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Biomedical subjects

Michael H Dahan

Publications and source records attributed to Michael H Dahan.

16 recordsLinked to original sources
PubMed2007

A randomized, prospective study comparing laser-assisted hatching and assisted hatching using acidified medium.

OBJECTIVE: To compare the clinical outcomes of patients whose transferred embryos underwent either laser-assisted hatching or hatching with acidified medium. DESIGN: Randomized, prospective, double-blinded study. SETTING: University-based IVF center. PATIENT(S): Clinical outcomes following IVF were compared in 159 patient cycles who randomly had all transferred embryos undergo laser-assisted hatching (Laser; n = 57) or hatching with acidified medium (Acid; n = 54). Patients whose embryos had zonae thickness <13 mum were not hatched (Thin; n = 8) and patients with > or =4 embryos at the 7- to 8-cell stage or higher on Day 3 were transferred on Day 5 (Day 5; n = 40). MAIN OUTCOME MEASURE(S): Implantation rates, clinical pregnancy rates, ongoing pregnancy rates, multiple pregnancy rates. RESULT(S): No significant differences were noted in clinical, ongoing, or multiple pregnancy rates between the four groups. The implantation rate for Day 5 transfers was significantly greater than both the Laser and Acid treatment groups. CONCLUSION: The use of a 1.48-micron infrared diode laser beam provides a safe and rapid method for performing assisted hatching and did not have a negative impact on patient care when compared to outcomes achieved using acidified medium.

Adult↗
PubMed2006

Congenital interruption of the ampullary portion of the fallopian tube.

We present a rare case of a congenital isolated missing segment of the fallopian tube, including hysterosalpingographic and laparoscopic images. We conclude that when this occurs without concomitant müllerian anomalies, the mechanism of development would not be expected to be associated with an increase in renal abnormalities.

Adult↗
PubMed2006

Serum sex hormone-binding globulin levels show too much variability to be used effectively as a screening marker for insulin resistance in women with polycystic ovary syndrome.

OBJECTIVE: To evaluate the relationship between serum sex hormone-binding globulin (SHBG) and parameters of insulin sensitivity in women with polycystic ovary syndrome (PCOS) and controls, and determine the feasibility of using SHBG levels to predict insulin resistance. DESIGN: Evaluation of a prospectively collected database. SETTING: University reproductive center. PATIENT(S): A total of 21 women with PCOS and 17 controls. INTERVENTION(S): Oral glucose tolerance test. MAIN OUTCOME MEASURE(S): Correlations of serum SHBG and parameters of insulin sensitivity. RESULT(S): [1] Among all participants, SHBG levels indicated a correlation between the fasting glucose-to-insulin (GI) ratio and the quantitative insulin sensitivity check index (QUICKI). Participants with PCOS demonstrated significant correlations of SHBG and fasting GI ratio, 1-hour postglucola insulin levels, and random 17-hydroxyprogesterone (17ohP4) levels. Among controls, SHBG and fasting serum glucose and 2-hour postglucola serum glucose levels were associated. [2] Participants with PCOS and lean controls exhibited different glucose and insulin responses to 75 g of glucose at 1 and 2 hours postchallenge, resulting in paradoxically similar GI ratios. CONCLUSION(S): [1] Although certain parameters of insulin status and serum SHBG demonstrated statistically significant correlation coefficients, these relationships are weak and SHBG cannot be used as a predictor of insulin resistance. [2] The post-glucose load GI ratio cannot be used to determine the magnitude of insulin resistance.

Adult↗
PubMed2006

Risk of surgery after use of potassium chloride for treatment of tubal heterotopic pregnancy.

BACKGROUND: Spontaneous heterotopic pregnancies are rare, but with assisted reproductive techniques the incidence may approach 1:100. With the widespread use of transvaginal ultrasonography, physicians have attempted treatment of heterotopic pregnancies with minimally invasive procedures such as transvaginal guided potassium chloride (KCl) injection. However, there are few data on the success of this treatment. CASE: A 30-year-old primigravida presented with a desired pregnancy and was found to have a tubal pregnancy in addition to an intrauterine pregnancy. Ultrasound-guided KCl injection into the heterotopic pregnancy was complicated by abdominal pain, surgical abdomen, and hemoperitoneum requiring salpingectomy. CONCLUSION: A review of the literature revealed that 55% of tubal heterotopic pregnancies treated by KCl injection required subsequent salpingectomy. This raises concerns about the advisability of this treatment.

