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Biomedical subjects

R E Bernardus

Publications and source records attributed to R E Bernardus.

At least 19 recordsLinked to original sources
PubMed1995

Clinical and subclinical varicocele: a useful distinction?

OBJECTIVE: The purpose of the study was to establish whether it is useful to make a distinction between clinical and subclinical varicoceles with a view to deciding for treatment or not. Therefore, we compared our results of treatment of clinical vs. subclinical varicoceles. STUDY DESIGN: The changes of semen parameters and the occurrence of pregnancies in 40 infertile men treated for clinical varicocele were compared with those in 46 infertile men treated for subclinical varicocele. The significance of individual semen changes was analysed by paired t-test in both groups and the results of both groups were compared by analysis of covariance. The pregnancy rates were calculated and the life table curves of pregnancy of both groups were compared. RESULTS: There were statistically significant increments in sperm density, motility and morphology both after treatment of clinical and subclinical varicoceles, and these increments did not differ significantly between both groups. The cumulative pregnancy rates after a mean follow-up period of 6.6 years amounted to 42.5% for clinical varicoceles and to 39.1% for subclinical varicoceles and the life table curves of pregnancy ran a rather similar course in both groups. CONCLUSION: We conclude that there is no reason to emphasize the palpatory findings in infertile men with varicocele.

Adult↗
PubMed1994

Time schedules of intrauterine insemination after urinary luteinizing hormone surge detection and pregnancy results.

A urinary luteinizing hormone (LH) test (LH Color, Organon, Oss, The Netherlands), was used to time intrauterine insemination in 177 cycles. Morning and evening urine samples were tested. In 58 women (33%) the test was positive in the morning urine sample. Fifteen of these patients were inseminated 8-10 h thereafter and one patient (6.7%) conceived. The remaining 43 women were inseminated the following day, 25-31 h after LH detection, and seven pregnancies (16.3%) ensued. In 119 cycles showing a positive urinary test in the evening sample, insemination was performed the next day, between 17 and 23 h after the LH surge, and 18 patients (15.1%) became pregnant. Statistical analysis showed no significant differences in pregnancy rates between the three different schedules, or in the time of insemination between conceptional and non-conceptional cycles within each group. Most ovulations occurred between 16 and 28 h after the positive test was observed. These findings suggest that while the lifespan of the gametes allows a relatively long period for fertilization, from 8 to 31 h after urinary LH surge detection, better results may be expected when inseminating about 24 (+/- 6) h after the positive test.

Adult↗
PubMed1993

Pituitary responsiveness after administration of a GnRH agonist depot formulation: Decapeptyl CR.

OBJECTIVE: This study was focused on the pattern of LH release from the pituitary during the initial response to high dose GnRH agonist administration. Secondly, the pattern of LH release and the pituitary responsiveness to physiological and pharmacological stimulation during long-term pituitary suppression by a high dose GnRH agonist was studied. In addition, the relation between serum agonist levels and pituitary function and responsiveness was investigated. DESIGN: DTrp6GnRH in microcapsules (Decapeptyl CR) was administered i.m. to 12 women on the third day of the cycle. High-rate blood sampling was carried out during the first 48 hours after the injection. Secondly, high-rate blood sampling for 6 hours and a GnRH challenge were performed before and weekly after administration, from week 4 till week 9. All samples were assayed for LH and FSH. LH patterns were analysed by applying a computerized pulse detection program. In the second or third week an oestradiol benzoate test was performed. Finally, triptorelin levels were measured before and weekly after administration. PATIENTS: Twelve patients, suffering from tubal infertility and recruited from the waiting list for in-vitro fertilization/embryo transfer (IVF/ET) participated in the study. RESULTS: During the first 48-hour period, LH and FSH levels demonstrated a rapid rise to peak values after 4 hours, subsequently declining to nearly normal levels. E2 rose to peak values at 12 hours and returned to the follicular range thereafter. LH pulse patterns showed a rapid increase in pulse intervals leading to a near absence of LH pulses at the end of the 48-hour period. From the fourth till the seventh week after agonist administration, LH pulse patterns showed a markedly increased pulse interval, decreased pulse amplitude, and a severely decreased mean LH level. In the same period, LH responses to GnRH were severely blunted or absent. Restoration of the pre-injection LH pulse pattern and the LH response to GnRH was observed during the eighth and ninth week. Oestradiol benzoate challenges showed an E2 rise to preovulatory levels in response to the injections. However, no changes were observed in LH and FSH concentrations. Triptorelin levels showed a peak within 48 hours and gradual decline towards pretreatment values in week eight. CONCLUSIONS: It is concluded from the study, that after administration of triptorelin depot in the early follicular phase, desensitization of the pituitary starts to develop within 24 hours. Pituitary responsiveness is completely absent in the second week and continues to exist until the eighth week after injection, when the agonist has disappeared from the circulation. These findings suggest profound alterations in GnRH receptor availability and post-receptor pathways, that prevent the pituitary from responding to physiological stimuli.

