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Biomedical subjects

N Mordel

Publications and source records attributed to N Mordel.

At least 19 recordsLinked to original sources
PubMed1995

Ovulation induction with clomiphene citrate complicated by deep vein thrombosis.

A case of recurrent deep vein thrombosis following standard clomiphene citrate treatment, in a patient with a history of a previous episode of deep vein thrombosis, is described. This case indicates that deep vein thrombosis might be a rare but hazardous complication of clomiphene citrate treatment in patients with certain risk factors. We recommend that the use of clomiphene citrate in such cases be undertaken with caution and under close surveillance.

Adult↗
PubMed1995

Sex ratio in triplets.

Since the introduction of different ovulation induction regimens the incidence of triplet pregnancies increased from a spontaneous rate of about 1:10,000 to the frequency of nearly 1:1000. Sex ratio of trigemini and male/female proportion of the three newborns within the same triplet set is the amazing issue that we attempted to elucidate in the present study. Data on 36 women with triplet pregnancies delivered in our hospital and information regarding 2717 triplet pregnancies reported by 16 relevant papers were included in this study. 36 women delivered 63 (58%) male and 45 (42%) female babies. Triplet sets of same gender comprised 33% of all trigemini. Sex ratios (male/female) for the spontaneous, menotropin and clomiphene group were 2.00, 1.57 and 0.94 respectively. Homogenous male/female set ratio was 5.0, 2.0 and 0.5 in menotropin, spontaneous and clomiphene groups respectively. As the percentage of ovulation induction triplet pregnancies increased constantly from 0% to 100%, a decline in the fraction of homogenous gender triplet sets was observed--from 73% to 23%. It may be concluded that sex ratio in triplet newborns is divergent according to different publications with most of the authors reporting a male/female ratio of less than 1.00. Ovulation induction results in a lower proportion of homogenous sex triplets sets. Superovulation by menotropins cause a higher percentage of male triplet newborns when compared to ovulation induction by clomiphene.

Clomiphene↗
PubMed1994

Perinatal outcome of triplet pregnancies following assisted reproduction.

PURPOSE: This collaborative work was undertaken to assess perinatal outcome of in vivo conceived triplets to those following in vitro fertilization and assisted reproductive technologies (ART). METHODS: 151 triplets were examined; 56 delivered following ART, 55 following ovulation induction by gonadotropins (GN), 27 following clomiphene citrate (CC), and 13 conceived spontaneously. RESULTS: Mean gestational length of triplets following ART (33.2 wks) was not different from those conceived following GN (33.4 wks) or CC (34.2 wks), but was significantly shorter compared to triplets following spontaneous conception (35.3 wks). Mean fetal birthweight following ART (1743 g) did not differ significantly from that following GN (1683 g) or CC (1863 g) but was significantly lower compared to those delivered after spontaneous conception (1963 g). Although no difference was found in the incidence of low birthweight infants between the groups studied, the incidence of very low birthweight newborns (<1500 g) following ART or GN was significantly higher than following spontaneous conceptions (30.6%, 30.3% vs 10.3%). Differences in perinatal mortality were not significantly different between the groups examined (77.9, 60.6, 111.0, 25.6/1000 for ART, GN, CC, and spontaneous conceptions respectively). CONCLUSION: In conclusion, a similar perinatal outcome was shown for triplets conceived following ART and those following ovulation induction by GN, suggesting that the in vitro conditions as such were not the main contributing factor influencing the clinical outcome but rather the GN treatment. Triplets conceived spontaneously have a better outcome compared to those following ovulation induction or ART in terms of gestational length and birthweight.

Birth Weight↗
PubMed1993

Conception rate after in vitro fertilization in patients who conceived in a previous cycle.