Adult↗
PubMed2005

Fetal weight, maternal age and height are poor predictors of the need for caesarean section for arrest of labor.

Retrospective data on 228 patients was analyzed in order to develop a predictive model of operative delivery, caesarean section for arrest of labor. The ANOVA, discriminant analysis and the Fisher discriminant function of SPSS were used. Birth weight, maternal age and maternal height were statistically significant risk factors, but only 10.9% of caesarean sections could be predicted with these variables. Seven percent of patients who delivered vaginally were predicted as needing a caesarean section for arrest of labor.

Adult↗
PubMed2005

Luteinizing hormone secretion is not influenced by insulin infusion in women with polycystic ovary syndrome despite improved insulin sensitivity during pioglitazone treatment.

It has been reported in women with polycystic ovary syndrome (PCOS) that LH secretion is not altered by insulin infusion. To determine whether insulin resistance may have precluded an effect of insulin, pulsatile LH secretion and gonadotropin responses to GnRH were examined in PCOS women (n = 9) before and after pioglitazone treatment (45 mg/d) for 20 wk in the presence and absence of a hyperinsulinemic euglycemic clamp (80 mU/m2.min). Frequent blood samples were obtained for 12 h (every 10 min) as well as during sequential administration of GnRH at doses of 2, 10, and 20 microg over 12 h. A significant (P < 0.05) improvement in insulin sensitivity was seen in the subjects after treatment. Mean LH levels, LH pulse frequency and amplitude, as well as gonadotropin responses to GnRH were not influenced by pioglitazone, either with or without insulin infusion. We conclude that in PCOS women, inappropriate gonadotropin release does not appear to be a consequence of hyperinsulinemia.

Adult↗
PubMed2005

Programming ovulation using estrogens for patients to time intercourse.

BACKGROUND: A woman wishing to conceive may be separated from her spouse at the time of ovulation. Moreover, some orthodox Jewish women have a unique problem when they are unable to initiate intercourse before ovulation. They are prohibited from participating in sexual relations from the start of menstruation until 7 days after the end of flow when they go to the ritual bath (mikveh). CASES: Two orthodox Jewish women who ovulated before restarting intercourse were treated with oral estrogens to delay ovulation. CONCLUSION: Women separated from their husbands at the time of ovulation and Jewish women who ovulate before ritual cleansing can effectively use oral estrogens to program ovulation.

Administration, Oral↗
PubMed2005

Oral contraceptives for inducing ovulation delay in orthodox Jewish women: a report of 2 cases.

BACKGROUND: Orthodox Jewish women are prohibited from participating in sexual intercourse from the start of menstruation to 7 days after the end of flow, when they participate in a ritual bath. CASE: Two orthodox Jews with ovulation prior to initiating sexual intercourse were treated with oral contraceptives to delay ovulation. CONCLUSION: Oral contraceptive treatment strategies are effective at delaying ovulation until after the ritual cleansing for orthodox Jewish women with short follicular phases.

Adult↗
PubMed2004

Tumor-level serum testosterone associated with human immunodeficiency virus lipodystrophy syndrome.

BACKGROUND: Human immunodeficiency virus (HIV) lipodystrophy syndrome consists of insulin resistance, hyperlipidemia, increased waist-to-hip ratios, and relative hyperandrogenemia, which resembles polycystic ovary syndrome. CASE: A 30-year-old HIV-positive multipara with lipodystrophy syndrome had an elevated level of serum total testosterone (244 ng/dL) in the tumor range. CONCLUSION: In HIV lipodystrophy syndrome, marked elevations of total serum testosterone in the range reserved for androgen-producing tumors may occur. The elevated testosterone levels are derived from the ovary and are responsive to gonadotropin suppression.

