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M M Quigley

Publications and source records attributed to M M Quigley.

At least 55 records · Page 3Linked to original sources
PubMed1984

Human in vitro fertilization and the law.

Physicians who intend to perform in vitro fertilization--or the newer alternative, in vivo fertilization and embryo transfer--should be aware of the plethora of laws that potentially cover their work. In perhaps no other area of medicine are there so many separate statutes and regulations that potentially apply. State fetal research laws, abortion statutes, human subject protection laws, and specific in vitro fertilization statutes can determine whether and how the procedure can be undertaken. When donor gametes or a surrogate carrier is used, additional laws governing artificial insemination, paternity, or adoption may come into play to determine the child's legal status and its relationship to the parties involved. This article is designed to guide physicians through the legal maze.

Advisory Committees↗
PubMed1984

Sperm concentration and the fertilization of human eggs in vitro.

The effect of sperm concentration on the fertilization of preovulatory and immature human eggs was studied in the context of an ongoing in vitro fertilization-embryo transfer (IVF-ET) program. Fertilization success was independent of the follicular recruitment protocol used, and with preovulatory eggs, was inversely related to sperm concentration over the range of 2.5 - 50 X 10(4) motile sperm/ml. Maximum fertilization (80.8%) occurred at a concentration of 2.5 X 10(4) motile sperm/ml. The incidence of polyspermic fertilization was directly related to the sperm concentration, decreasing from 5.5% at 10 X 10(4) to 0% at 1-2.5 X 10(4) motile sperm/ml. Immature eggs cultured in vitro, then inseminated, also demonstrated an inverse relationship between fertilization and sperm concentration with a maximum fertilization rate of 66.6% at 5 X 10(4) motile sperm/ml. The percentage of motile sperm in the inseminating population had no influence on fertilization rates unless the value dropped below 40%. Fertilization success using sperm from oligospermic and polyzoospermic males was also examined. In contrast to males with normal semen parameters, oligospermic males demonstrated highest fertilization success at 50 X 10(4) motile sperm/ml. The IVF of preovulatory eggs using sperm from polyzoospermic males was comparable to that for males with normal semen parameters at equivalent sperm concentrations. The implications of these findings to the application of IVF-ET technology to the infertile couple is discussed.

Embryo Transfer↗
PubMed1984

The use of ovulation-inducing agents in in-vitro fertilization.

In view of the increasing pregnancy rate associated with increased numbers of embryos transferred to the uterus, it is optimal to transfer more than one embryo to each patient. This requires treatment with ovulation-inducing agents to increase the number of preovulatory follicles developing. However, the degree of ovarian "hyperstimulation" must be limited to prevent subsequent luteal-phase dysfunction. In all probability, the ideal regimen for enhanced follicular recruitment to achieve these goals has not as yet been determined. Up to this time multiple different regimens have been used throughout the world, all of which have achieved an increase in the number of embryos available for uterine replacement. Unfortunately, as the degree of augmented follicular development is increased, there appears to be a progressive shortening of the luteal length. It remains to be determined whether or not this shortening of the luteal length can be overcome by pharmacologic support of the luteal phase. In addition, if all embryos recovered are to be transferred to the uterus in the treatment cycle, there is a substantial risk (ranging from 10% to 35%) that if a woman becomes pregnant, she will have a multiple pregnancy. As ethical constraints challenge the advisability of selecting only some of the available embryos for uterine replacement, the development of cryopreservation for subsequent uterine replacement appears highly desirable.

Clomiphene↗
PubMed1984

Characterization of long-term monolayer cultures of human granulosa cells from follicles of different size and exposed in vivo to clomiphene citrate and hCG.

