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Biomedical subjects

S Bassil

Publications and source records attributed to S Bassil.

At least 19 recordsLinked to original sources
PubMed1999

In vitro fertilization outcome according to age and follicle-stimulating hormone levels on cycle day 3.

PURPOSE: In a retrospective study, the prognostic factors of in vitro fertilization outcome were studied in women of 39 years of age or older, with an elevated cycle day 3 follicle-stimulating hormone (FSH) level. METHODS: Ovarian stimulation was achieved with a combination of gonadotropin-releasing hormone agonist/human menopausal gonadotropin in a short protocol. All patients underwent FSH dosage on cycle day 3 prior to stimulation. The pregnancy rate was studied according to age, FSH levels, and stimulation parameters. RESULTS: There was a negative correlation between day 3 FSH levels and the number of ovocytes retrieved. Cycles canceled because of the absence of ovarian response had a significantly higher mean FSH value (18.2 mlU/ml) than cycles ending in ovocyte retrieval (14.6 mlU/ml). Patients with three or more growing follicles during stimulation achieved a significantly higher pregnancy rate per egg retrieval (16%) compared to patients with fewer than three growing follicles (6%). Eighty percent of those pregnancies were obtained during the first two IVF cycles. Even with an elevated FSH level, some patients developed three or more follicles after stimulation. In such cases, the number of embryos available for transfer was the only significant limiting factor to achieving pregnancy. CONCLUSIONS: As our results suggest, there is a discrepancy between biological and chronological ovarian age. In patients with an elevated cycle day 3 FSH level and over 40 years of age, alternatives to fertility treatments (ovum donation, adoption, or no treatment) should not be considered as first choices. Indeed, even with elevated FSH levels, a 16% pregnancy rate per egg retrieval may be obtained if three or more growing follicles can be seen during ovarian stimulation. However, in the presence of fewer than three growing follicles during ovarian stimulation, the patient should be informed about the discouraging prognosis of the running cycle.

Adult↗
PubMed1999

Successful laparoscopic management of adnexal torsion during week 25 of a twin pregnancy.

Adnexal torsion is a rare occurrence during pregnancy. Here we present a case of adnexal torsion during the 25th week of pregnancy, which was managed laparoscopically. The woman had achieved a successful twin pregnancy after in-vitro fertilization/intracytoplasmic sperm injection. She was admitted to the emergency department with acute abdominal pain. Abdominal ultrasound with colour Doppler mapping of the intra-ovarian blood flow showed adnexal torsion. Laparoscopic management was successfully carried out.

Abdominal Pain↗
PubMed1999

Outcome of in-vitro fertilization through natural cycles in poor responders.

This prospective study examines the benefits of using natural cycles instead of stimulated cycles in poor responders to in-vitro fertilization (IVF) treatment. Eleven patients in whom puncture was cancelled or who failed to conceive because of a poor response were included in the analysis. The data for natural cycles (n = 16) were compared with data obtained during previous stimulated cycles (n = 25) in the same women. Out of 16 natural cycles, 13 (81.3%) were scheduled for oocyte retrieval compared to 13 out of 25 stimulated cycles (52%). Eighteen metaphase II oocytes were obtained during stimulated cycles, giving a 66% fertilization rate. In natural cycles, 11 metaphase II oocytes were available giving a fertilization rate of 78.6%. A mean number of 51.5 +/- 25 ampoules of gonadotrophins per cycle were used during ovarian stimulation. Three clinical pregnancies were obtained after embryo transfer in natural cycles (18.8%/started cycle) compared to none in stimulated cycles. Our findings demonstrate that an encouraging number of pregnancies can be achieved by IVF during natural cycles in poor responders to ovarian stimulation. This may not be the first approach to consider in IVF but it should be offered as an alternative after two ovarian response failures using classical protocols of stimulation.

Adult↗
PubMed1997

An ectopic pregnancy developing in a previous caesarian section scar.