OBJECTIVE: To evaluate whether a previously successful in vitro fertilization and embryo transfer (IVF-ET) cycle is a favorable prognostic factor for a subsequent cycle. DESIGN: A retrospective comparison between current IVF patients who have previously conceived in an IVF versus natural cycle. SETTING: The IVF unit of a university hospital. PATIENTS: Group A consisted of 51 patients (70 cycles of IVF-ET) who previously conceived in an IVF-ET cycle, and group B included 141 patients (201 cycles of IVF-ET) who previously conceived in a natural cycle. All couples with male factor infertility were excluded. Ovulation induction protocol was identical for both groups and consisted of gonadotropin-releasing hormone agonist pretreatment followed by gonadotropin stimulation. MAIN OUTCOME MEASURES: Pregnancy rate per ET, cumulative pregnancy rate, and livebirth rate in both groups. RESULTS: The following parameters were comparable for both groups: age, menotropin dosage required for an adequate stimulation, ovarian response, mean number of oocytes retrieved per cycle, fertilization and cleavage rates, and the mean number of embryo transferred. Group A attained a significantly higher pregnancy rate (PR) than group B (31.4% versus 19.4%). Group A also achieved a significantly higher livebirth rate (22.9% versus 11.4%) than group B. Similarly, the cumulative PR curves and the cumulative livebirth rate curves for three consecutive IVF-ET cycles differed significantly between the two groups. CONCLUSION: A previous successful IVF cycle is a positive prognostic factor for a repeated IVF attempt. This effect could be because of either an improved endometrial response or a better embryo quality. It may be that this patient population is relatively immune to the known untoward effects of ovulation induction on endometrial development and, therefore, may represent a potential clinical model that can be used to further identify the factors influencing uterine receptivity after ovulation induction.

Adult↗
PubMed1993

The effect of gonadotropin-releasing hormone agonist on embryo quality and pregnancy rate following cryopreservation.

OBJECTIVE: To examine the effect of GnRH analogue (GnRH-a) on the quality of frozen-thawed embryos and the pregnancy rate (PR) resulting from transfer. DESIGN: A retrospective study of two groups of women undergoing transfers of frozen-thawed embryos. In group 1 ovulation induction with hMG was begun after hypophyseal desensitization with GnRH-a for 2 weeks. In group 2 ovulation was induced with hMG only. The freezing and thawing techniques were identical for both groups. SETTING: In vitro fertilization unit at a university hospital. PATIENTS: The study group (group 1) included 108 women who underwent 137 transfer cycles of frozen-thawed embryos, and the control group (group 2) included 44 women in 51 cycles of thawed ETs. INTERVENTIONS: Ovum pick-up and ET techniques were the same for both groups. Methods of embryo freezing and thawing were identical, as were the morphological criteria for grading the embryos. RESULTS: The morphology of embryos was similar in both groups, as was the number of embryos that had at least 50% intact blastomeres (83% +/- 23% and 78% +/- 30% for group 1 and group 2, respectively). The PR (16 of 137 [11.7%] and 6 of 51 [11.8%], respectively) as well as the abortion rate (30%) were similar for both groups. CONCLUSIONS: The use of GnRH-a does not affect the quality of embryos nor the pregnancy outcome. Because the yield of frozen embryos per ovum pick-up is higher in cycles stimulated by GnRH-a/hMG, the PR per pick-up cycle is thus anticipated to be higher.

Abortion, Spontaneous↗
PubMed1993

Novel parameters of human sperm hypoosmotic swelling test and their correlation to standard spermatogram, total motile sperm fraction, and sperm penetration assay.

OBJECTIVE: To improve the accuracy of human sperm hypoosmotic swelling test by introducing new morphological evaluation parameters for this test. DESIGN: Individual semen samples were processed, and the standard spermatogram, total motile sperm fraction, sperm penetration assay (SPA), and hypoosmotic swelling test were performed. SETTING: Male infertility clinic and andrologic laboratory in a university medical center. PATIENTS: One hundred eighteen subfertile men undergoing an infertility work-up. MAIN OUTCOME MEASURES: The results of hypoosmotic swelling test were subdivided into four groups (hypoosmotic swelling test 1, 2, 3, 4) according to the different shapes of hypoosmotically affected spermatozoa tails. RESULTS: The hypoosmotic swelling test 3 had the best correlation with the different sperm parameters: motility, total motile sperm fraction, concentration, and SPA. The hypoosmotic swelling test 1 showed a satisfactory interrelation for concentration and for total motile sperm fraction but no correlation for motility and SPA. The hypoosmotic swelling test 2 and the hypoosmotic swelling test 4 demonstrated no correlation at all with motility, concentration, morphology and SPA. CONCLUSIONS: The precision of hypoosmotic swelling test may be improved by using the hypoosmotic swelling test 3 type of spermatozoa tail shape as the parameter for a normally functioning spermatozoa.

Female↗
PubMed1993

Elective suture of uterine cervix in triplets.

