PubMed Health⌕ Search

Biomedical subjects

Owen K Davis

Publications and source records attributed to Owen K Davis.

9 recordsLinked to original sources
PubMed2007

Outcome of in vitro fertilization in women 45 years and older who use autologous oocytes.

OBJECTIVE: To determine the IVF outcome in women over the age of 44 years. DESIGN: Retrospective analysis. SETTING: University-based IVF center. PATIENT(S): Two hundred eighty-eight consecutive IVF cycles in women over the age of 44 years. INTERVENTION(S): IVF. MAIN OUTCOME MEASURE(S): Ovarian response and cycle outcome. RESULTS: The mean age of the patients was 45.4 (+/-0.73) years, with a range of 45-49 years. Fifty-seven of 288 (19.8%) did not start because of an elevated FSH or ovarian cyst. Just over 30% (70/231) had their cycle cancelled before retrieval. The mean number of oocytes was 6.8 (+/-3.8), and the mean number of fertilized zygotes was 5.4 (+/-3.4). On average, the mean numbers of embryos replaced were 3.2 (+/-1.5). An overall pregnancy rate of 21.1% (34/161) per retrieval was found. Of these, 85.3% (29/34) experienced a pregnancy loss. The overall delivery rate was 3.1% (5/161) per retrieval. Only patients at 45 years of age with a good response (>5 oocytes) achieved a delivery. CONCLUSION(S): We have shown that IVF is a reasonable option for women of very advanced maternal age (>44 years) but is limited to those at the age of 45 years with a response of >5 oocytes.

Age Factors↗
PubMed2006

Simultaneous bilateral ovarian torsion in the follicular phase after gonadotropin stimulation.

OBJECTIVE: To present and discuss the first report of follicular phase bilateral ovarian torsion following a cancelled IVF cycle. DESIGN: Case report. SETTING: University-based assisted reproductive technology program. PATIENT(S): A 41-year-old nulligravid patient on day 3 of her menses following a cancelled IVF cycle. INTERVENTION(S): Gonadotropin ovulation induction; laparoscopy with detorsion of left and right ovaries; aspiration of cysts. RESULT(S): Ovarian torsion resolved; follicular development in the following natural cycle. CONCLUSION(S): This is a unique case of simultaneous bilateral ovarian torsion following a cancelled IVF cycle and presenting in the ensuing follicular phase. Physicians should be aware of this unusual risk related to persistently enlarged ovaries in the cycle following gonadotropin stimulation. Furthermore, management of the infertility patient should be conservative and focused on ovarian preservation whenever feasible. Early surgical intervention can permit reperfusion and salvage of the affected adnexa.

Abdominal Pain↗
PubMed2004

Relationship between maternal age and aneuploidy in in vitro fertilization pregnancy loss.

OBJECTIVE: To determine the fetal loss rate after documented fetal cardiac activity (7-week sonogram) and to evaluate the chromosomal makeup of these losses in IVF pregnancies. DESIGN: Retrospective analysis. SETTING: University-based IVF center. PATIENT(S): Two thousand fourteen consecutive IVF pregnancies with documented fetal cardiac activity. MAIN OUTCOME MEASURE(S): Miscarriage rates and karyotypes of pregnancy losses were analyzed. RESULT(S): The overall pregnancy loss rate after demonstrated fetal cardiac activity was 11.6% (233/2014). A highly significant increase in fetal loss with advancing maternal age was observed (<30 years = 5.3% vs. 31-34 years = 7.6% vs. 35-39 years = 12.8% vs. > or =40 years = 22.2%). Patients with a multiple gestation were more likely to deliver a live infant, compared with those with a singleton detected at a 7-week sonogram. Of the 233 losses in the study period, cytogenetic analyses were obtained for 74 (31.8%). Three specimens were nondiagnostic. Fifty-two patients had abnormal karyotypes (71.2% [52/71]). Eighty-two percent of the pregnancy losses in women aged > or =40 years were associated with chromosomally abnormal fetuses, compared with 65% of the losses in women aged <40 years (odds ratio, 3.35; 95% confidence interval, 0.96-11.97). CONCLUSION(S): Pregnancy loss after documentation of fetal cardiac activity is >10%. This loss is significantly increased with advancing maternal age. The major underlying cause of these losses seems to be chromosomal aneuploidy.

Abortion, Spontaneous↗
PubMed2004

Autologous endometrial coculture in patients with IVF failure: outcome of the first 1,030 cases.

OBJECTIVE: To analyze the effectiveness of autologous endometrial coculture (AECC) in improving embryo quality and pregnancy rates in 1,030 consecutive cycles of in vitro fertilization-embryo transfer (IVF-ET) utilizing AECC from January 1996 to December 2001. STUDY DESIGN: Embryos from each of 1,030 patients allocated to growth on AECC were analyzed for outcome. All patients had previously undergone failed IVF cycles. During a luteal phase biopsy (5-12 days after the luteinizing hormone surge) performed prior to the treatment cycle, glandular (G) and stromal (S) endometrial cells were isolated by enzymatic digestion and separated based on differential sedimentation rates. These cells were cryopreserved, then plated as a 50%/50% combination of G and S cells prior to embryo exposure. The conditioned medium was changed every 2 days. Embryos were randomly grown on endometrial coculture (ECC) or conventional media if > 6 oocytes were normally fertilized. Otherwise, all embryos were grown on AECC. RESULTS: The patients' mean age was 36.9 (+/-3.1) years. The patients had on average a history of 3.1 (+/- 1.7) failed prior attempts. When comparing a previous cycle (same institution only), the cleaved embryos on day 3 were of an improved quality (6.8+/-1.2 vs. 5.5+/-1.0 blastomeres and 14.6% +/- 9.3 vs. 27.2% +/- 9.8 fragmentation, P <.05). Twenty-two (2.13%) patients did not undergo ET secondary to poor embryonic development. Overall positive and clinical pregnancy rates of 49.8% and 41.5% were noted, respectively. Age remained the most important predictor of outcome. CONCLUSION: We demonstrated a significant improvement in embryo quality with ECC. We also demonstrated that patients with a poor prognosis secondary to prior IVF failures can have a good outcome when utilizing AECC.

Adult↗
PubMed2004

Obesity and in vitro fertilization: negative influences on outcome.

OBJECTIVE: To determine the influence of body mass index (BMI) on in vitro fertilization (IVF) outcome by studying a large cohort of good-prognosis IVF patients. STUDY DESIGN: This was a retrospective study at a university-based IVF center evaluating 920 good-prognosis patients (< 40 years, all with normal ovarian reserve) undergoing luteal leuprolide down-regulation and gonadotropin stimulation for IVF and evaluating IVF outcome, including response to stimulation, cancellation rates and pregnancy outcome based on obesity status. RESULTS: One hundred forty-eight (16.09%) patients were classified as obese (BMI > 27). Obese patients were more likely to undergo cancellation (14.9% vs. 9.1%, p = 0.03) when compared to nonobese patients. There was no difference in the amount of gonadotropins required. Obese patients had fewer oocytes retrieved and lower peak estradiol levels than did nonobese patients. In spite of the lower response, the clinical pregnancy rates per retrieval were no different (56.4% for both groups). CONCLUSION: Obese patients undergoing IVF are more likely to undergo cancellation. If cancellation does not occur, obesity confers a risk of a lower stimulation response. Despite this, the clinical pregnancy rates (per retrieval) were no different in obese patients and nonobese patients.

Adult↗