To determine the effects of prolonged hCG treatment in vitro upon granulosa cells from follicles of various sizes previously exposed to clomiphene citrate and hCG in vivo, progesterone and relaxin concentrations of spent media were correlated with light microscopic and ultrastructural characteristics. Intact, freshly dispersed cells were characterized by numerous lipid droplets, elliptical mitochondria with tubular or lamellar cristae, moderate rough-surfaced endoplasmic reticulum (RER), sparse smooth-surfaced endoplasmic reticulum (SER), and few Golgi. After 10-24 days in culture, 2 morphologically distinct cell types, 'granulosa-type' and 'luteal-type', were noted at the light microscopic level. Ultrastructurally, lipid droplets decreased in number, mitochondria became pleomorphic, RER became more prominent and dilated, and Golgi became more widely dispersed. Tubular SER became abundant and annular nexuses became more numerous after hCG treatment in vitro. Granulosa cells generated from all follicles responded to hCG treatment with significantly increased progesterone secretion after 4 days in culture. Relaxin was not detectable in any sample of medium. This study shows that human granulosa cells from 15-25-mm follicles retain their differentiated function of progesterone secretion in long-term culture and recover responsiveness to hCG in vitro, as demonstrated by enhanced progesterone secretion and development of prominent SER and increased annular nexuses.

Cells, Cultured↗
PubMed1984

Evaluation of progestogens for postoperative adhesion prevention.

Progesterone (P) has been shown to have potent antiinflammatory and immunosuppressive properties. Previous reports have suggested that the use of P decreases postoperative adhesion formation. To further evaluate the role of pharmacologic doses of progestogens in adhesion prevention, 42 mature New Zealand White rabbits underwent standardized injuries to the uterine horns, fimbriae, and pelvic peritoneum and received one of six treatments. Group S had intraperitoneal placement of normal saline (0.9%); group H received intraperitoneal placement of 32% dextran 70; group IM-P received intramuscular P-in-oil 10 days before and after laparotomy in addition to intraperitoneal saline; group IP-P had intraperitoneal placement of an aqueous P suspension; group DP received medroxyprogesterone acetate intraperitoneally; and group C received no intramuscular or intraperitoneal adhesion-prevention agents. The animals were sacrificed 6 weeks after laparotomy, and the adhesions were scored. Intraperitoneal saline (group S) significantly reduced the amount of adhesions when compared with the control group (C) (P less than 0.05). No significant difference was observed when group S was compared with group H. Intramuscular P added to saline (group IM-P) did not cause further reduction in adhesions when compared with group S. Both group IP-P and group DP had more adhesions than did group S (P less than 0.01). These data fail to support previous claims regarding adhesion prevention by the use of locally or parenterally administered progestogens.

Animals↗
PubMed1983

Correlation of human in vitro fertilization with the hamster egg bioassay.

We compared fertility potential measurements by the zona-free hamster egg bioassay with the in vitro fertilization of human eggs. Sperm from 24 husbands participating in an in vitro fertilization-embryo transfer program were used in 27 inseminations of the wives' eggs and in simultaneous inseminations of hamster eggs. In seven cases, a positive fertility assessment was obtained in the absence of fertilization of the wives' eggs attributable to egg immaturity or in one case to equipment failure. In the remaining 20 cases, at least one egg was fertilized, for a level of 73%. In 90% of the husbands who fertilized their wives' eggs, a positive fertility assessment was obtained. Two husbands gave false-negative assessments. To account for these, alternative culture conditions were examined; sperm exposure to longer preincubations or at higher concentrations usually improved assessments. These results indicate that fertility assessment with this bioassay is highly correlated with the fertilization of human eggs in vitro.

Animals↗
PubMed1983

Comparison of two clomiphene citrate dosage regimens for follicular recruitment in an in vitro fertilization program.

Clomiphene citrate (CC) (150 mg/day) is used in most clinical in vitro fertilization and embryo transfer (IVF-ET) programs to induce maturation of several preovulatory follicles rather than the one characteristic of the unstimulated cycle. This study examines whether a reduced dosage of CC will induce the maturation of a similar number of follicles. The advantage of the reduced dosage should be a decrease in the dose-dependent antiestrogenic effects of CC. Normally ovulating women undergoing treatment in an IVF-ET program received CC on cycle days 5 to 9. Thirty-six patients received 150 mg/day, and 60 patients received 50 mg/day. There were no significant differences between the groups in the number or the size of follicles as measured by ultrasonography on the day of human chorionic gonadotropin administration. All seven clinical pregnancies were in the 50 mg group (P less than 0.05). These data suggest that there is no advantage to the 150 mg/day dosage of CC as compared with 50 mg/day with respect to enhanced follicular recruitment, and the higher dosage may have a detrimental effect on pregnancy establishment.

Chorionic Gonadotropin↗
PubMed1982

Follicular size and number in human in vitro fertilization.

