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M Wren

Publications and source records attributed to M Wren.

10 recordsLinked to original sources
PubMed2003

Does egg-sharing compromise the chance of donors or recipients achieving a live birth?

BACKGROUND: To evaluate the effect of egg-sharing and the outcome of assisted reproductive treatment (ART) in standard IVF/ICSI patients, egg-sharing donors and egg-sharing recipients. METHODS: Descriptive cohort study to evaluate 276 egg-sharing cycles involving 192 egg-sharers, 274 recipient cycles receiving eggs from egg-sharers and 1098 non-egg-sharing standard IVF/ICSI cycles from January 1998 to December 2002. Patients were divided into three groups: group A, egg-sharers; group B, non-egg-sharers, age <36 years, FSH <10 IU/l, BMI <30 kg/m(2); and group C, egg-sharing recipients, all ages. Duration and amount of gonadotrophin required to achieve follicular maturity, number of eggs collected and donated, fertilization rate, pregnancy rates and live birth rates were compared between donor, recipient and standard IVF/ICSI patients. The chi(2 )test was used to test for statistical significance (P < 0.05). RESULTS: There was no significant difference in pregnancy rate and live birth rate of egg-sharers, group A (42.0%, 33.0%), non-egg-sharers, group B (40.0%, 30.9%) and recipients, group C (41.4%, 28.6%). The number of oocytes collected, number of mature follicles and amount of gonadotrophin used was not significantly different between the two groups (A and B). The average number of embryos transferred and the mean number of eggs allocated between egg-sharers and recipients was not statistically different. CONCLUSION: Egg-sharing does not compromise the chance of achieving a pregnancy or live birth for the egg-sharer or the recipient as compared to standard IVF/ICSI patients. The egg-sharers were not at a higher potential risk of ovarian stimulation syndrome and there was no imbalance of egg allocation.

Adult↗
PubMed1998

Obstetric outcome in 232 ovum donation pregnancies.

OBJECTIVE: To study the obstetric outcome of ovum donation pregnancies. DESIGN: A retrospective analysis of 232 ovum donation pregnancies in the six years from 1988 to 1993. SETTING: Infertility clinic in a private hospital. PARTICIPANTS: All ovum donation recipients that achieved pregnancy in the clinic during the stated time period. MAIN OUTCOME MEASURES: Percentages of live birth and miscarriages and ectopic pregnancies; number of sacs identified in the uterus at early (four weeks after transfer) and later scans; incidence of antepartum and postpartum haemorrhage; incidence of pregnancy-induced hypertension; incidence of preterm, low birthweight and small-for-gestational age babies; and incidence of operative deliveries. RESULTS: Of 232 pregnancies, 151 babies were born (live birth rate of 20%); and 81 were lost (57 before eight weeks, 17 after eight weeks and seven ectopic pregnancies). In nine cases there were no intrauterine sacs at the early scan (two 'chemical pregnancies' and seven ectopic pregnancies). In 169 cases there was initially one intrauterine sac, ending with 102 singleton deliveries (60%); in 47 cases there were initially two intrauterine sacs, ending with 11 singleton deliveries (23%) and 32 twin deliveries (68%); in the seven cases where three sacs were identified initially, there were no singleton deliveries, three twin deliveries (one selective fetal reduction) and three triplet deliveries. Women with premature ovarian failures had a significantly higher pregnancy rate compared with those with functioning ovaries (P < 0.02). However, in the former group, the miscarriage rate was also significantly higher (P < 0.03) so that the number of term births was similar. The incidence of vaginal bleeding was 12% in the first trimester, 1.5% in the second trimester, and 2% in the third trimester. The incidence of postpartum haemorrhage was 12%. Thirty-two women had pregnancy-induced hypertension (23% of all deliveries). This occurred in 22/105 singletons (21%), 7/32 twins (22%) and in all three (100%) of the triplets. In the singleton group 13% of infants were preterm, 18% had a birthweight < 2.5 kg and 15% were < 3rd centile for birthweight at delivery (small-for-gestational age). Ovarian function was found to be the only factor that significantly influenced the incidence of small-for-gestational age babies (odds ratio 8.84; 95% confidence interval 1.1-70.0; P = 0.007). The overall operative delivery rate was 85% with the caesarean section rate being 69%. CONCLUSIONS: Women who become pregnant following oocyte donation should be considered obstetrically as high risk, especially those with ovarian failure because of the increased incidence of small-for-gestational age infants in these pregnancies. They are also at higher risk of pregnancy-induced hypertension and postpartum haemorrhage.

