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R Wainer

Publications and source records attributed to R Wainer.

13 recordsLinked to original sources
PubMed2002

[True and false hyperprolactinemia: how to discriminate one from the other in infertility management?].

Serum prolactin measurement is usually performed in infertility evaluation, even if there's no specific clinical presentation of hyperprolactinemia. High levels of prolactin are noted in 20 to 30% of menstrual abnormalities and in about 10% of regular menses. It is of importance to determine whether hyperprolactinemia is related to pituitary adenoma, drug administration, general diseases, or circulating large forms of prolactin, in order to avoid heavy, expensive, time consuming and unnecessary clinical investigations or therapeutic actions. We must first to confirm the biological diagnosis of hyperprolactinemia with few repeated plasmatic measurements, and, later, if necessary use TRH-metoclopramide test and/or pituitary magnetic resonance imaging.

Female↗
PubMed2001

[Can donor insemination be optimised?].

OBJECTIVE: To compare the different donor insemination technics. MATERIAL AND METHOD: Analysis of the published studies about donor insemination which value the effectiveness of Intra Cervical Insemination (ICID) and Intra Uterine Insemination (IUID), the interest of ovulation induction, the possible complications, and the cost-effectiveness ratio. RESULTS: The meta-analysis of the Cochrane data base (10 comparative studies IUID versus ICID, 2568 donor insemination cycles) lead to a pregnancy rate per cycle (PRC) 17.77% with IUID versus 7.68% with ICID. The odds ratio is 2.63 (CI from 1.85 to 3.73). With these PRC, the direct cost per evolutive pregnancy is 54,780 F with ICID and 25,675 F with IUID. CONCLUSION: If it is possible to propose ICID to patient with an excellent regularity of ovulation. IUID with ovulation induction by gonadotropins is today the gold standard, and more especially as the law restrict the number of donor inseminations. Indeed, the IUID is two or three times more effective than ICID, consume the half of sperm straws, use a semen of moderate quality, there is no complication provided that the cycle is cancelled if there is more than two mature follicles and the cost-effectiveness ratio is greatly in favour with IUID.

Cervix Uteri↗
PubMed2001

[Smoking and ovarian fertility].

Smoking reduce the natural fertility and the delay to conceive increase with the number of cigarettes. In In Vitro Fertilization, the pregnancy rates per cycle are reduced with smokers compared with no smokers (OR: 0.66). The menopause arrive on average 2 years before with the smokers and the damages of ovarian reserve increase with smoking. The deleterious effects on ovary arrive, early in utero with regard to maternal smoking, and after the puberty, on the pre-ovulatory period where toxic, vascular and mutagen effects induce inhibition of ovocyte apoptosis, promoting ovocyte aneuploidy and subsequently miscarriage. The protection of ovarian fertility is one argument more to stop early smoking.

Aging↗
PubMed2001

An idiopathic infertility with oocytes metaphase I maturation block: case report.

BACKGROUND: A case of idiopathic primary infertility was attributed to a block in oocyte meiosis affecting the transition between metaphase I and metaphase II. METHODS AND RESULTS: A couple suffering unexplained primary infertility was unsuccessfully treated by various means of assisted reproductive technology. After four unsuccessful pregnancy attempts using intrauterine inseminations (IUI), IVF was attempted (all oocytes remained unfertilized), followed by an ICSI cycle. None of the retrieved oocytes expelled the polar body, and therefore were not injected. The failure of these assisted reproduction cycles was, in both cases, due to the immaturity of the oocytes recovered. Cytogenetic analysis of the oocytes retrieved for ICSI provided evidence of meiotic arrest. Using cytogenetic staging criteria we were able to show that this arrest occurred between metaphase I and anaphase I. CONCLUSIONS: Meiotic blocks affecting oocytes have already been described for various mammals. We discuss here mechanisms that might be involved in this possibly inherited disorder in humans, and ways in which our knowledge of them could be increased.

Adult↗
PubMed1997

Does hydrosalpinx reduce the pregnancy rate after in vitro fertilization?