Adult↗
PubMed1992

Reliability of home urinary LH tests for timing of insemination: a consumer's study.

In this study, intrauterine insemination (IUI) was timed either after the detection of a urinary luteinizing hormone (LH) surge at home by the patient (group A), or following a positive LH test as interpreted by the gynaecologist (group B). Afterwards, samples tested by the patient were retested by the gynaecologist and vice versa. The gynaecologist also rechecked his own findings and the results were correlated with ultrasound data and charts of basal body temperature. Forty-seven cycles were evaluated. The patient's and the gynaecologist's readings agreed (+/- 12 h) in 42 of the cases (89%), and in five cycles (11%) a difference greater than 24 h was found. The intra-observer variation in the gynaecologist's results was +/- 12 h in four cycles (8.5%). These findings suggest that the LH test can be used as a reliable home device for the prediction of pending ovulation and timing of IUI.

Adult↗
PubMed1992

Pituitary and ovarian suppression after early follicular and mid-luteal administration of a LHRH agonist in a depot formulation: decapeptyl CR.

In order to study its effect on pituitary and ovarian function, a single dose of triptorelin depot (Decapeptyl CR, Ferring) was administered to 12 women in the early follicular (EF,n = 6) or mid-luteal phase (ML,n = 6) of a normal cycle. In all 12 women the initial pituitary and ovarian responses were similar. Luteinizing hormone (LH) and follicle stimulating hormone (FSH) rose to peak values within 48 h, and declined to hypogonadotropic levels within 2 weeks' time. Steroid levels showed a slight to marked rise after injection and fell to hypogonadal values within 1 week. LH suppression was maintained until the 8th week after the injection, while FSH levels rose to normal between the 3rd and 4th week. Estrogen secretion started to be restored in the course of the 7th and 8th week. Menses occurred between the 11th and 13th week after the injection of the drug. This study demonstrates the possibility of rapid induction of a hypogonadotropic and hypogonadal condition in regularly cycling women by administration of a single triptorelin depot. Suppression of pituitary and ovarian function appears to be continued until the 8th week after the injection.

Adult↗
PubMed1991

Pregnancy rates after timed intercourse or intrauterine insemination after human menopausal gonadotropin stimulation of normal ovulatory cycles: a controlled study.

Forty-eight patients with male (n = 16) or idiopathic (n = 32) infertility were stimulated with human menopausal gonadotropin. Intrauterine insemination (IUI) or natural intercourse were performed after either human chorionic gonadotropin (hCG)-induced or spontaneous, urinary luteinizing hormone (LH) surge-monitored ovulation. A total of 148 cycles were analyzed. In 40 cycles treated with hCG-induced ovulation and IUI, 3 (7.5%) patients conceived, whereas 37 women accomplished natural intercourse after hCG-induced ovulation and 2 (5.5%) became pregnant. When inseminated after a spontaneous LH surge, 3 (8.8%) of 34 patients achieved a pregnancy; no conception occurred in 37 spontaneously ovulatory cycles combined with timed intercourse. Pregnancy rates did not substantially differ between the treatment modalities or between mono-ovulatory and polyovulatory cycles. The cycle characteristics between spontaneous ovulatory and hCG-induced cycles significantly did differ.

Chorionic Gonadotropin↗
PubMed1991

Results of IVF from a prospective multicentre study.

Part of a cost-effectiveness study of in-vitro fertilization was the evaluation of the medical results of this fertility treatment. Data were prospectively collected from greater than 3000 IVF treatments in five Dutch hospitals during a 2-year period. The average 'take-at-least-one-healthy-baby-home-rate' per started treatment was 10% (the average clinical pregnancy rate per embryo transfer was 20%). After more IVF treatments, about one in three to four couples were successful. Differences in results were mainly caused by patient characteristics, the treatment episode and the treating hospital. These differences remained in a multivariate logistic regression analysis.

Cost-Benefit Analysis↗
PubMed1991

Selective drop-out in successive in-vitro fertilization attempts: the pendulum danger.

Success rates from in-vitro fertilization (IVF) in the long term are dependent on selection procedures with regard to continuation into further IVF episodes. Publications on success rates in successive episodes will give incentives to adapt selection criteria, but if these publications do not deal explicitly with patient selection, the adaptations might change their direction every time: the pendulum danger.

Female↗
PubMed1991

Urinary luteinizing hormone testing and prediction of ovulation in spontaneous, clomiphene citrate and human menopausal gonadotropin-stimulated cycles. A clinical evaluation.

