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Biomedical subjects

R Frydman

Publications and source records attributed to R Frydman.

At least 19 recordsLinked to original sources
PubMed1992

[Sterility and medically assisted fertilization].

In vitro fertilization is now part of the treatment of infertility. Since 12 years, indication have been extended to male or female infertility factors. The successes have also been increased and the actual pregnancy rate is about 18% pregnancies by retrieval. Different methods are available such as GIFT, ZIFT, TET and progresses will certainly come from new techniques such as micro-manipulation, oocyte freezing and genetic procedures applied to assisted reproduction technologies.

Female↗
PubMed1992

Anonymous oocyte donation: a psychological study of recipients, donors and children.

The psychological features of anonymous, personalized oocyte donation are examined. The specific psychological profiles of recipients and donors are described, as well as the psychological experience of patients undergoing fertilization attempts. Preliminary data from an ongoing 3-year longitudinal study of children born by these medically assisted procreation techniques are reported.

Denial, Psychological↗
PubMed1992

Controlled preparation of the endometrium with exogenous oestradiol and progesterone: a novel regimen not using a gonadotrophin-releasing hormone agonist.

In women having inactive ovaries, controlled preparation of the endometrium has been achieved with exogenous oestradiol and progesterone. We report on the feasibility and practicality of using a similar regimen for timing transfers of cryopreserved embryos in women whose ovaries have not been suppressed. A total of 91 women having cryopreserved embryos from previous in-vitro fertilization (IVF) attempts received 4 mg/day of oestradiol valerate, starting on cycle day 1 of spontaneous (n = 85) or induced (n = 6) menstruation. A single blood sample was obtained on cycle day 14 for the measurement of plasma progesterone, oestradiol and luteinizing hormone (LH). Vaginal administration of micronized progesterone (300 mg/day) was started on day 15. Cryopreserved embryos were transferred on day 17 or 18 provided that day 14 plasma progesterone remained < or = 0.5 ng/ml, thereby confirming the absence of spontaneous ovulation prior to the administration of exogenous progesterone. Out of 91 cycles studied, plasma progesterone was found to be elevated (> 1 ng/ml) in only three (3.2%). Of the 88 scheduled transfers, 31 did not take place because no embryo survived thawing. In the remaining 57 cycles, 116 embryos were transferred resulting in 10 pregnancies, giving pregnancy and embryo implantation rates of 17.5 and 8.6% respectively. When a positive beta human chorionic gonadotrophin (HCG) titre was obtained, supplementation with oral oestradiol and vaginal progesterone was continued until placental autonomy was achieved. Of the 10 pregnancies, five (50%) were lost during the first trimester (biochemical, n = 1; miscarriage, n = 3; ectopic, n = 1).(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Spontaneous↗
PubMed1992

Influence of sperm parameters on outcome of subzonal insemination in the case of previous IVF failure. off.

Subzonal insemination (SUZI) has been proposed for patients with sperm male factor infertility, and in cases of in-vitro fertilization (IVF) failures. However despite SUZI, there still remain couples with very low fertilization rates and even with fertilization failures. Since sperm parameters are known to influence the IVF fertilization rate, we investigated the relation between sperm parameters and the SUZI issue in cases of previous IVF failures with normal or subnormal sperm. Twenty-seven couples were included in the study and were split into two groups according to whether they had normal or subnormal sperm. In the first part of the study a randomized prospective trial comparing SUZI to classic IVF insemination was carried out (11 cycles). In the second part, all the oocytes had SUZI (35 cycles). None of the control inseminated oocytes fertilized. Including all the cases, the fertilization rate after SUZI was 29.8% with a pregnancy rate of 15.2% per cycle. We concluded that: (i) SUZI is efficient for achieving fertilization in cases of IVF failures; (ii) the post SUZI fertilization rate is inversely correlated to the percentage of acrosome defects in the semen (P < 0.001); and (iii) when the sperm is normal, the oocyte quality might be responsible for the previous IVF failures. In spite of a good fertilization rate for this indication, it seems that the chance of having a baby is low.

Adult↗
PubMed1992

Spontaneous luteinizing hormone surges can be reliably prevented by the timely administration of a gonadotrophin releasing hormone antagonist (Nal-Glu) during the late follicular phase.