Adult↗
PubMed2004

Relationship of GnRH-stimulated LH release to episodic LH secretion and baseline endocrine-metabolic measures in women with polycystic ovary syndrome.

BACKGROUND AND OBJECTIVE: In polycystic ovary syndrome (PCOS) inappropriate gonadotrophin secretion is characterized by increased pulse frequency and amplitude, elevated 24-h mean serum concentrations, and greater responses to GnRH. While the mechanism(s) responsible for this increased release of LH are not well understood, enhanced LH secretion has been attributed to increased pituitary sensitivity to GnRH and feedback influences from circulating steroid hormones. To address these considerations, we conducted a study to examine the relationships between GnRH-stimulated LH responses, episodic gonadotrophin secretion, and baseline measurements of endocrine-metabolic function in PCOS. PATIENTS: Serum LH responses to sequential multidose GnRH administration and pulsatile gonadotrophin secretion were examined in 13 PCOS and 13 normal women. MEASUREMENTS: Serum LH, steroid hormone, insulin and glucose levels were determined in blood samples obtained during assessment of episodic gonadotrophin secretion and LH responses to GnRH stimulation. DESIGN: Each subject was studied on two consecutive days. On study day 1 each subject underwent frequent blood sampling every 10 min for 12 h. On study day 2 each received sequential doses of GnRH, 2 microg, 10 microg and 20 microg, administered intravenously at 4-h intervals over a continuous 12-h period. RESULTS: Serum LH responses following GnRH were markedly greater in PCOS compared to normal women, as expected. In individual PCOS, peak LH responses to GnRH were significantly correlated with corresponding basal LH and LH pulse amplitude, but not LH pulse frequency. In the PCOS group, LH responses were positively correlated with serum oestradiol (E2) and inversely related to body mass index (BMI). Between-group differences in LH responsiveness disappeared when controlling for serum testosterone (T) levels. CONCLUSIONS: These results indicate that the absolute LH increment following GnRH is largely dependent on baseline LH levels and may account for the well-documented difference in LH responsiveness between PCOS and normal women. That neither LH responses to GnRH nor LH pulse amplitude were correlated to LH pulse frequency suggests involvement of other factors along with GnRH to account for increased LH secretion in PCOS. In addition to E2 and BMI, serum testosterone appears to be, at least in part, responsible for differences in LH secretion and release between PCOS and normal women.

Adult↗
PubMed2003

Evidence for abnormal granulosa cell responsiveness to follicle-stimulating hormone in women with polycystic ovary syndrome.

Women with polycystic ovary syndrome (PCOS) undergoing ovulation induction appear to be extremely sensitive to gonadotropin stimulation and at increased risk for ovarian hyperstimulation syndrome. To determine granulosa cell responsiveness to recombinant human FSH (r-hFSH), dose-response studies were conducted in 16 individual PCOS patients and 7 normal women. Each subject received an iv injection of r-hFSH at doses of 0, 37.5, 75, or 150 IU in a randomized fashion on four separate occasions. Blood samples were obtained at frequent intervals before and for 24 h after r-hFSH administration for measurement of gonadotropins and steroid hormones. Our results showed that administration of r-hFSH produced instantaneous and equivalent dose-related increases in serum FSH in PCOS and normal women, which were followed by similar exponential decreases to baseline levels within 24 h in both groups. In PCOS subjects, the peak mean incremental response of serum estradiol (E(2)) to 150 IU of r-hFSH was 1.8-fold greater (P < 0.0001) and considerably accelerated compared with that found in normal women. In contrast, E(2) responses to 37.5 IU and 75 IU were similar between groups. Regression analysis of maximal E(2) concentrations in response to r-hFSH in each individual subject revealed that the slope of the linear trend line in the group of women with PCOS (r = 0.82) was significantly greater (P < 0.01) than that of normal controls (r = 0.71). The time-course of response revealed that in PCOS women, increases of E(2) were not sustained, compared with those of normal controls, because peak concentrations were followed by an estimated 40% decrement in circulating levels, whereas E(2) levels in normal women persisted for 24 h after reaching maximal values. These findings indicate that women with PCOS exhibit a significantly greater capacity for E(2) production in response to iv r-hFSH, compared with normal women. In PCOS, E(2) production was relatively transient because after peak concentrations a marked decline was detected at each dose, unlike normal women who exhibited persistent elevations of E(2) for up to 24 h. That this distinction was dose-dependent supports the concept of an FSH dose-response threshold, beyond which PCOS but not normal women are susceptible to ovarian hyperresponsiveness.

