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Biomedical subjects

Mark V Sauer

Publications and source records attributed to Mark V Sauer.

At least 19 recordsLinked to original sources
PubMed2006

Initial presentation of undiagnosed acute intermittent porphyria as a rare complication of ovulation induction.

OBJECTIVE: To discuss the diagnosis and management of acute intermittent porphyria following ovulation induction. DESIGN: Case report. SETTING: Academic IVF center. PATIENT(S): A patient with polycystic ovary syndrome and primary infertility undergoing ovulation induction with clomiphene citrate. INTERVENTION(S): Serial phlebotomy, IV fluid, inpatient observation. MAIN OUTCOME MEASURE(S): Condition at discharge. RESULT(S): The patient was diagnosed with severe hyponatremia caused by acute volume depletion and possible syndrome of inappropriate antidiuretic hormone secretion, secondary to acute intermittent prophyria, and was successfully managed with supportive measures. Neurovisceral symptoms resolved, and severe hyponatremia was corrected with IV saline solution without complications. CONCLUSION(S): Acute intermittent porphyrias are rare complications of ovulation induction, but should be considered in patients who develop unexplained hyponatremia or neurovisceral symptoms.

Adult↗
PubMed2006

Assessing the reproductive performance of men co-infected with HIV-1 and hepatitis C undergoing assisted reproduction.

OBJECTIVE: To assess the reproductive performance of men co-infected with hepatitis C virus (HCV) and human immunodeficiency virus (HIV-1) undergoing assisted reproduction. DESIGN: A retrospective analysis. SETTING: University-based assisted reproductive technology (ART) center. PATIENTS: We reviewed 217 consecutive ART cycles performed on 106 HIV-1 serodiscordant couples between August 1997 and March 2004, in which 28 men (26%) were seropositive for HCV and HIV-1 (group 1). MAIN OUTCOME MEASURES: Patient demographics and laboratory testing were compared to reproductive outcomes of men undergoing similar treatment but infected only with HIV-1 (group 2). RESULTS: Co-infected men and their partners were of similar age as men infected only with HIV-1. Comparing group 1 to group 2, like values were noted for HIV-1 viral loads [1,993 +/- 1,140 copies/ml (mean +/- SE) vs. 1,659 +/- 487 copies/ml]; CD4 counts (520 +/- 98 vs. 604 +/- 38 mm(-3)); and semen parameters. IVF performance and outcomes were similar, with fertilization rate (0.68 +/- 0.03 vs. 0.71 +/- 0.02); number of normally cleaving embryos (6.0 +/- 0.5 vs. 5.3 +/- 0.3); embryo implantation rate (0.27 +/- 0.04 vs. 0.2 +/- 0.02); and clinical pregnancy rate (40 vs. 29%). Although the male mortality rate was low in both groups, morbidity among co-infected men was significantly higher. Seven of 28 men (25%) had detectable HCV viral loads, and 14 (50%) had elevated liver function tests. CONCLUSION: Men co-infected with HCV and HIV-1 do reasonably well undergoing ART to prevent transmission of viruses to their partners and children.

Adult↗
PubMed2006

Elevated serum müllerian-inhibiting substance may be a marker for ovarian hyperstimulation syndrome in normal women undergoing in vitro fertilization.

We identified patients who experienced ovarian hyperstimulation syndrome (OHSS) (n = 16) and compared their baseline pretreatment levels of müllerian-inhibiting substance (MIS) to age- and weight-matched patients with normal responses to gonadotropins (n = 14). Baseline serum MIS in patients with OHSS were sixfold higher than those seen in normal controls (3.62 +/- 0.87 vs. 0.63 +/- 0.09 ng/mL; P=.0036), indicating that MIS could potentially serve as a useful marker for identifying patients at risk for OHSS.

Adult↗
PubMed2006

Family members serving the gestational carrier needs of women lacking a uterus: a report of two cases.

CASE REPORT: In two instances, a designated relative served as a gestational carrier for a woman who no longer had a uterus. In the first case, a 38-year-old woman underwent an emergency cesarean hysterectomy due to worsening fatty degeneration of the liver in the third trimester, culminating in massive hemorrhage, consumptive coagulopathy and the loss of twins at 28 weeks gestation following successful in vitro fertilization. In the second case, a 28-year-old had congenital absence of the uterus and vagina. Both surrogates volunteered for service and were carefully screened medically, reproductively, and psychosocially prior to proceeding. All parties were required to execute informed consent and contracts with private attorneys before entry. Both gestational carriers conceived following the initial embryo transfer; one as the result of previously cryopreserved embryos, the other from embryos obtained following the synchronized in vitro fertilization of newly aspirated oocytes. Gestational carriers were prescribed oral estradiol and vaginal progesterone to prepare the uterus for implantation, and maintained this regimen throughout the first trimester of pregnancy. The pregnancies proceeded uneventfully and resulted in the delivery of singleton births at term. Both infants were formally adopted after delivery by the genetic parents in compliance with the advice of counsel under New York State law. CONCLUSION: Family members serving as gestational carriers provide women with functional ovaries but no uterus, the opportunity to have genetic offspring, while avoiding much of the high cost and social uncertainty of commercial surrogates.

