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M R Peyser

Publications and source records attributed to M R Peyser.

At least 19 recordsLinked to original sources
PubMed1992

The predictive fertilization value of the hypoosmotic swelling test (HOST) for fresh and cryopreserved sperm.

BACKGROUND: The hypoosmotic swelling test (HOST) was recommended as a predictive test for in vitro fertilization (IVF) outcome. These results, however, were controversial and the results for thawed semen were insufficient. The present study was conducted in order to clarify the predictive value of the HOST for IVF in fresh and thawed sperm. METHODS: The hypoosmotic swelling test was performed in three groups: husband's fresh semen "subfertile" group, donor's thawed semen group, and donor's fresh semen "fertile" group. RESULTS: No correlation was found between HOST values and sperm characteristics in fresh or thawed sperm. Fresh sperm HOST values correlated with IVF fertilizations. No such correlations were found when thawed sperm was used. HOST values were significantly higher in the fresh fertile donor group than in the fresh subfertile group (P less than 0.001). Following the freezing and thawing process, HOST values decreased dramatically. Nevertheless, the fertilization rate was still higher compared to that of the fresh subfertile group (P less than 0.001). There were significantly more IVF cycles with no fertilizations when HOST values were below 45%. CONCLUSION: The HOST has a predictive value for fertilization of oocytes in IVF cycles when fresh semen, but not thawed sperm, is used. The freezing-thawing process affects the outer membrane of the spermatozoon and changes its characteristics, leading to a decrease in HOST values. Sperm characteristics that play a role in the fertilization process are not expressed directly by HOST values.

Cell Membrane↗
PubMed1992

Vaginal injury resulting from sliding down a water chute.

A 27-year-old woman was admitted to the hospital because of profuse vaginal bleeding from a vaginal laceration caused by the impact of water to the perineum after sliding down a water chute. At the time of the accident the patient was using a vaginal tampon. The potential mechanism for this trauma is discussed.

Adult↗
PubMed1992

Abruptio placentae associated with perforated appendicitis and generalized peritonitis.

A primigravid woman at 35 weeks' gestation was admitted with abdominal pain, fever, and vomiting. Forceful contractions and signs of fetal distress suggested abruptio placentae. During caesarean section, seropurulent exudate and a perforated appendix were found; an appendectomy was performed. A mechanism linking appendicitis with abruptio placentae is suggested.

Abruptio Placentae↗
PubMed1992

High initial values of beta-subunits of human chorionic gonadotropin in ovum donation pregnancies indicate better implantation.

Fifty-five patients were treated by ovum donation, and a control group of 165 patients underwent IVF. The number of pregnancies obtained were 28 and 25, respectively. The initial beta-hCG values, as well as the PRs and implantation rates, in the ovum donation series were significantly higher than those of the IVF series. The clinical significance and potential application of these observations are discussed.

Chorionic Gonadotropin↗
PubMed1992

Embryo reduction in multifetal pregnancies using saline injection: comparison between the transvaginal and the transabdominal approach.

A total of 30 patients with multifetal pregnancies, all resulting from treatment with superovulatory agents or assisted reproductive techniques, underwent embryo reduction. All patients had three or more fetuses (one sextuplet, two quintuplets, seven quadruplets and 20 triplets). The procedure was carried out using intra-embryonal injection of 0.9% sodium chloride solution. Embryo reduction was carried out via the transabdominal approach in 10 patients, performed at 11-12 weeks of gestation, and via the transvaginal route in 20 other patients, at 8-10 weeks of gestation. In the transabdominal group, one patient aborted following repeated attempts at embryo reduction while the other nine gave birth to healthy newborns (eight twins and one triplet). In the transvaginal group, four pregnancies are currently ongoing (all beyond 28 weeks of gestation), 14 pregnancies resulted in a delivery of at least one live newborn (13 twins and one singleton), one patient had a late abortion at 24 weeks' gestation and another was delivered at 27 weeks' gestation due to severe pre-eclampsia. Transvaginal ultrasound-guided needle procedures are commonly practised in most in-vitro fertilization units. The employment of this route for embryo reduction, performed at an earlier gestational age and with the use of a non-toxic substance such as 0.9% saline solution, is advocated.

Abdomen↗
PubMed1992

Migration sedimentation technique as a predictive test for the fertilizing capacity of spermatozoa in an in-vitro fertilization programme.