Abortion, Spontaneous↗
PubMed1997

Epidermal growth factor receptor in vulvar malignancies and its relationship to metastasis and patient survival.

OBJECTIVE: To evaluate the level of epidermal growth factor receptor (EGF-R) expression in vulvar malignancies and to determine if a correlation exists between EGF-R levels and metastasis or patient survival. METHODS: All patients with a diagnosis of invasive squamous cell carcinoma of the vulva who were treated at our institution with a primary radical vulvectomy and inguinal lymph node dissection from 1983 to 1993 were eligible for the study. Sixty-one patients with available tissue blocks of benign vulvar epithelium, the primary malignant vulvar lesion, and groin node metastasis (when positive) were included in the study. Semiquantitative EGF-R expression was determined in a blinded fashion utilizing immunohistochemical staining of appropriate tissue samples. Survival was calculated utilizing Kaplan-Meier life table analysis based upon disease-free survival. RESULTS: A significant increase (P < 0.001) in mean EGF-R levels was demonstrated in the primary tumor (67%) versus benign vulvar epithelium (31%). In the 14 patients with lymph node metastasis, the mean EGF-R level in the primary tumor was 65% versus 88% in the metastatic lesion (P < 0.001). The likelihood of lymph node metastasis was elevated in those patients with a benign tissue EGF-R level > or =40% (P < 0.03) and in those patients with a primary tumor EGF-R level > or =90% (P < 0.025). Life table analysis revealed a cumulative disease-free survival of 45% for all patients. Disease-free survival in those patients with EGF-R levels > or =90% in the primary tumor was 25%, contrasting with a disease-free survival of 54% in those patients with EGF-R levels <90% (P < 0.05). CONCLUSIONS: There is a progressive increase in EGF-R expression from benign vulvar epithelium to primary malignant tissue to metastatic lesions within the same patient. Increased expression of EGF-R in the primary vulvar malignancy is significantly associated with lymph node metastasis and decreased patient survival. Increased expression of EGF-R in histologically benign vulvar epithelium has a significant association with lymph node metastasis and may predict decreased patient survival.

Carcinoma, Squamous Cell↗
PubMed1992

A prospective randomized study comparing aspiration only with aspiration and flushing for transvaginal ultrasound-directed oocyte recovery.

OBJECTIVE: To compare aspiration only with aspiration and flushing of ovarian follicles during transvaginal ultrasound (US)-directed oocyte recovery. DESIGN: Prospective randomized study. PATIENTS: One hundred patients who were undergoing an in vitro fertilization (IVF) treatment cycle. INTERVENTIONS: All patients underwent pituitary desensitization before the administration of gonadotropins. Monitoring of ovarian stimulation and the criteria for the administration of human chorionic gonadotropin were similar in both groups. In patients in whom aspiration alone was used, each follicle was aspirated until it was empty. The US probe was then rotated until every drop of follicular fluid had been aspirated before the next follicle was aspirated and the procedure repeated. For patients who had aspiration and flushing, each follicle was aspirated and then flushed up to a maximum of six times before moving to the next follicle. In both groups, all follicles greater than 10 mm were aspirated. RESULTS: The indication for IVF and mean age of the patients were comparable in the two groups. There were no significant differences between the aspiration and the aspiration and flushing groups in terms of the number of oocytes retrieved (11 versus 9), the oocyte recovery rates (77.5% versus 77.0%), the fertilization rates (55.6% versus 60.0%), the number of embryos transferred (2 versus 2), or the number of clinical pregnancies (12 versus 13). The time taken for oocyte recovery was significantly shorter (15 versus 30 minutes, P less than 0.00001), and the dose of pethidine required significantly less (50 mg versus 100 mg, P less than 0.00001) in the aspiration only group. CONCLUSIONS: Aspiration alone produces comparable oocyte recovery rates as aspiration and flushing while significantly reducing the length of the procedure and the dose of analgesia required. Aspiration alone suffices for virtually all cases during transvaginal US-directed oocyte recovery.