A new gonadotrophin releasing hormone antagonist (Nal-Glu) was used during the late follicular phase of the natural cycle in order to prevent spontaneous surges of luteinizing hormone (LH). Eight regularly ovulating women (group 1) received two injections of Nal-Glu (5 mg) administered 48 h apart when plasma oestradiol levels exceeded 125 pg/ml. Human menopausal gonadotrophin (HMG, 225 IU) was administered simultaneously with Nal-Glu and repeated every 12 h thereafter until either a spontaneous LH surge occurred or human chorionic gonadotrophin (HCG, 5000 IU) was administered. HCG was arbitrarily administered 48 h after the second Nal-Glu injection. Six other women (group 2) receiving only HMG served as controls. In seven of the eight women in group 1, LH and progesterone remained low for 96 h following Nal-Glu, i.e. until HCG administration. In the remaining woman in this group, LH started to rise 12 h before HCG injection. In this group, Nal-Glu did not interfere with follicular development or the plasma profile of oestradiol. All women developed one single dominant follicle with the exception of one subject who had already spontaneously developed two dominant follicles prior to administration of Nal-Glu and HMG. In group 2, LH rose spontaneously in all women before the planned HCG injection. The luteal phase was apparently not altered by Nal-Glu. These results suggest that Nal-Glu administration during the late follicular phase of natural cycles supported by HMG, can prevent the spontaneous LH surge while not interfering with follicular growth.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Effects of luteal estradiol on the secretory transformation of human endometrium and plasma gonadotropins.

To study the role of luteal estradiol (E2), we interrupted the supply of E2 during the luteal phase of E2 and progesterone (P) replacement cycles. Thirty-one women, aged 26-37 yr, with absent or inactive ovaries received three different treatment regimens: group I (n = 11) received transdermal E2 and vaginal P according to a protocol designed to approximate levels of estrone (E1), E2, and P seen during the menstrual cycle. Groups II (n = 11) and III (n = 9) received identical treatments, except that in group II no E2, and in group III no E2 or P, was administered after day 15. Endometrial biopsies were obtained on days 20 and 24 in groups I and II, and on days 14 and 20 in group III. In group I, plasma E1 and E2 reached menstrual cycle levels, whereas in groups II and III, discontinuation of the E2 supply on day 15 resulted in a prompt decrease to castrate levels of plasma E1 and E2. In groups I and II, menopausal FSH and LH levels decreased to 26 +/- 6 and 30 +/- 7 IU/L, respectively, on day 13 (mean +/- SEM). In group I, administration of E2 and P starting on day 15 further lowered plasma gonadotropin levels. In group II, administration of P only failed to induce a similar decrease in plasma FSH and LH. No uterine bleeding occurred before day 25 in women of groups I or II, while women of group III bled within 2 days of E2 withdrawal. Endometrial biopsies were similar in groups I and II. Histological features were characteristic of early and late luteal phases on days 20 and 24, respectively. Endometrial maturation assessed by estrogen and progesterone receptors identified by immunocytochemistry showed the typical distribution seen on day 24 of the menstrual cycle with no difference between groups I and II. We conclude that in women deprived of ovarian function, administration of P only after 14 days of E2 priming prevented uterine bleeding and induced normal secretory transformations of the endometrium, but failed to suppress plasma gonadotropins.

Administration, Cutaneous↗
PubMed1992

[Medical and ethical problems posed by the prenatal diagnosis of distal absence of a limb].

Eight cases of distal amputation of limb are reported. The diagnosis were made by ultrasound scans at 18-25 weeks of amenorrhea. In all cases, according to the French law, our team of fetal medicine refused the therapeutic terminations of pregnancy requested by the parents. The therapeutic terminations of pregnancy were achieved by another unit of fetal medicine in France, or in another country. These reported cases address many questions about the aim of fetal medicine (therapeutic terminations of pregnancy or treatment of infants), the place of the parents request in the decision, the different decision arguments, and the variations in the decision between different fetal medicine crew facing to similar prenatal diagnosis.

Abortion, Legal↗
PubMed1992

[Quadruplet pregnancies: management and obstetric and pediatric outcome].

Multi-fetal gestations are associated with increased frequency of maternal, fetal and neonatal complications. Data on the prognosis of multi-fetal pregnancies are of particular importance when the option of selective termination is considered. The present study details the obstetric management, neonatal outcome, and follow-up of seven quadruplet pregnancies in a french university center. The perinatal mortality was 250/1000. The neonatal mortality was 214/1000. The incidence of respiratory distress syndrome was 38%, bronchopulmonary dysplasia 19% and intraventricular hemorrhage 9.5%. Follow-up from one to 16 years shows that no child is handicapped. Our specific management for higher order multi-fetal pregnancies include early diagnosis, meticulous follow-up, early decrease of maternal activity, midwives at home, psychological care, delivery by cesarean section and a neonatalogist for each baby at the time of delivery.

Abortion, Therapeutic↗
PubMed1992

[Pregnancy after renal transplantation. 27 patients and review of the literature].