In an attempt to maximize the success of in vitro fertilization (IVF) and embryo transfer (ET) as a treatment for human infertility, we have examined the relationship of follicular size and number to the rates of oocyte recovery, fertilization, cleavage, and ET in clomiphene citrate-stimulated cycles. The recovery of oocytes from follicles less than 20 mm in diameter was significantly reduced over that from larger follicles, and those oocytes that were obtained from smaller follicles showed a significantly lower rate of fertilization and cleavage. In addition, the overall chance that a patient would undergo ET was greater in a cycle in which more than one follicle 20 mm or larger was developing than in a cycle in which a single large follicle was developing. This latter observation suggests that attempts at laparoscopic oocyte retrieval should be confined to cycles in which more than one accessible large follicle is developing, thereby maximizing the success rate while minimizing the risk and expense for the patient.

Embryo Transfer↗
PubMed1981

Production of testosterone and estrogen in vitro by gonadal tissue from a 46,XY true hermaphrodite with gonadal failure and gonadoblastoma.

A phenotypic female patients with 46,XY true hermaphroditism and clitoromegaly was found at laparotomy to have normal müllerian structures with a right streak gonad and a left dysgenetic ovotestis that contained a gonadoblastoma. Karyotypes of peripheral lymphocytes and cells from labial skin and both gonads were all 46,XY, so an unrecognized mosaic or chimera was unlikely. Tissue from both gonads was studied in vitro and estrogen and testosterone production measured. The streak produced 186.6 pg/mg/24 hr of estrogen and 78 pg/mg/24 hr of testosterone, whereas the dysgenetic ovotestis produced 85.8 pg/mg/24 hr of estrogen and 184.6 pg/mg/24 hr of testosterone (more than double the testosterone produced by the streak). Comparisons between these data and those previously published suggest that dysgenetic streak gonadal tissue is more active steroidogenically than postmenopausal ovarian stroma.

Adolescent↗
PubMed1980

Utility of assay of alpha subunit of human chorionic gonadotropin in management of gestational, trophoblastic malignancies.

All patients who were treated with chemotherapy for malignant gestational trophoblastic neoplasms at the Southeastern Regional Trophoblastic Disease Center and who experienced remission during the period January 1, 1978, through December 31, 1979, were studied in an attempt to determine if the application of an assay for the alpha subunit of human chorionic gonadotropin (hCG-alpha) could predict those patients who would have recurrences. For each patient, the first three weekly serum samples with undetectable HCG by the hCG beta-subunit radioimmunoassay as well as the two preceding samples with detectable hCG were assayed in a homologous hCG-alpha assay. Results reaffirm previous data that the latter assay is useful only in patients receiving oral contraceptives for suppression of pituitary gonadotropin secretion. No patient who has remained in remission had a mean level of hCG-alpha in the three hCG-negative samples greater than 1 ng/ml. Of those patients who had recurrences of trophoblastic disease, two of three had hCG-alpha levels greater than 1.5 ng/ml. Although these data are preliminary, they suggest that the routine measurement of hCG-alpha in patients successfully treated for trophoblastic disease may aid in identification of a group of patients who require additional or more intensive follow-up and/or additional chemotherapy to prevent later recurrences.

Adolescent↗
PubMed1979

Successful management of infertility due to polyzoospermia.

Polyzoospermia is a rare cause of male infertility. In our clinical practice, patients with exceedingly high sperm counts (ranging from 650 million/ml to 1.75 billion/ml) have invariably been found to have associated poor sperm motility and poor sperm migration in postcoital tests, although the sperm appear morphologically normal. Cases of two infertile couples are presented in which each husband had sperm counts greater than 1 billion/ml. Two methods are reported for the successful management of their infertility problems: (1) precoital dilutional douching and (2) in vitro seminal fluid dilution with 5% dextrose-Ringer's lactate solution and artificial insemination homologous. Each method resulted in improved sperm motility, postcoital tests, and pregnancy.

Adult↗
PubMed1977

Polyhydramnios and acute renal failure.

Two patients with acute renal failure in pregnancies complicated by polyhydramnios and multiple gestations are discussed. An acute increase in the size of the gravid uterus, overdistended with excess amniotic fluid, and a twin gestation were believed to have been related causally to the observed renal failure.

Acute Kidney Injury↗