Adult↗
PubMed2006

American physicians remain slow to embrace the reproductive needs of human immunodeficiency virus-infected patients.

Nearly 1 million Americans are infected with HIV. Most are living well and enjoying productive lives. Yet few programs in the United States permit unrestricted access to assisted reproduction for HIV-seropositive patients. Some of these individuals have conventional problems causing infertility. Many others are attempting to minimize viral transmission to their spouse or offspring. European centers remain far ahead of those in the United States in advancing techniques and offering services to safeguard the uninfected while providing effective, affordable care to the HIV-seropositive patient.

HIV Infections↗
PubMed2006

Oocyte and embryo donation 2006: reviewing two decades of innovation and controversy.

For over 21 years, oocyte and embryo donation have been used to treat infertility caused by a variety of conditions affecting the ovary. Many disorders, including premature ovarian failure, advanced reproductive age, unexplained recurrent implantation failure and inherited conditions, are amenable to gamete donation, with high pregnancy rates and good obstetrical outcomes observed in recipients. Protocols for the medical screening of recipients and donors, as well as infectious disease and genetic testing, have become relatively uniform and well accepted. Established guidelines allow synchronization of the menstrual cycles of both women to ensure that embryos are transferred to a receptive endometrium. The high demand for donor services has led to escalating costs and long waiting lists. American programmes bid against each other to secure the participation of young women often motivated as much by financial reward as altruism. In the United States, where the majority of oocyte donation is practised, more than 100,000 treatment cycles have occurred. However, to date no meaningful longitudinal studies detailing the long term effects of treatment on donors, recipients, children born, or families created have been published. Throughout its history, oocyte and embryo donation has proven to be both efficacious and clinically innovative, yet remains highly controversial.

Embryo Transfer↗
PubMed2006

Italian Law 40/2004: a view from the 'Wild West'.

The passage of Law 40/2004 in Italy dramatically affected the manner in which assisted reproduction is conducted there. A recent attempt to modify this highly restrictive legislation failed to gain popular support and was defeated in a 2005 referendum. The public's desire to regulate the field of IVF is probably a result of growing concern over the use and misuse of the technology as portrayed in the popular press and media. Practitioners using this technology throughout the world should take note of the impact legislation brings upon the delivery and accessibility of care, and be appreciative of the social sensitivity of the general population regarding the safe guarding of human embryos.

Attitude to Health↗
PubMed2006

HIV seroconversion in a woman preparing for assisted reproduction: an inherent risk in caring for HIV-serodiscordant couples.

A woman preparing to undergo IVF and intracytoplasmic sperm injection to avoid horizontal viral transmission of HIV from her seropositive husband was discovered to be HIV seropositive, presumably secondary to a condom break or unprotected intercourse. Had this event occurred after treatment, the sperm-washing technique used to avoid infection would have undoubtedly been called into question. Nearly all HIV-serodiscordant couples are sexually active and therefore at risk for transmitting infection, either due to improper condom use or unprotected intercourse. Physicians willing to treat HIV-serodiscordant couples must accept the inevitability of viral transmission in occasional individuals. Furthermore, it should not be presumed that all patients who experience seroconversions after either intrauterine insemination or IVF procedures do so as a result of inadequacies in the sperm preparation technique.

Adult↗
PubMed2005

Fertility sparing therapy for ovarian cancer has inherent risks and benefits.

INTRODUCTION: Fertility sparing therapy for epithelial ovarian cancer has been suggested for well-selected patients with early stage disease. The overall recurrence rate of 10% and 5-year disease free survival greater than 90% is similar in conservative and traditional surgical management of epithelial ovarian cancer. Thus, conservative approaches may be considered in young women diagnosed with FIGO stage I cancer who wish to preserve reproductive function. Subsequent use of assisted reproductive technologies (ART) may facilitate production of biologic offspring in these cancer survivors. However, each candidate requires unique consideration by subspecialists to avoid potentially fatal management errors. CASE REPORT: We present two cases in which fertility sparing therapy for early stage epithelial ovarian cancer was considered. The first case delineates the comprehensive work-up required to identify candidates for this therapy, while the second case illustrates the successful application of a fertility sparing approach. DISCUSSION: The conservative management of early epithelial ovarian cancer and use of ART to obtain offspring are reviewed.

