The evolution and outcome of pregnancies from oocyte donation.
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Biomedical subjects
Publications and source records attributed to P Serhal.
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Cryopreserved spermatozoa from men having treatment for lymphoma or testicular tumour have been reported to function sub-optimally. We report on three successful pregnancies following gamete intra-Fallopian transfer (GIFT) using such cryopreserved sperm samples. In one case, ovum donation was required since the woman had premature ovarian failure.
A case of partial Asherman syndrome and blocked fallopian tube following complication of cesarean section is presented. Two IVF-ET attempts failed where difficulty at uterine embryo transfer was encountered. Transtubal embryos transferred 48 hr after transvaginal oocyte collection and in vitro fertilization resulted in an in utero pregnancy and delivery.
Oocyte donation offers the prospect of achieving a successful pregnancy to a group of patients traditionally considered to be irreversibly sterile. In patients with ovarian failure, it is possible to create an endometrial milieu that is receptive to embryonic implantation by giving exogenous steroid replacement. A high fertility potential can be achieved with a low miscarriage rate in oocyte recipients irrespective of the patient's age. This reflects the improved biological performance of oocytes obtained from young donors. In oocyte recipients, it is now feasible to dissociate the stages of embryonic development and endometrial maturation. Hence, oocyte donation can provide insights into as yet unresolved questions such as the duration of the 'implantation window' in humans. Oocyte donation will undoubtedly complement basic IVF in trying to elucidate the biological interactions between the conceptus, endometrium and steroid environment in human reproduction.
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An analysis of the outcome of first gamete intrafallopian transfers for 1071 women indicates that for those aged 40 years or more all the oocytes had to be transferred to obtain a 19.2% pregnancy rate. In this age-group pregnancy rate and multiple pregnancy rate were significantly lower than those for younger women. Success rate, but not multiple pregnancy rate, was significantly higher in the group of women from whom 11 or more oocytes were recovered and transferred after ovulation induction than when only 1-4 oocytes were recovered and transferred. The findings suggest that the number of oocytes transferred should depend on clinical circumstances.
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One case of ovarian ectopic associated with twin intrauterine viable pregnancy after in vitro fertilization, and one case of contralateral tubal ectopic pregnancy after gamete intra fallopian transfer performed with normal fallopian tubes, are reported. The possible pathogenesis and the management are discussed. The risk of ectopic pregnancy after assisted conception can be present even when the fallopian tubes are apparently normal.