Dose-Response Relationship, Drug↗
PubMed2003

Enhanced granulosa cell responsiveness to follicle-stimulating hormone during insulin infusion in women with polycystic ovary syndrome treated with pioglitazone.

Women with polycystic ovary syndrome (PCOS) are known to exhibit insulin resistance with compensatory hyperinsulinemia. To determine the role of hyperinsulinemia on follicle function in PCOS, we examined 24-h estradiol (E(2)) responses to recombinant human FSH (r-hFSH), 75 IU, before and during insulin infusion both before and after administration of pioglitazone (30 mg/d) in seven PCOS women. Each subject underwent two 10-h hyperinsulinemic-euglycemic clamps at rates of 30 (low dose) and 200 (high dose) mU/m(2).min, respectively. During both low- and high-dose insulin infusions, E(2) responses to r-hFSH were unaltered compared with that observed in the absence of insulin. Pioglitazone administration for 5 months improved insulin sensitivity as indicated by significantly (P < 0.05) increased glucose infusion rates during the clamp studies. At 3 months of treatment, r-hFSH-stimulated E(2) responses were not different from those observed before treatment. With pioglitazone treatment, E(2) responses to r-hFSH remained unchanged during low-dose insulin infusion, whereas a highly significant (P < 0.02) increased response was noted with the high-dose hyperinsulinemic-euglycemic clamp. In addition to a greater magnitude of response, peak levels of E(2) were sustained longer compared with that seen before treatment. The data indicate that granulosa cell responsiveness to FSH was enhanced by insulin after improved insulin sensitivity induced by pioglitazone. These findings are consistent with the possibility that PCOS granulosa cells are insulin resistant.

Adult↗
PubMed2003

Increased luteinizing hormone secretion in women with polycystic ovary syndrome is unaltered by prolonged insulin infusion.

In PCOS women with insulin resistance, hyperinsulinemia may contribute to inappropriate gonadotropin secretion. To determine whether insulin influences gonadotropin release in PCOS, pulsatile LH secretion and gonadotropin responses to GnRH were evaluated before (phase 1) and during (phase 2) insulin infusion. In phase 1, 11 PCOS and 9 normal women on separate days underwent 1) frequent blood sampling (q 10 min) for 12 h and 2) gonadotropin stimulation by successive doses of GnRH, 2 microg, 10 microg, and 20 microg, administered i.v. at 4 h intervals over a continuous 12 h. In phase 2, studies were repeated 2 h after initiation of a 12-h hyperinsulinemic-euglycemic clamp (80 mU/m(2).min). Administration of insulin to both groups failed to alter mean serum gonadotropin concentrations, LH pulse frequency, or LH pulse amplitude. Moreover, gonadotropin responses to GnRH were unchanged by insulin infusion. In PCOS and normal women, a significant reduction of serum androstenedione was associated with insulin administration, whereas no differences were noted for the remaining androgens and estrogens measured. These findings demonstrated that in PCOS women, LH secretion and gonadotropin responses to GnRH were not influenced by insulin administration. Insulin infusion had little effect on steroid hormone production with the possible exception of androstenedione. These results suggest that inappropriate LH secretion in PCOS is not a direct consequence of insulin resistance and compensatory hyperinsulinemia.

Adult↗
PubMed2002

Spontaneous subserosal venous rupture overlying a uterine leiomyoma. A case report.

BACKGROUND: Patient age, parity and leiomyoma size are considered risks for venous rupture overlying a leiomyoma. CASE: A 28-year-old woman presented with abdominal pain and decreasing hematocrit from spontaneous rupture of a uterine leiomyoma vein. CONCLUSION: Congestion of a vein overlying a leiomyoma, irrespective of the patient's age or parity or size of the leiomyoma, is a risk factor for rupture.

Adult↗