We report the course and outcome of 30 pregnancies in 27 renal transplant patients between 1970 and 1988. Delay between transplantation and pregnancy was 7.3 +/- 4.8 years. There were 1 twin pregnancy and 3 successive pregnancies. Immunosuppressive regime was prednisone and azathioprine in 28 cases and cyclosporine in 2. Hypertension (33%), preterm delivery (74%) and premature rupture of the membranes (33%) were the main complication encountered. The cesarean section rate was 73%, mainly because of these complications. Twenty-seven patients delivered of 31 healthy children. There was no congenital anomaly. Mean birth weight was 2.640 +/- 645 g. In utero growth retardation occurred in 7 cases (23%). Pregnancy after renal transplantation is of good prognosis for both the mother and child but the course of pregnancy can be complicated by hypertension, preterm birth and growth retardation.

Adult↗
PubMed1992

[Pregnancy after hepatic transplantation. 17 pregnancies].

The number of orthotopic liver transplantations (OLT) is increasing and longterm survival is improving. More women recipients may choose to become pregnant. We report a one-center experience with the course and outcome of 17 pregnancies in 17 liver transplant out of 675 OLT since 1985. 10 women delivered of 10 healthy infants at 38 +/- 1.5 week's gestation. There was no preterm delivery and the mean birth weight was 2.990 +/- 370 g, birth weight was adequate for gestational age in any case. Four cesarean sections were performed for obstetrical indications. No congenital anomalies occurred in the children. Hypertension occurred in 2 out of twelve patients and appeared as the main complication to deal with. There was one case with graft function impairment at 37 weeks' gestation. One uncomplicated pregnancy is ongoing at 29 weeks' gestation. There were 4 spontaneous and 2 therapeutic abortions for impaired liver function. Pregnancy is successful in a large proportion of these patients but must be planned and managed as high-risk situations by an obstetrician and a specialist of the liver transplant. Pregnancy should be advised against in patients with poor liver function or active viral infection; a 12 months interval from OLT to pregnancy is since to be the minimal requirement. Post-transplant immunosuppressive therapy consisted of azathioprine, corticosteroids and ciclosporin A, and was maintained throughout pregnancy. Genetic counselling should be provided when the primary liver disease is inherited. This being said, as shown by the results of our study and those reported in the literature, pregnancy is not only feasible but also successful in a large proportion of OLT recipients.

Abortion, Spontaneous↗
PubMed1992

Labor induction in women at term with mifepristone (RU 486): a double-blind, randomized, placebo-controlled study.

OBJECTIVE: To determine the efficacy and safety of mifepristone as an induction agent for the initiation of labor or as a cervical ripening agent in women at term. METHODS: Our study group contained 120 women at term (after 37.5 weeks' amenorrhea) who had clear clinical indications for labor induction. They were randomized to receive either 200 mg of mifepristone or placebo on days 1 and 2 of a 4-day observation period, with labor induction planned for day 4. Eight patients, three treated with mifepristone and five receiving placebo, had to be excluded from the survey because they required cesareans for medical reasons (fetal distress or maternal complications) less than 12 hours after taking the first tablet. RESULTS: Forty-one subjects entered spontaneous labor, 31 treated with mifepristone and ten in the control group (P < .001). Forty-five needed cervical maturation with prostaglandins on day 4, 13 of whom had received mifepristone and 32 of whom had been given placebo (P < .001). Thirteen women treated with mifepristone and 13 who had taken placebo had mature cervices sufficient for classic labor induction with oxytocin and amniotomy. Patients who delivered vaginally needed a much lower amount of oxytocin when mifepristone had been given, and the mean time interval between day 1 of the survey and the onset of labor was also significantly shorter in this group. CONCLUSION: Although more studies are needed, we have found mifepristone to be a safe, efficient, and suitable induction agent for initiation of labor in women at term.

Adult↗
PubMed1992

[Recipients of oocytes donated anonymously. Psychological aspects].

This study concerns fifty patients who were investigated after a semi-directed interview. Several factors came to light: the type of couples who use assisted reproductive techniques (diagnostic and psychological profiles); the stability of the couple when failure and when success occurred; the hope of having a child and their ideas concerning the child's future; secrecy, questions that were asked concerning the practice of anonymity and non-anonymous donation of oocytes; the relationships between the recipients and the donors as well as the specific relationships that develop between the couples and their physicians. The conclusion reached from the studies show that the diagnoses of the various causes for sterility give rise to different problems. Donor anonymity makes it possible for the recipient to stamp their own pattern of identity on the child about to be born and make him part of their family history. Bringing the technique into conception of the child does not seem to interfere with the relationship between the couple and with their desire to have a child. The upbringing of the child is the responsibility of the couple.

Adult↗