OBJECTIVE: To report the diagnosis and management of an ectopic pregnancy (EP) developing in a caesarean section scar. DESIGN: Case report. SETTING: University medical school. PATIENT(S): A patient with a previous history of two caesarean sections developing an EP. INTERVENTION(S): Methotrexate (MTX) was administered locally under ultrasonographic guidance. MAIN OUTCOME MEASURE(S): Weekly screening of blood hCG levels and yolk sac resorption by endovaginal sonography. RESULT(S): The diagnosis was suspected by vaginal echography and confirmed by magnetic resonance imaging. Local injection of KCl and MTX provoked a progressive resorption of the pregnancy. Human chorionic gonadotropin was undetectable on day 82. CONCLUSION(S): To prevent uterine rupture in cases of an EP developing in a caesarean section scar, a medical approach can be proposed.

Adult↗
PubMed1997

The relationship between ovarian vascularity and the duration of stimulation in in-vitro fertilization.

The role of transvaginal pulsed colour Doppler ultrasound in the assessment of ovarian vascularity was studied in 196 in-vitro fertilization (IVF) cycles. The changes in ovarian blood flow after gonadotrophin-releasing hormone agonist (GnRHa) down-regulation and human menopausal gonadotrophin (HMG) stimulation were determined. The data obtained showed that the ovarian blood flow was significantly improved by oestradiol secretion (P = 0.05) and human chorionic gonadotrophin (HCG) administration (P = 0.003). Folliculogenesis was affected by blood flow supply. The resistance index (RI) value was significantly different (P = 0.05) according to the duration of ovarian stimulation. Patients with a mean RI value >0.56 had a longer stimulation with a significantly lower mean number of oocytes retrieved (P = 0.01) despite the administration of a standard dose of HMG. The RI value is a good indicator of modifications in ovarian vascularization during stimulation. Doppler blood flow measurement could be used to determine the optimal timing for the beginning of HMG administration in patients undergoing ovarian stimulation after down-regulation for IVF treatment.

Adult↗
PubMed1997

Rectovaginal septum adenomyotic nodules: a series of 500 cases.

OBJECTIVE: Laparoscopic procedure with excision of deep fibrotic endometriotic nodules of the rectovaginal septum and histological study of the lesions. SETTING: An academic teaching hospital. PARTICIPANTS: A series of 500 women undergoing laparoscopy for pelvic pain or infertility. RESULTS: Laparoscopic (n = 497) and laparotomic (n = 3) excision of endometriotic nodules resulted in considerable pain relief. Histologically the rectovaginal nodule was similar to an adenomyoma as it was a circumscribed nodular aggregate of smooth muscle and endometrial glands and stroma. The variations in oestrogen receptor and progesterone receptor content suggested a regulatory mechanism different from that of eutopic endometrium. CONCLUSION: This form of disease should be considered as an entity distinct from peritoneal and ovarian endometriosis, and originating from the Müllerian rests present in the rectovaginal septum.

Endometriosis↗
PubMed1997

Predictive factors for multiple pregnancy in in vitro fertilization.

OBJECTIVE: To study predictive factors influencing the multiple pregnancy rate in in vitro fertilization (IVF). STUDY DESIGN: Retrospective study. RESULTS: In 1,736 IVF cycles, 453 pregnancies occurred. The rate of singleton, twin and triplet pregnancies was 44%, 22% and 4.5%, respectively. Eighty-one percent of these clinical pregnancies ended with a delivery, giving a "take-home baby" rate of 23.8%/oocyte retrieval. As expected, a statistically significant positive correlation was found between the number and quality of embryos replaced and the occurrence of multiple pregnancies. A statistically significant correlation was also found when parameters such as age, stimulation parameters and embryo characteristics were incorporated into the analysis. This correlation was different for singleton, twin and triplet pregnancies. CONCLUSION: Based on the findings of this study, in patients with a good prognosis for IVF outcome, only two embryos of good quality should be replaced regardless of the maternal age or number of IVF attempts.

Embryo Transfer↗
PubMed1996

Expansive benign lesions: treatment by laser.

Submucous fibroids, polyps and dysfunctional bleeding are responsible for meno-metrorrhagia in women over 40 years of age. The authors describe the technique of hysteroscopic myomectomy and endometrial ablation using the Nd-YAG laser and the advantages of the preoperative use of GnRH agonist therapy. They report their results in a series of 746 patients treated for meno-metrorrhagia (366 cases of myomectomy and 380 cases of endometrial ablation).