Adult↗
PubMed1992

Laparoscopic zygote intrafallopian transfer using augmented local anesthesia.

In this study, 29 laparoscopic ZIFTs were performed in 21 patients using local anesthesia augmented with intravenous analgesia. The technique was well tolerated; significant discomfort arose only when the fallopian tubes were manipulated and was minimized by transferring zygotes to one tube only. Seven pregnancies resulted, of which three have delivered and one is ongoing.

Adult↗
PubMed1991

The optimum dose and mode of administration of luteinizing hormone releasing hormone analogue in in-vitro fertilization: a comparison of three regimens.

Three regimens for administration of the luteinizing hormone releasing hormone analogue (LHRHa), buserelin, were compared in terms of pituitary down-regulation prior to ovarian stimulation for in-vitro fertilization (IVF). Thirty-three patients who had failed to conceive in previous IVF cycles were randomly divided into three groups. Patients in Group I (n = 11) received intranasal (i.n.) buserelin 200 micrograms four hourly for 21 days; patients in Group II (n = 11) received subcutaneous (s.c.) buserelin 500 micrograms twice a day for 7 days, followed by 500 micrograms daily for 14 days; patients in group III (n = 11) received (s.c.) buserelin 500 micrograms three times a day for 7 days. In all three groups administration of buserelin was continued until serum oestradiol levels were less than 100 pmol/l, at which time human menopausal gonadotrophin (HMG) was commenced. All the patients achieved pituitary down-regulation after seven days of treatment with buserelin, except for four patients who developed ovarian cysts and two with polycystic ovarian disease. The total dose of HMG used and the ongoing pregnancy rate were not significantly different between the three groups. A much higher proportion of patients in Group I developed side-effects and found their treatment disruptive to their life-style. Our results suggest that patient variables (e.g. polycystic ovaries, ovarian cysts) rather than the dose and mode of administration of buserelin, are the major determinant of the length of time needed for pituitary down-regulation. The s.c. route is preferable and the smallest dose of buserelin that will produce pituitary down-regulation should be used.

Adult↗
PubMed1991

A prospective study of acute radiculopathy after scoliosis surgery.

We have prospectively studied 45 patients undergoing scoliosis surgery (48 procedures) for evidence of postoperative acute radiculopathy. Posterior spinal fusion was performed in 42 patients (Cotrel Dubousset 28, Harrington rod with wires 9, Hartshill rectangles 5); anterior spinal fusion in 5 (Webb Morley) and an anterior release procedure in 5. Fourteen patients (29%) had sensory and/or motor signs of radiculopathy post-operatively, with moderate to severe symptoms in 10 and mild symptoms in 4. The radiculopathies were considered traumatic in 7 patients, in whom radiculopathy correlated with placement of a hook or passage of a sublaminal wire. In the remaining 7 patients, traction was considered the likely mechanism of injury; in these there was a significant association with the degree of postoperative correction of the scoliosis where it was substantially beyond the preoperatively demonstrated flexible range (p = 0.008). A system of intraoperative electromyographic monitoring for possible prevention of this complication is described. Radiculopathy is a common complication of scoliosis surgery.

Acute Disease↗
PubMed1976

Temperature-sensitive mutants of the slime mould Physarum polycephalum. II. Mutants of the plasmodial phase.

Methods are described for the isolation and testing of temperature-sensitive plasmodial strains of Physarum polycephalum. Nineteen temperature-sensitive strains were found by screening plasmodia derived from mutagenised amoebae and the properties of these are described. A scheme is outlined for the detection of specific mitotic cycle lesions amongst temperature-sensitive strains, and the properties of a presumptive mitotic cycle mutant are described.

Cell Division↗