factors were examined in 50 women with primary infertility and presumed in utero diethylstilbestrol (DES) exposure and in 50 age-matched controls. Uterine deformities and endometriosis were more frequent in the DES-exposed women than the controls. When managed from one to four years, only 4% of DES-exposed women with primary infertility conceived (with no conceptions resulting in a viable fetus) as compared to 44% of controls. Primary infertility of one to two years' duration with uterine deformities characteristic of DES exposure seems to signal a poor prognosis for pregnancy despite treatment of identifiable fertility factors.
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.
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.
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A 16-year-old woman who presented with amenorrhea had absence of the uterus, a normal vagina and gonadal dysgenesis.
A study was designed to compare the systemic absorption of metronidazole by the oral and vaginal routes. Nine subjects received single 500-mg doses of the oral, vaginal insert, and vaginal cream preparations on three occasions. Approximately 20% bioavailability was demonstrated from both vaginal forms. Mean peak plasma concentrations were 15.56 micrograms/mL for the oral form, 1.86 micrograms/mL for the cream, and 1.89 micrograms/mL for the insert. The mean times to peak concentration were 1.23 hours for the oral dose and 11.11 hours and 20.11 hours for the cream and insert, respectively. The data demonstrate that some vaginal absorption occurs from both the cream and insert preparations of metronidazole.
Thirty-three patients with the diagnosis of chromosomally competent premature ovarian failure were reviewed for evidence of autoimmune disease. Thirty-nine percent of subjects had an associated autoimmune disorder, of which thyroid disease was the most common. One patient had vitiligo and one had adrenal insufficiency. A family history of autoimmune disease was elicited from 18% of subjects, all of whom proved to have an autoimmune disease themselves. From these findings, and a review of other studies, the authors conclude that an associated autoimmune disease, or other evidence of autoimmunity, is present in 30 to 50% of patients with premature ovarian failure.
Rupture of the gravid uterus is a serious obstetric emergency that threatens maternal and fetal life. In certain cases the classic clinical picture may be absent. Most asymptomatic ruptures are in the lower segment and of minor extent or are really dehiscences of scars. This paper presents a case of massive spontaneous rupture involving the entire corpus diagnosed at elective postpartum sterilization. This unusual event stimulated a review of the causes and clinical presentations of uterine rupture.
STUDY OBJECTIVE: To determine whether the pregnancy rate for gamete intrafallopian transfer (GIFT) patients who received thiopental sodium was different from the pregnancy rate for patients who received propofol for the induction of general anesthesia. DESIGN: Retrospective review of clinical records. SETTING: Private outpatient infertility clinic. PATIENTS: Two hundred eighty-two consecutive GIFT procedures performed on 230 patients with infertility. INTERVENTION: Patients undergoing GIFT were divided into two groups on the basis of whether they received thiopental or propofol for induction of anesthesia. MEASUREMENTS AND MAIN RESULTS: Clinical pregnancy following each GIFT procedure was assessed by multiple-serum beta human chorionic gonadotropin and ultrasound determinations. The pregnancy rates of 24.6% and 25.8% for the thiopental and propofol groups, respectively, were not significantly different. CONCLUSIONS: The pregnancy rate following GIFT for patients given propofol for induction of general anesthesia did not differ from that for patients given thiopental.
Laparoscopic surgery has gained wide acceptance in the treatment of ectopic pregnancy. When compared with conventional surgical techniques, the laparoscopic approach reduces perioperative morbidity, hospital costs, length of hospital stay, and recovery time. Laparoscopic surgery, however, often requires special surgical skills and expensive equipment. In this paper we review the literature on the efficacy of the laparoscopic approach to salpingectomy and report a simple technique for such a procedure. Any gynecologist who performs laparoscopic tubal sterilization by electrocautery has the necessary equipment and can develop the skills to carry out this procedure.