The incidence of triplet pregnancies has increased several times due to the widespread use of ovulation induction agents. Premature delivery is the main complication of triplet gestations. In twin conceptions it was shown definitely that elective cervical suture does not prolong these pregnancies. However, in higher order multifetal gestations the uterus is extremely overdistended and the application of cerclage is equivocal. This work intended to assess the value of elective cervical sutures in prolonging triplet pregnancies. Twelve of 35 women with triplet conceptions hospitalized at our high-risk pregnancy unit underwent an elective cerclage at 12 to 14 weeks and 23 women served as control subjects. None of them had any history or physical findings of cervical incompetence prior to the procedure. The gestational age (weeks) at delivery was 33.0 +/- 5.1 and 34.7 +/- 2.8 (mean +/- SD) for the sutured and noncerclage groups, respectively. The birthweight (grams) of the neonates was 1833.0 +/- 524.5 and 1884 +/- 455.5 (mean +/- SD) for the cerclage and nonsutured women, respectively. It seems that triplet gestations as such do not benefit from an elective cervical suture.

Birth Weight↗
PubMed1993

Discordancy in triplets.

Discordancy in twins is generally described as a weight difference between the fetuses of 15 to 25% and its prevalence in normal twin gestations is estimated at 15 to 29%. The present study was performed in order to determine the frequency of discordant newborns in uncomplicated triplet gestations. One hundred and fourteen normal triplet newborns were delivered during a period of 11 years. Their birthweight ranged from 493 to 2533 gm, with a mean of 1894.2 +/- 468.5 gm (+/- sd). In 58% of these 38 sets of triplets the difference in weight between the largest and smallest newborn was more than 15%. About a quarter of the newborns had a greater than 25% dissimilarity in their birthweights. There was no substantial fetal-fetal transfusion or difference in the Apgar scores between the discordant fetuses. It may be concluded that triplet newborns have a rate of discordancy double that of twins. Discordance per se does not necessarily mark an underlying complication of pregnancy or a bad perinatal outcome.

Birth Weight↗
PubMed1993

Sonographic growth curves of triplet conceptions.

The diagnosis of inappropriate intrauterine fetal growth in triplet pregnancies requires normal standard sonographically determined growth curves. The aim of the present study was to establish such nomograms. The biparietal diameter (BPD), femur length, head and abdominal circumferences (HC, AC) were once in 3 weeks sonographically evaluated in 108 normal triplet fetuses. The resulting growth curves were compared with those of normal singleton fetuses. The data showed that, compared with singletons, the mean triplet fetal BPD progressively lags to a maximum of 2 1/2 weeks as pregnancy continuous from the 25th to the 36th gestational week. Similarly, mean femur length of triplet fetuses gradually shortfalls to the greatest of 2 weeks as gestation advances from the 25th to the 36th week. HC to AC ratio of the triplet fetuses does not differ from the singletons curve. It may be concluded that a normal fetal growth curve in triplet pregnancies demonstrates a 1- to 3-week delay compared with singleton gestations.

Embryonic and Fetal Development↗
PubMed1993

A comparison of sonographic growth curves of triplet and twin fetuses.

Sonographic growth curves of 47 normal triplet pregnancies were compared with those of 71 uncomplicated twin gestations. Starting from the 25th week, the biparietal diameter in triplets was found to lag progressively compared with that of twins, reaching a mean difference of 2 weeks at 36 weeks gestation. Similarly, a significant difference was found between the femur length and head to abdomen circumference ratio growth curves of triplets and twins. It is concluded that as pregnancy continues from the 25th to the 36th gestational week, there is a significant delay in the growth patterns of normal triplet pregnancies compared with twin gestations.

Age Factors↗
PubMed1993

Gonadotrophin-releasing hormone agonist and ovarian hyperstimulation syndrome in assisted reproduction.

The available literature concerning the association between gonadotrophin-releasing hormone agonist and ovarian hyperstimulation syndrome has been reviewed and the different patterns by which this agent may contribute to the development of such iatrogenic complication has been elicited, and guidelines have been presented for prevention of this malady. Gonadotrophin-releasing hormone agonist acts directly on human granulosa cells, probably in its own dose-dependent manner. The extent of this action is probably subjected to follicular maturation stage and to the degree of gonadotrophin pre-treatment. Various agonist effects in assisted reproduction may be implicated in the development of ovarian hyperstimulation syndrome: a higher amount of menotrophin; premature luteinization prevention; 'flare-up' effect; and a higher pregnancy rate. Different methods for prevention of ovarian hyperstimulation syndrome may be attempted: (i) all embryo cryopreservation with luteal phase reinitiation of agonist; (ii) avoidance of ovulatory human chorionic gonadotrophin (HCG) and continuation of agonist; (iii) cancellation of ovulatory HCG, prolongation of agonist and later recommencement of menotrophin; (iv) pre-ovulatory LH surge triggering by agonist instead of the conventional HCG. Gonadotrophin-releasing hormone agonist may affect the steroidogenic ovarian stroma directly and such interaction may aggravate the development of ovarian hyperstimulation syndrome.