Adult↗
PubMed1996

A unilateral hydrothorax as the only manifestation of ovarian hyperstimulation syndrome: a case report.

OBJECTIVE: To describe a rare case of unilateral hydrothorax occurrence after ovarian stimulation for IVF. DESIGN: Case report. SETTING: A university hospital. PATIENT(S): A 39-year-old female suffering from primary infertility due to a severe male factor. INTERVENTION(S): Thoracocentesis with IV albumin administration for correction of a concomitant hypoalbuminemia. MAIN OUTCOME MEASURE(S): Laboratory values of hematologic measures and electrolytes, screening of the thoracic fluid aspirated for viral and bacterial infections, resolution of pleural effusion after the second thoracocentesis as determined by chest roentgenogram. RESULT(S): Treatment of this manifestation of the ovarian hyperstimulation syndrome (OHSS) by thoracocentesis with albumin perfusion. CONCLUSION(S): This report describes a very rare case of thoracic complication after ovarian stimulation. It demonstrates that pleural effusion may be the only manifestation of the OHSS and implies a careful management of patients with pulmonary complaints after treatment with exogenous gonadotropins.

Adult↗
PubMed1996

Morphometric, immunohistological and three-dimensional evaluation of the endometrium of menopausal women treated by oestrogen and Crinone, a new slow-release vaginal progesterone.

Recently advanced computerized technology was applied to the investigation of morphometric, immunohistological and three-dimensional changes of the endometrial mucosa in order to evaluate quantitatively the effects of three doses of a new slow-release vaginal progesterone on the endometrium in post-menopausal women. A total of 20 menopausal women, deprived of ovarian function, were given oestrogen for 12 days and a combined therapy of oestrogen (administered orally) and progesterone for another 12 day period. Progesterone was administered vaginally through a new gel (Crinone) utilizing a bioadhesive, biocompatible polymer as a base to achieve a sustained release effect. An endometrial biopsy was taken before treatment, after oestrogen-only treatment and after the oestro-progestogen therapy. Before treatment, all the patients exhibited an atrophic endometrium. After oestrogen-only treatment, typical proliferative changes occurred: an increase in the endometrium thickness, an increase in the mitotic index, numerous cylinder-like glands and no coiled glands, and high concentrations of oestrogen receptors (ER) and progesterone receptors (PR). After the oestro-progestogen therapy, whatever the dose of progesterone given, a secretory transformation of the endometrial mucosa occurred, mitotic activity decreased significantly, more ramified and coiled glands were observed, and a decrease in PR content was noted in epithelial and stromal nuclei, and a decrease in PR content was also observed in epithelial nuclei but not in stromal nuclei. Accurate new techniques of image analysis have shown that crinone therapy could eliminate the proliferative effects of oestrogen treatment in post-menopausal women, despite doses as low as 45 mg of progesterone administered vaginally every other day. The results suggest that the sustained release effects of Crinone are clinically relevant.

Capillaries↗
PubMed1996

Large ovarian endometriomas.

The management of large endometriomas was described in a series of 814 patients. Combined therapy using gonadotrophin-releasing hormone agonist (GnRHa) and carbon dioxide laser laparoscopy was proposed. Drainage and GnRHa for 12 weeks provoked a reduction of the endometrioma size up to 50% of the initial value. After vaporization of the internal wall, a cumulative pregnancy of 51% after 1 year was achieved. A recurrence rate of 8% was observed for a follow-up of 2-11 years. Histological data demonstrated that the epithelium covering the ovary which is the mesothelium can invaginate in the ovarian cortex. Some of the invaginations were seen to be continuous with endometrial tissue, strongly suggesting the metaplasia theory in the pathogenesis of ovarian endometrioma.

Combined Modality Therapy↗
PubMed1996

Luteal support after in-vitro fertilization: Crinone 8%, a sustained release vaginal progesterone gel, versus Utrogestan, an oral micronized progesterone.