The migration-sedimentation technique (MST) has been proposed as a means of separating high quality motile spermatozoa. The present study was conducted in order to evaluate whether sperm performance following separation by MST predicts their fertilizing capacity in an in-vitro fertilization (IVF) programme. Ninety semen specimens were analysed for use in an IVF-embryo transfer (ET) programme. Each specimens was divided into two parts: one was processed in the IVF programme and was used after sperm swim-up separation for insemination of human ova. The other aliquot (0.2 ml) was separated by MST, and the sperm then characterized by their concentration, motility, degree of motility and morphology. Sperm characteristics after separation by MST were then correlated with the results of the IVF-fertilization rates. In 79 of 90 IVF-ET cycles, at least one oocyte was fertilized. All post-MST sperm characteristics were significantly higher in cycles with fertilizations compared to IVF cycles without fertilization. A larger percentage of the total motile spermatozoa were recovered after MST in semen specimens with fertilization, compared to semen specimens without fertilization (39.9 +/- 3.6 and 20.6 +/- 6.6%, respectively; P < 0.05). This value was correlated with the percentage of fertilized oocytes (r = 0.24; P < 0.02). More IVF cycles with fertilizations were recorded in cases in which the recovery of motile sperm was > 25% (P < 0.005), or when more than 1.5 x 10(6) motile spermatozoa were recovered after MST (P < 0.0001). As sperm characteristics after MST correlated significantly with their fertilizing capacity, the MST test could be used in evaluation of the fertilizing capacity of spermatozoa.

Cell Separation↗
PubMed1991

The efficiency of cryopreserved semen versus fresh semen for in vitro fertilization/embryo transfer.

The efficiency of cryopreserved donor semen versus fresh donor semen in an in vitro fertilization/embryo transfer programme was evaluated. Thirty-nine in vitro fertilization/embryo transfer cycles were performed using fresh donor semen (group A) and 74 cycles were carried out using cryopreserved semen (group B). All patients underwent a uniform controlled ovarian hyperstimulation using high doses of human menopausal gonadotropins. Oocytes were retrieved transvaginally under ultrasound imaging. Semen (fresh or frozen-thawed) were prepared for insemination by a washing technique. Each ovum was inseminated with 500,000-600,000 motile spermatozoa. No significant difference was noted between the two groups regarding female age, duration of infertility, and number of ova retrieved per aspiration. Even though the fertilization rate in group B was significantly lower than in group A (55.5 +/- 3.8 vs 70.4 +/- 3.5, P = 0.008), pregnancy rates per embryo transfer were similar--39.3 and 38.5%, respectively.

Adult↗
PubMed1991

Atypical response to luteinizing hormone-releasing hormone (LH-RH) agonist (suprefact nasal) in induction of ovulation in in vitro fertilization (IVF).

Animal and human research has indicated the presence of receptors to luteinizing hormone-releasing hormone (LH-RH) in the ovaries. However, the role of these receptors is not yet clear. Forty-five patients were treated with Suprefact (D-Serg-Des-Gly10-GnRGH), starting in the midluteal phase of a nonstimulatory menstrual cycle. The Suprefact (300 micrograms t.i.d.) was administered as a nasal spray until the administration of human chorionic gonadotropin (hCG). On the third to fifth day of the following menstrual cycle, the patients were treated with a high dose of human menopausal gonadotropin (hMG). hCG was administered when at least two follicles reached a mean diameter of 18 mm. Five of these patients who ovulated spontaneously and had normal menstrual cycles did not respond to the stimulation with hMG. Treatment was stopped after 12 days of hMG administration. During the following cycle of the five patients, levels of gonadotropins were found to be in the normal range, and all of them responded as expected to hMG administered for 3 days only (hMG test). These findings suggest that LH-RH agonist may interfere with ovarian steroidogenesis.

Administration, Intranasal↗
PubMed1991

Avoidance of cancellation of potential hyperstimulation cycles by conversion to in vitro fertilization-embryo transfer.

OBJECTIVE: The study was undertaken to minimize the rate of ovarian hyperstimulation and to avoid cancellation of human treatment cycles in women treated with human menopausal gonadotropin (hMG) for induction of ovulation. SETTING: Patients were treated in the fertility clinic and in vitro fertilization unit of our institution, which is a government, university-affiliated hospital. PATIENTS: Ninety anovulatory patients were treated with hMG. Of these, 12 were at high risk for ovarian hyperstimulation. The criteria for potential ovarian hyperstimulation syndrome were rising excessive 17 beta-estradiol levels of greater than 1,500 pg/mL in the presence of multiple follicles with a mean diameter greater than 15 mm. These patients were transferred for continuation of treatment to our in vitro fertilization-embryo transfer (IVF-ET) unit. INTERVENTIONS: The patients underwent ova retrieval by the ultrasonically guided transvaginal approach. RESULTS: Of the 12 patients, 5 conceived (41.6%). Two patients had a mild ovarian hyperstimulation syndrome, and 1 had a moderate syndrome and was hospitalized for observation for 48 hours. CONCLUSION: In view of the results, we suggest that IVF-ET should be considered in cases in which ovarian hyperstimulation syndrome is imminent, rather than withhold human chorionic gonadotropin and cancelling the treatment cycle.

Adult↗
PubMed1991

Ovulation induction with gonadotropins in women with polycystic ovary disease.