Clinical Protocols↗
PubMed1993

Transverse versus longitudinal uterine incision in cesarean delivery of triplets.

It is commonly accepted that cesarean section is the preferred mode of delivery of triplets. The present study was performed to evaluate maternal complications and neonatal outcome in 21 women operated on by a transverse lower segment incision as compared to 8 parturients who underwent surgery by a longitudinal uterine incision. There was no significant difference in mean gestational age at delivery, mean weight of the newborns, Apgar scores, perinatal mortality rates, or intraoperative or postpartum hemorrhage incidence between the two groups. Thus, a transverse lower segment uterine incision should be used in triplet deliveries to increase the chances of a normal vaginal delivery in the future.

Apgar Score↗
PubMed1992

Enhancing in vitro fertilization of mouse oocytes by partial zona pellucida digestion.

This work was undertaken in order to evaluate the effect of partial zona digestion on fertilization in vitro of mouse oocytes and assess zona surface changes induced by the procedure. Three hundred forty-six oocytes allocated for treatment were exposed to Ham's F-10 medium supplemented with 0.5% Pronase for either 3 min (188 oocytes) or 5 min (158 oocytes); 324 oocytes served as controls. Oocyte losses incurred as a result of the procedure were small (15 oocytes; 4.3%). Control and Pronase-treated oocytes were each divided into four subgroups and inseminated with 5 x 10(5), 5 x 10(4), 5 x 10(3), or 5 x 10(2) sperm cells/ml. Fertilization was assessed 8 hr following insemination by the appearance of two pronuclei and development to the two- to four-cell stage the following day. The morphology of the zona pellucida following Pronase treatment was assessed by phase-contrast and scanning electron (SEM) microscopies performed immediately after treatment. Fertilization rate of control oocytes was 80% at a sperm concentration of 500,000/ml and gradually declined to approximately 30% at 500 cells/ml. In contrast, treated oocytes inseminated with 500 sperm cells/ml demonstrated a normal rate of fertilization. At this low sperm concentration the longer Pronase treatment was significantly (P less than 0.05) more efficient in enhancing fertilization (69 and 88% for 3 and 5 min of Pronase treatment, respectively). Polyspermic fertilization was not observed in any of the subgroups. Phase-contrast microscopic examination of oocytes at the time of Pronase treatment showed an initial swelling of the zona pellucida for 30-60 sec with a time-dependent increase in its transparency.

Animals↗
PubMed1992

Artificial endometrial preparation for oocyte donation: the effect of estrogen stimulation on clinical outcome.

Morphologic studies of the endometrium have demonstrated that varying the duration of an artificial follicular phase (AFP) in women with ovarian failure did not adversely affect its developmental capacity. The aim of this study was to evaluate whether such manipulations of endometrial stimulation could influence the pregnancy rate in women undergoing oocyte donation (OD). Twenty-nine women were investigated in 51 cycles of OD. Endometrial preparation was performed with a fixed dose of micronized estradiol, 4 mg/day, administered for 5-35 days in accordance with oocyte availability. On the day of donation progesterone in oil, 50 mg/day, was added to the regimen. Oocytes were donated anonymously by patients undergoing routine in vitro fertilization. Fifteen clinical pregnancies were achieved, for a success rate of 29.4%. Using logistic regression analysis the success rate was found to be closely associated with the duration of estrogen stimulation. The pregnancy rate was 7.7, 52, and 7.7% after an AFP of 4-11, 12-19, and 20-29 days, respectively. It seems that for optimal results in an OD program, estrogen stimulation should be kept at between 12 and 19 days. These results also imply that, contrary to endometrial morphology, which seems to be tolerant to extreme AFP durations, functional receptivity is less permissive and is adversely affected by such manipulations.

Adult↗
PubMed1992

CA-125 is present in significant concentrations in periovulatory follicles of in vitro fertilization patients.