Two progesterone presentations, a vaginal application of 90 mg progesterone per day (Crinone) or 300 mg progesterone administered orally (Utrogestan), were compared for luteal phase support of patients undergoing an in-vitro fertilization (IVF) procedure. A total of 283 patients were randomly allocated to either treatment. The treatment started within 24 h after the embryo transfer procedure and continued until day 30 in cases of implantation. Efficacy was assessed using the pregnancy and delivery rates. Safety was assessed through specific symptoms and usual safety monitoring. The pregnancy rates per transfer were not significantly different in the Crinone and Utrogestan groups at days 12 (Crinone 35.3%, Utrogestan 29.9%, P = 0.55), 30 (Crinone 28.5%, Utrogestan 25.0%, P = 0.61) and 90 (Crinone 25.9%, Utrogestan 22.9%, P = 0.69). No differences in the spontaneous abortion rates were seen thereafter. The delivery rates (number of deliveries per patient; Crinone 23.0%, Utrogestan 22.2%, P = 1.00), as well as the ratio of newborn babies per embryo transferred (Crinone 11.7%, Utrogestan 11.1%, P = 0.91), were not significantly different. Safety parameters were similar in both groups, except for drowsiness, which was more significantly frequent in the oral progesterone group than in the Crinone group at all time points. No serious adverse events were recorded in this study. The fact that Crinone matches the efficacy of the larger doses of progesterone used orally reflects an advantage of the transvaginal route of administration which avoids the metabolic inactivation of progesterone during its first liver pass.

Administration, Oral↗
PubMed1995

A magnetic resonance imaging approach for the diagnosis of a triplet cornual pregnancy.

OBJECTIVES: To describe a rare case of triplet cornual pregnancy after IVF-ET and to assess the role of magnetic resonance imaging (MRI) for early diagnosis. DESIGN: Case report. SETTING: Infertility and IVF Unit, in an university medical center. PATIENT: A 31-year-old healthy patient with a 3-year history of primary male infertility. INTERVENTION: Standard IVF-ET treatment cycle, using a GnRH-agonist (long protocol) and hMG for ovarian stimulation. RESULTS: A cornual triplet pregnancy is described with the approach for the diagnosis. Magnetic resonance imaging was complementary to endovaginal sonography for early diagnosis and permitted a timed conservative management. CONCLUSIONS: When transvaginal ultrasound findings did not provide an accurate location of the pregnancy, MRI was indicated to confirm the diagnosis.

Adult↗
PubMed1995

Uterine vascularity during stimulation and its correlation with implantation in in-vitro fertilization.

The changes in uterine artery blood flow in women undergoing in-vitro fertilization cycles were studied throughout stimulation after gonadotrophin-releasing hormone (GnRH) desensitization. The data obtained showed that the uterine vascularity was related to hormonal changes. The GnRH agonist effect was seen only after the third week of administration, and the uterine perfusion was significantly (P = 0.002) improved by the oestradiol secretion. Human chorionic gonadotrophins increased the resistance index (RI) significantly (P = 0.0001) for a period of 48 h. Then the progesterone secretion modified the curve with a significant improvement in the uterine blood flow (P = 0.03). Comparison of the RI value 2 days before human menopausal gonadotrophin (HMG) commencement, in patients with and without pregnancy, showed a higher RI in patients who did not conceive but no difference was observed on the day of embryo transfer. The pregnancy rates were similar whatever the range of the RI observed. The data available so far suggest that haemodynamic parameters alone, detected by Doppler sonography, do not provide full information on endometrial receptivity on the day of embryo transfer. A resistance index > 0.79 before HMG commencement seems to indicate poor uterine vascularity and may necessitate an increase in the HMG doses to prevent endometrial immaturity.

Adult↗
PubMed1995

Rectovaginal septum, endometriosis or adenomyosis: laparoscopic management in a series of 231 patients.

A series of 231 cases of deep-infiltrating endometriosis of the rectovaginal septum is presented. Laparoscopic procedures with excision of deep fibrotic endometriotic nodules were performed in all cases. In three cases, the bowel lumen was entered. No other peri-operative complications were observed. Three cases of urinary retention were reported. The nodule resection resulted in considerable pain relief. Histologically, the rectovaginal nodule was similar to an adenomyoma. Indeed it was a circumscribed nodular aggregate of smooth muscle and endometrial glands. This form of disease must be considered as a specific disease which originates from the Mullerian rests present in the rectovaginal septum and we suggest that it be called 'rectovaginal adenomyosis'.

Endometriosis↗