Seventy-two infertile women with polycystic ovary disease (PCOD) and clomiphene citrate treatment failure underwent 220 human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG) treatment cycles for ovulation induction over a period of 19 months. Forty-two patients ovulated but failed to conceive on clomiphene, and the remaining 30 failed to ovulate on clomiphene. Monitoring of treatment consisted of serum 17 beta-estradiol (E2) levels and ultrasonic assessment of follicular growth. Treatment was withheld whenever the E2 levels exceeded 1,500 pg/mL and/or when more than two follicles greater than or equal to 17 mm in diameter each were encountered on ultrasonography. Twenty-nine patients conceived (40.2%), and 23 delivered viable infants. Twenty-three of the 29 pregnancies were achieved in the 42 patients who ovulated on clomiphene, while only 6 pregnancies resulted in the 32 anovulatory patients on clomiphene. Six patients (20.6%) aborted in the first trimester. Multiple pregnancies consisted of only two sets of twins (6.9%). There were only two cases of mild hyperstimulation (2.7%) and no severe hyperstimulation. Because of the low occurrence of multiple pregnancies and hyperstimulation and the reasonable success rate, all PCOD patients should be started on this protocol.

Adult↗
PubMed1991

Success rates in in vitro fertilization treatment and its correlation with high titer antibodies for Chlamydia trachomatis.

The prevalence of specific chlamydial IgG and IgA antibodies was determined in 86 infertile women undergoing in vitro fertilization (IVF) and in 56 male partners; 32.5% of women (28 of 86) under investigation had both types of antibodies at a titer of IgG greater than or equal to 1:128 and IgA greater than or equal to 1:16; 9% of their male partners (5 of 56) who were tested were also seropositive. The prevalence of local IgA in semen was 9.6% (5 of 52). Pregnancy was later achieved by IVF in 13 of 32 seropositive and 19 of 32 seronegative women. Our data suggest that high levels of specific antichlamydial antibodies (IgG and IgA) are not correlated with the outcome of IVF-embryo transfer treatment.

Adult↗
PubMed1990

Management of severe postpartum hemorrhage by intrauterine irrigation with prostaglandin E2.

Continuous intrauterine irrigation with minute amounts of prostaglandin E2 was used in 22 patients with severe postpartum hemorrhage unmanageable by conventional therapy. Twenty-one women were treated because of uterine atonic hemorrhage and one because of late postpartum hemorrhage from subinvolution. A quick tetanic contraction of the uterine muscle with dramatic and sustained hemostasis was achieved in all patients. The therapeutic response was continuous and uninterrupted regardless of the predisposing factors for the hemorrhage or the hemodynamic condition of the patients. No side effects were observed.

Blood Volume↗
PubMed1990

A prospective randomized trial of human chorionic gonadotrophin or dydrogesterone support following in-vitro fertilization and embryo transfer.

A randomized, prospective blind study was carried out to investigate the need for luteal phase support in patients undergoing in-vitro fertilization (IVF). One-hundred-and-fifty-six patients undergoing IVF in cycles stimulated with human menopausal gonadotropin (HMG) and human chorionic gonadotrophin (HCG) stimulated IVF, were divided into three different groups for luteal phase treatment. Fifty-four patients received dydrogesterone three times daily (TID) beginning on the day of embryo transfer (ET). Fifty-one patients received HCG on days 3, 6 and 10 following ET. Fifty-one patients received placebo p.o. TID beginning on the day of ET. There was no difference between the groups in pregnancy rate, rate of spontaneous abortion, proportion of normally developing fetuses or rate of chemical pregnancy. The data indicate that supplementation of the luteal phase may not improve the success rates of IVF-ET cycles.

Adult↗
PubMed1990

Penetration of clindamycin, cefoxitin, and metronidazole into pelvic peritoneal fluid of women undergoing diagnostic laparoscopy.

A single dose of clindamycin, cefoxitin, or metronidazole was administered to each of 30 women. The mean concentration of cefoxitin in pelvic fluid at 1 h exceeded those of the other two drugs (P less than 0.007). Cefoxitin concentrations were inferior to those of the other drugs when compared with the published MIC for 90% of Bacteroides fragilis strains.

Adult↗
PubMed1989

Bacterial infection and human fetal wastage.

Twenty-eight of 57 fetuses delivered after intrauterine death were found to have a variety of aerobic and facultative bacteria in the heart, anus, placenta, brain and cerebrospinal fluid. Subclinical maternal bacteremia, possibly originating in the urinary tract, appears to be a common cause of second- and third-trimester fetal demise.

Amniotic Fluid↗
PubMed1979

Midtrimester placenta previa: normal or pathologic finding.

During the years 1974-1977 ultrasonic placentography demonstrated midtrimester placenta previa (MTPP) in 123 women. The procedure was performed because of vaginal bleeding in 65 cases and prior to amniocentesis in 58 asymptomatic cases. Eighty-eight patients were found to have grade I placenta previa (PP), 12 to have grade II, 14 to have grade III, and 9 patients to have grade IV PP. These different variants of PP were correlated with the ultimate outcome of these pregnancies: Bleeding due to PP or PP at term were reasons for cesarean section in 4 cases of grade I PP, in 2 cases of grade II, in 7 cases of grade III, and in 7 out of 9 cases of grade IV PP. Among those patients who had grades III and IV PP, 13 out of 23 had premature or immature deliveries. These results suggest that finding of MTPP, especially symptomatic MTPP, should alert the physician to the clinical significance of PP later in pregnancy.

Cesarean Section↗