Adult↗
PubMed2005

Rectus sheath hematoma after transvaginal follicle aspiration: a rare complication of in vitro fertilization.

OBJECTIVE: To discuss the diagnosis and management of rectus sheath hematomas after transvaginal follicle aspiration. DESIGN: Case report. SETTING: A single healthy patient in an academic IVF center. PATIENT(S): A healthy patient undergoing routine transvaginal follicle aspiration for IVF. INTERVENTION(S): CT scan, serial phlebotomy, IV fluid, in-patient observation. MAIN OUTCOME MEASURE(S): Condition at discharge. RESULT(S): Patient was successfully managed with conservative measures. After the initial decline, serial hematocrits were stable over 24 hours without any operative interventions. CONCLUSION(S): Rectus sheath hematomas are rare complications of IVF and can be managed conservatively.

Adult↗
PubMed2005

Surviving the shifting focus from basic research to clinical activities in reproductive endocrinology and infertility.

Important members of our clinical and scientific community are defecting to the private sector as frustration with academic medical centers grows intolerable. Departments need to rethink traditional paradigms for assigning research, teaching, and clinical care duties to allow faculty the time to do these activities with the care and attention they deserve.

Academic Medical Centers↗
PubMed2005

Assessing the treatment efficacy of IVF with intracytoplasmic sperm injection in human immunodeficiency virus-1 (HIV-1) serodiscordant couples.

The purpose of this study was to evaluate the treatment efficacy of using IVF-intracytoplasmic sperm injection (ICSI) in HIV serodiscordant couples interested in having children while minimizing the risk of viral transmission. This study reviews the cases of HIV serodiscordant couples (n = 142) seeking fertility treatment at an assisted reproductive centre. The main outcome measures were successful pregnancy rate and HIV seroconversion rate. In calculating crude pregnancy rates, only patients who were actually treated were taken into account. To compensate for cancelled patients, and patient drop-out, lifetable analysis was performed. Life-table analysis demonstrated that 37.0 +/- 5.0% of couples attain a successful pregnancy after one completed IVF-ICSI with embryo transfer (IVF-embryo transfer) cycle. Following two and three IVF-embryo transfer cycles, the pregnancy rates rose to 56.8 +/- 6.0 and 73.4 +/- 6.9% respectively. Overall pregnancy rates were inversely related to age. There were no HIV seroconversions in treated patients or in delivered babies. It is concluded that the use of IVF-ICSI to avoid disease transmission in HIV-1 serodiscordant couples desiring children appears to be safe and yields high rates of pregnancy. However, success is influenced by the woman's age.

Adult↗
PubMed2005

Sperm washing techniques address the fertility needs of HIV-seropositive men: a clinical review.

It is estimated that nearly 40 million people worldwide are infected with HIV. HIV/AIDS prevalence among young people is high, with youth under age 25 years accounting for approximately half of all new infections. Nearly 1 million Americans are HIV-seropositive. Today, HIV-seropositive individuals live active and productive lives despite their illness, largely a result of prescribed highly active antiretroviral therapy (HAART). Most individuals are of reproductive age, and many desire to have children. Various assisted reproductive techniques have been used to reduce or eliminate infectious elements known to be present in semen so that isolated spermatozoa can be safely inseminated or used for intracytoplasmic sperm injection into oocytes. Presently, several European centres and a few US groups offer assistance to HIV seropositive men and their seronegative partners by performing either intrauterine insemination (IUI) or IVF. Since 1987, more than 3600 published attempts have been reported in which processed spermatozoa from HIV-seropositive men were used to establish pregnancy in HIV-seronegative women. Although the data remain observational, sperm washing techniques appear to be relatively safe and effective, offering HIV-serodiscordant couples an opportunity to have children.

Fertilization in Vitro↗
PubMed2005

Addressing the growing problem of multiple gestations created by assisted reproductive therapies.

Iatrogenic multiple pregnancy is the most significant complication of assisted reproductive technology (ART). Approximately half of all children born subsequent to ART result from a plural gestation. Furthermore, the majority of triplets and higher order births are the product of ART. The risks for multiple pregnancy vary with practice patterns and the techniques used to achieve pregnancy. Recognizing the potential for serious morbidity associated with multiple pregnancies, infertility specialists have developed strategies to reduce the complication of multiple pregnancies while maintaining acceptable pregnancy rates. Implementation of these refined practices has led to a reduction in the incidence of higher order multiple births, although the incidence of twins has yet to be minimized. Further reduction in the incidence of multiple births after ART necessitates a redefinition of success to emphasize the healthy singleton birth rate, rather than crude pregnancy rates.