A urinary luteinizing hormone test was utilized to predict ovulation in 99 spontaneous, 122 clomiphene citrate, and 82 human menopausal gonadotropin stimulated cycles. Tests were performed in early morning and evening specimens and follicular development was monitored by daily ultrasonography. A positive detection rate of 98, 97, and 94%, respectively, was obtained. Evidence of luteinized unruptured follicles was seen more frequently in stimulated cycles, concurring with negative test results. In 2 spontaneous, 1 clomiphene citrate and 5 hMG induced cycles two distinct LH surges were detected concomitant with a pattern of follicular atresia and subsequent new follicular development. Most ovulations occurred between 16 and 28 h after LH detection, significantly earlier in spontaneous than in clomiphene citrate stimulated cycles (p less than 0.02), whereas pre-ovulatory follicles were larger in the clomiphene citrate group (p less than 0.001). The mean duration of the follicular and luteal phases, as calculated from the LH peak, was substantially shorter in the hMG cycles than in the other two groups (p less than 0.001).

Adult↗
PubMed1990

[The results of in-vitro fertilization in a Dutch multicenter study].

Part of a cost-effectiveness study on in-vitro fertilisation was the evaluation of the medical results of this fertility treatment. Data were prospectively collected from more than 3000 IVF treatments in the five Dutch hospitals during a two-year period. The average take-at-least-one-healthy-baby-home rate per started treatment was 10% (the average clinical pregnancy rate per embryo transfer was 20%). After several IVF treatments about one in three or four couples were successful. Ranges in results were mainly caused by patient characteristics, the individual treatment number and the treating hospital. Male subfertility and long-lasting and primary infertility result in a bad prognosis. Success rates differed substantially between hospitals, even after correction for patient mix.

Cost-Benefit Analysis↗
PubMed1990

Intrauterine insemination does and clomiphene citrate does not improve fecundity in couples with infertility due to male or idiopathic factors: a prospective, randomized, controlled study.

In the present prospective study we compared, in terms of pregnancy rates, the differences between intrauterine insemination (IUI) of in vitro capacitated husband's semen and timed natural intercourse in spontaneous or clomiphene citrate (CC) stimulated cycles. A rapid urinary luteinizing hormone peak detection test was used for timing of ovulation. Forty patients suffering from longstanding infertility of male (n = 17), cervical (n = 2), and idiopathic (n = 21) origin were randomly assigned into four distinct treatment modalities during 4 consecutive cycles. A total of 132 cycles were analyzed. In 35 cycles treated with CC plus IUI, five conceptions were achieved, whereas three pregnancies occurred in 32 inseminated spontaneous cycles. Only 1 patient conceived after timed intercourse in 31 CC stimulated cycles, and no pregnancy resulted from 34 spontaneous cycles combined with timed intercourse. There was a statistically significant higher conception rate in cycles in which IUI was performed, whereas the use of CC does not seem to improve the pregnancy rate. Analysis of results for other modifying factors did not substantially affect the relative risk (odds ratio) of pregnancy.

Adult↗
PubMed1989

Pregnancy rate is significantly higher in in vitro fertilization procedure with spermatozoa isolated from nonliquefying semen in which liquefaction is induced by alpha-amylase.

In 115 patients (group I) in which normal liquefaction of semen occurred, the fertilization rate of the yielded oocytes was 71.2% after standard in vitro fertilization procedure, and the viable pregnancy rate per patient per cycle was 13.0%. In a comparable group of 26 patients (group II), in which semen liquefaction did not occur spontaneously, alpha-amylase was added in order to liquefy the semen. In this group, the fertilization rate was 86.7% of the yielded oocytes, and the viable pregnancy rate per patient per cycle was 26.9% (P less than 0.05). It is concluded that alpha-amylase can be of use to liquefy nonliquefying semen, and that the resultant spermatozoa have a positive effect on pregnancy results.

Adult↗
PubMed1985

Twin pregnancy: case reports illustrating variations in transfusion syndrome.

The twin transfusion syndrome is diagnosed in 5.5% to 14.6% of monochorionic twins and the classical picture reveals a small anemic donor and a large plethoric recipient. Many other clinical discrepancies have been described. Today, by ultrasound it is possible to diagnose the syndrome in (early) pregnancy. In these case reports different clinical pictures and the importance of ultrasound are described. In twin pregnancies repeated ultrasound examinations should be considered with the consequences of vascular anastomoses.

Adult↗
PubMed1985

The significance of the ratio in follicle-stimulating hormone and luteinizing hormone in induction of multiple follicular growth.

Among the patients enrolled in the Norfolk In Vitro Fertilization Program there were 32 who had been stimulated according to the basic stimulation protocol using two ampules of human menopausal gonadotropin (hMG) daily. Because of their inadequate response, 23 of these 32 patients were stimulated subsequently with a combination of two ampules of "pure" follicle-stimulating hormone (FSH) and two ampules of hMG on cycle days 3 and 4. The remaining nine patients received four ampules of "pure" FSH only on cycle days 3 and 4. Stimulation was continued with hMG in both FSH regimens. Ten thousand units of human chorionic gonadotropin was used for final maturation. Parallel with the increase in the ratio of exogenous FSH to luteinizing hormone, an increase in oocyte recovery was observed, as well as an improvement in transfer and pregnancy rates. It was concluded that FSH enrichment had a beneficial effect in these patients.

Adult↗