OBJECTIVE: To determine the effect of hydrosalpinges on the pregnancy rate in an IVF program. DESIGN: Multicentric retrospective analysis of clinical and laboratory data. SETTING: Two assisted reproductive technology centers in university hospitals. PATIENT(S): Four hundred forty-three women, under 38 years of age, with pure tubal infertility. The patients were classified into the following five groups: bilateral hydrosalpinges (n = 37), unilateral hydrosalpinx (n = 54), bilateral tubal occlusion (n = 207), unilateral tubal occlusion (n = 55), and severe tubal disease without complete occlusion (n = 90). MAIN OUTCOME MEASURE(S): Pregnancy and implantation rates. RESULT(S): The pregnancy and the implantation rates per transfer (12.3% and 5.4%) obtained by women with bilateral hydrosalpinges are significantly lower than the rates (means = 23.1% and 12%) for all other tubal infertility groups. CONCLUSION(S): Bilateral hydrosalpinges have a deleterious effect on the outcome of IVF program.

Adult↗
PubMed1996

[Prognostic sperm factors in intra-uterine insemination with partner's sperm].

We studied the prognostic value of sperm characteristics for the outcome of intra-uterine insemination with partner sperm (IUIPS). A total of 712 cycles of IUIPS following induction of ovulation with gonadotrophin (hMG/hCG) for 277 sterile couples attending the assisted reproductive technology centre of Poissy Hospital (78300-France) between January 1991 and December 1994 was studied retrospectively. Ninety-two clinical pregnancies were obtained giving an overall rate of 12.9% per cycle. None of the characteristics of the sperm as assessed initially correlated with outcome. In contrast, the number of motile spermatozoa given (n) affected outcome: for n < 1 x 10(6) the pregnancy rate was 2%; for n = 5 to 8 x 10(6) the rate was 19%. However, for +/- 8 x 10(6) the proportion of biochemical pregnancies and miscarriages was 40% which was significantly higher than for smaller concentration. The resort of IVF following 4 IUIPS failures leads to a pregnancy rate per cycle of only 6.7%.

Adult↗
PubMed1995

Prospective randomized comparison of intrauterine and intracervical insemination with donor spermatozoa.

From March 1990 to September 1993, 20 women underwent a total of 89 cycles of intracervical inseminations with donor semen (ICI) and 23 women underwent 67 cycles of intrauterine inseminations with donor semen (IUI). The women were assigned to the two groups randomly, but ensuring that the ages of the women and pathologies of the male partner (azoospermia or severe oligozoospermia) were similar in the two groups. There was no significant difference between the characteristics of the two groups and the method used to induce ovulation (HMG/HCG) was identical. Two semen straws were used for each insemination cycle. Semen was prepared for IUI on a Percoll gradient. Thirteen clinical pregnancies were obtained in the IUI group (19.4% of the attempts) and six in the ICI group (6.75%). After six cycles of insemination, 75.4% of the women of the IUI group obtained a pregnancy, as compared to 35% in the ICI group. These good results may be due to the method of induction of ovulation, but also to the technique itself, increasing the number of motile spermatozoa at the site of fertilization. The time taken to obtain a pregnancy is thus shorter with IUI than with ICI, and the number of semen straws required is smaller. In-vitro fertilization (IVF) should be proposed after six failures by IUI.

Cervix Uteri↗
PubMed1993

[Retrospective evaluation of an intra-uterine insemination program with donor].

The results of 109 intra-uterine inseminations with cryopreserved prepared donor semen (IUId) in stimulated cycles, performed among 42 couples from November 1987 to June 1991, were analysed. The single IUId was performed 39 +/- 3 hours after the injection of human chorionic gonadotrophin. For each IUID 1,25 +/- 1.4 x 10(6) motile spermatozoa (mean +/- standard deviation) were inseminated. 27 pregnancies were obtained and the pregnancy rate per cycle was 24.8%. The number of motile spermatozoa inseminated was significantly higher in the group of pregnant women than in the population without pregnancy (1.64 x 10(6) x 10(6)/IUI versus 1.13 x 10(6)/IUI). The sperm count and the number of motile spermatozoa inseminated were significantly higher when the semen was prepared on discontinuous Percoll gradients than after swim-up in Menezo B2 medium (8.2 x 10(6)/ml versus 4.3 x 10(6)/ml and 1.7 x 10(6) versus 0.77 x 10(6)). Among the 27 clinical pregnancies, 3 were twins and 2 were triplets. The ovarian hyperstimulation associated with the use of a prepared semen of donor, generate a high risk of multiple pregnancies. To improve the results without increasing the risk of multiple pregnancies, we propose to inseminate about 1.5 x 10(6) motile spermatozoa with a maximum plasma estradiol level of 1 100 pg/ml, on the day of hCG injection, associated with 2 preovulatory follicles. This technique may augment the rate of pregnancy and represents an appreciable time gain. These results must be confirmed by randomized prospective studies.