Female↗
PubMed2005

Deaths of HIV-positive men in the context of assisted reproduction: five case studies from a single center.

Provision of reproductive services to individuals infected with HIV-1 is gaining popular acceptance and is generally endorsed by specialists in reproductive medicine. In the situation in which the male is HIV positive and the female partner is not infected, a large body of evidence has demonstrated that the use of assisted reproductive technology is effective for achieving pregnancy, while eliminating the risk of viral transmission to the mother and fetus. No reports have documented the well-being of the HIV-infected partners subsequent to seeking fertility services. In the current report, we document the cases of five HIV-positive men who died secondary to complications of HIV infection shortly after participating in the assisted reproduction program for HIV-1-serodiscordant couples at Columbia University. Three of these couples successfully achieved pregnancy and live birth, including one set of triplets, and one case of posthumous conception; the fourth case resulted in the cryopreservation of all embryos after the sudden death of the male before the time of embryo transfer; the fifth couple failed to conceive. None of the deaths, which occurred within a few months to 2 years from initial consultation, were related to infertility treatment. The demographic and social statuses of these patients were not different from the general population of men seeking assisted reproduction in our clinic. Regarding the HIV infection status of these cases, three patients had a longer duration of infection compared to the general population of men in our cohort, and one had a significantly lower CD4 cell count. All five men had stable HIV viral loads, and were determined by their primary care providers to be clinically healthy at the time of entry into the program for assisted reproduction. The untimely deaths of these patients underscores the importance of the thoughtful consideration of the complex issues involved in family planning for these individuals, including advanced directives for the use of cryopreserved gametes and embryos, and the social, emotional, and practical issues for the children and surviving partners subsequent to the death of the HIV-positive parent.

Adult↗
PubMed2005

Further HFEA restrictions on egg donation in the UK: two strikes and you're out!

The UK and Europe have lagged far behind the USA in the number of egg donation cycles performed over the past two decades. This disparity has been largely attributed to governmental restraints placed on the method within these locales, combined with the lack of regulation in the USA. Severely limiting donor compensation and requiring donors to be identified 18 years or more after their participation will undoubtedly lead to the demise of egg donation as the UK now knows it. Throwing more money at the problem, in the form of increased donor compensation, is unlikely to fix the shortage of participants that is to come. As already witnessed, increasing numbers of women and couples will probably seek treatment outside their native borders to escape the unreasonable demands placed upon their personal liberties by government. Regulation will promote 'reproductive tourism' as patients seek care in areas of the world where self-determination is protected by law.

Disclosure↗
PubMed2004

The vascular endothelial growth factor (VEGF)/VEGF receptor 2 pathway is critical for blood vessel survival in corpora lutea of pregnancy in the rodent.

The vascular endothelial growth factor (VEGF)/VEGF receptor 2 (VEGFR-2) pathway regulates proliferation, survival, and permeability of vasculature. This pathway is active during the formation of a corpus luteum, a highly vascularized, endocrine organ with a short life span during the nonpregnant state. In the pregnant state, the life span of corpora lutea is much longer because they play a critical role in supporting pregnancy development. We hypothesized that the VEGF/VEGFR-2 pathway plays a critical role in regulating angiogenic events in the corpora lutea of pregnancy. Injection of the neutralizing anti-VEGFR-2 antibody DC101 (ImClone Systems, Inc., New York, NY) on embryonic d 3.5 (preimplantation) or 6.5 (postimplantation) disrupts function of the corpora lutea of pregnancy in CD1 mice, as evidenced by a decrease in organ size, regression of luteal vessels, and a fall in progesterone secretion within 24 h postinjection. Inhibition of the VEGFR-2 caused removal of endothelial cells, mostly through endothelial cell detachment from the vascular basement membrane. Luteal steroid-producing epithelial cells were eliminated through apoptosis secondary to vasculature becoming dysfunctional. Disruption of luteal function caused arrest of embryonic development. The effect of antibody is specific to the ovary, because pregnancy progresses normally in ovariectomized, progesterone-replaced animals treated with anti-VEGFR-2 antibody. Embryonic blood vessels were not affected directly by the antibody, because it did not reach the embryo. Administration of an antibody against VE-cadherin (E4G10), which specifically blocks endothelial proliferation, did not disrupt luteal function and pregnancy development. Thus, VEGFR-2-mediated endothelial cell signals are critical to maintain functionality of luteal blood vessels during pregnancy. Potential clinical applications of inhibitors of the VEGF/VEGFR-2 pathway include emergency contraception and medical treatment of ectopic and abnormal intrauterine pregnancies.

Animals↗