OBJECTIVE: To evaluate the presence of CA-125 in follicular fluid (FF) and its possible correlation to FF estradiol (E2), progesterone (P) and testosterone (T) and in vitro fertilization and embryo transfer (IVF-ET) outcome. DESIGN: Twenty-eight patients undergoing IVF-ET were randomly chosen and 123 FF were sampled. SETTING: Clinical IVF-ET program and immunology laboratory for tumor diagnosis in a university tertiary care center. PATIENTS: Pure tubal factor patients treated by midluteal (long) gonadotropin-releasing hormone agonist protocol coupled with follicular phase human menopausal gonadotropin. INTERVENTIONS: Transvaginal follicular aspiration followed 48 hours later by ET. MAIN OUTCOME MEASURES: The 28 treatment cycles resulted in six gestations including five take-home infants. The mean levels (+/- SD) were 30.1 +/- 66.0 U/ML for CA-125, 28.5 +/- 58.1 ng/ML for E2, 2,360.5 +/- 2,846.3 ng/ML for P, and 7.22 +/- 7.08 ng/ML for T. The FF CA-125 levels were found to be widely divergent in different follicles of the same patient. There was no significant correlation between FF CA-125 and E2, P, T, oocyte fertilization, embryo quality, and pregnancy rates. CONCLUSIONS: CA-125 exists in significant amounts in FF of periovulatory follicles of IVF-ET patients. Intrafollicular CA-125 secretion is neither interrelated to follicular steroidogenesis nor is correlated to the outcome of IVF-ET.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1992

The correlation of interleukin 1 and tumour necrosis factor to oestradiol, progesterone and testosterone levels in periovulatory follicular fluid of in-vitro fertilization patients.

Data has accumulated suggesting reciprocity between cytokines and the reproductive system. The present study was performed in order to evaluate the correlation between interleukin 1 (IL-1) and tumour necrosis factor (TNF) concentrations in follicular fluid and its oestradiol, progesterone and testosterone levels. A total of 39 follicular fluid samples, from eight patients undergoing in-vitro fertilization and embryo transfer were evaluated. All of the patients were treated by a midluteal (long) protocol involving a gonadotrophin releasing hormone agonist (GnRHa) coupled with follicular phase human menopausal gonadotrophin. Mean levels in follicular fluid of IL-1, TNF, oestradiol, progesterone and testosterone were 1.58 +/- 0.42 fmol/0.1 ml, 4.69 +/- 4.18 pg/ml, 28.5 +/- 58.1 ng/ml, 2360.5 +/- 2846.3 ng/ml and 7.22 +/- 7.08 ng/ml respectively. There was a significant (P less than 0.01) positive correlation between IL-1 and progesterone levels. There was no significant correlation between the different lymphokines and oestradiol secretion, oocyte fertilization, embryo quality and pregnancy rates. It is concluded that IL-1 and TNF exist in follicular fluid. It may be hypothesized that IL-1 has a local regulatory action, possibly promoting luteinization.

Adult↗
PubMed1992

The correlation between interleukin 2 and soluble interleukin 2 receptors to oestradiol, progesterone and testosterone levels in periovulatory follicles of in-vitro fertilization patients.

The present study was performed to evaluate the correlation between follicular fluid levels of interleukin 2 (IL-2) and IL-2 soluble receptor (sIL-2R), oestradiol, progesterone and testosterone levels, oocyte fertilization, embryo quality and pregnancy rates. Twenty-eight patients with a pure tubal factor and undergoing in-vitro fertilization and embryo transfer were randomly chosen and treated with gonadotrophin releasing hormone agonist (GnRHa) in the midluteal phase (long protocol) coupled with follicular phase administration of human menopausal gonadotrophin. Transvaginal follicular aspiration was performed 36 h after human chorionic gonadotrophin administration, followed 48 h later by embryo transfer. One hundred and twenty-three follicular fluids were sampled. The mean follicular fluid levels (+/- SD) were 2.30 +/- 0.80 fmol for IL-2, 458.2 +/- 236.0 units/ml for sIL-2R, 28.5 +/- 58.1 ng/ml for oestradiol, 2360.5 +/- 2846 ng/ml for progesterone and 7.22 +/- 7.08 ng/ml for testosterone. There was a significant (P less than 0.01) correlation between IL-2 and testosterone levels. No correlation was found between the lymphokines and serum oestradiol, follicular fluid progesterone, oocyte fertilization, embryo quality and pregnancy. It may be concluded that significant concentrations of IL-2 and sIL-2R exist in follicular fluid. Wide variations in follicular IL-2 and sIL-2R concentrations of different follicles were found in the same patients.

Estradiol↗