Adult↗
PubMed1989

[Prevention of iron-deficiency anemia in pregnancy using early iron supplementation: a controlled trial].

An iron supplementation trial versus placebo was performed in double blind on 191 attending at 3 month the antenatal clinic of Poissy maternity. Iron status of mothers and newborns was assessed at 3, 5, 7 month, during the delivery and 2 months after the delivery, using biochemical indicators (hemoglobin level, serum ferritin). The compliance was good in 165 pregnant women (86% of the initial sample): 81 in the iron group, 84 in the placebo group. Among the placebo group, anemia (Hb less than 11 g/dl) was observed at the end of the pregnancy in 30% of women. Depletion of iron stores started at 5 month. In the iron group, hemoglobin level increased significantly during the pregnancy and anemia was observed only in 3% of women at the delivery. Iron status of newborns and two months after delivery was related to mothers iron status at delivery and particularly at the 7th month of pregnancy.

Adult↗
PubMed1985

[Study of the iron status of a population of pregnant women].

Serum ferritin, haemoglobin, erythrocyte constants, serum iron and the fixation capacity of transferrin were determined in 233 pregnant women consulting a maternity clinic in the Paris area. 1 metropolitan frenchwoman out of 9 and almost half of the immigrants were found to suffer from anaemia at term. A virtual absence of iron reserves (serum ferritin less than microgram/l) was found in 20% of the metropolitan women during the 3rd month of pregnancy, in 60% during the 6th month and in 75% during the 9th month. The figures were 60%, 100% and 90% respectively in the immigrant group. Considering the anaemia-related risks and the eventual repercussions of iron deficiency on a pregnancy, the health of the mother and the foetus, a systematic increase in iron as of the 2nd trimester of pregnancy is recommended.

Adult↗
PubMed1984

Oxprenolol placental transfer, plasma concentrations in newborns and passage into breast milk.

Thirty-two pregnant hypertensive patients were treated with oxprenolol administered in combination with dihydralazine as Trasipressol tablets. Before delivery, oxprenolol was demonstrable in the maternal plasma and the amniotic fluid. The free fraction of oxprenolol in the maternal serum (15% +/- 7.8; mean +/- s.d.; n = 25) was similar to that in normal serum. At the end of delivery, oxprenolol was found in both the maternal and umbilical plasma in most cases. Measurable, but low oxprenolol concentrations were present in the newborn plasma. After delivery, oxprenolol was demonstrable in the maternal plasma and breast milk. An infant weighing 3 kg and consuming 500 ml of breast milk per day would receive a maximum dose 60 times less than the normal daily dose for a hypertensive adult (4 mg/kg).

Adolescent↗
PubMed1981

[Arterial blood gas analysis in acute pulmonary embolism].

Arterial blood gases (pH, pO2, p CO2) were studied in 100 patients with documented pulmonary embolism (Group A), confirmed by pulmonary angiography (n = 51) or scintigraphy ( n = 49). The pO2 ranged from 32 to 97 mm Hg (average 60,5 +/- 13 mm Hg). Hypoxaemia was found in 97 cases and would therefore seem to be a reliable sign of pulmonary embolism. In the three cases in which it was absent, the embolism was small. Hypoxaemia was associated with hypocapnia and alkalosis in 91 cases. However, hypoxaemia was not a specific finding; it was also present in 49 patients with suspected pulmonary embolism (Group B) in whom the diagnosis was excluded by pulmonary angiography or scintigraphy. A previous history of cardiovascular disease was found in 37 patients (76%) in this group: of the 12 remaining patients, 6 were heavy smokers and 4 were significantly obese. No correlation was found between the degree of hypoxaemia and the extent of amputation of the vascular bed on pulmonary angiography or scintigraphy. Nevertheless, a pO2 of under 50 mm Hg was always associated with a severe embolism with amputation of over 40% of the pulmonary vascular bed. A significant correlation was found between the severity of hypoxaemia and the degree of cyanosis (p less than 0,05) and ECG changes (p less than 0,01). The average pO2 was 59 +/- 12 mm Hg in patients with cardiovascular disease ( n = 21) and 55 +/- 11 mm Hg with known pulmonary disease ( n = 6). A higher average pO2 was found when these conditions were absent (61,5 +/- 13 mmHg). The difference was not statistically significant unless previous cardiac and pulmonary disease were associated (pO2 = 51 +/- 14 mm Hg, p less than 0,05).

Acute Disease↗