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Biomedical subjects

S L Padilla

Publications and source records attributed to S L Padilla.

At least 19 recordsLinked to original sources
PubMed1997

Comparison of synthetic serum substitute and fetal cord serum as media supplements for in vitro fertilization: a prospective, randomized study.

OBJECTIVE: To compare the value of synthetic serum substitute and fetal cord serum (FCS) as protein supplements in the media used for IVF. DESIGN: Prospective, randomized study of 45 patients undergoing IVF. SETTING: Private infertility practice. INTERVENTION(S): The protein supplement for use in IVF medium was randomized prospectively to synthetic serum substitute or FCS. MAIN OUTCOME MEASURE(S): Oocyte fertilization rate, incidence of embryo arrest, number of embryos transferred, ongoing pregnancy rate, and implantation rate were assessed. RESULT(S): There was no significant difference in the fertilization rate, incidence of embryo arrest, number of embryos transferred, ongoing pregnancy rate, and implantation rate. CONCLUSION(S): Synthetic serum substitute is a better alternative to FCS as a protein supplement for IVF because of its availability and cost effectiveness. Synthetic serum substitute can be used in culture medium for sperm washing, insemination, culture, and transfer translating to decreased technician time without a significant difference in fertilization, pregnancy, or implantation rate.

Adult↗
PubMed1996

Use of the flare-up protocol with high dose human follicle stimulating hormone and human menopausal gonadotropins for in vitro fertilization in poor responders.

OBJECTIVE: To analyze the effect of high dose human FSH in combination with hMG with a flare-up leuprolide acetate (LA) protocol in patients undergoing IVF at risk for a poor response. DESIGN: Prospective. SETTING: Free-standing ambulatory IVF center. PATIENTS: Two hundred eighty-four patients underwent a LA screening test for IVF. Patients with a lack of flare response were considered at risk for a poor response and underwent ovarian stimulation with the flare-up LA protocol in combination with high dose human FSH and hMG. RESULTS: The poor responder group was compared with the good responders on the flare-up LA protocol and to patients undergoing ovulation induction with a luteal phase LA protocol. There were 53 poor responder flare-up LA cycles, 177 good responder flare-up LA cycles, and 54 luteal phase LA cycles. The cancellation rate was higher in poor flare-up LA responders (11.3 percent) compared with good flare-up LA responders (1.1 percent) and luteal phase LA cycles (1.8 percent). Peak E2 levels, number of oocytes, and number of embryos were significantly higher in the good flare-up LA responders. Fertilization rate was similar in all groups. Ongoing pregnancy rate per retrieval was 28 percent in good responders, 29 percent in poor responders, and 33 percent in luteal phase LA patients. Only one patient (0.4 percent) was hospitalized for severe ovarian hyperstimulation. CONCLUSION: The flare-up protocol with high-dose human FSH and hMG is a very good alternative for patients who are at high risk for a poor response. Although peak E2 and number of oocytes were significantly lower in this group, the patients who responded had the same fertilization and pregnancy rate as the good responders. Cancellation rate remains high in poor responders.

Adult↗
PubMed1996

Laparoscopically assisted gamete intrafallopian transfer with local anesthesia and intravenous sedation.

OBJECTIVE: To determine the length of procedure, length of recovery, patient tolerance, complications, and pregnancy rate (PR) of laparoscopically assisted GIFT performed during local anesthesia with i.v. sedation. DESIGN: A retrospective study. SETTING: Freestanding private ambulatory surgical center. PATIENTS: Thirty-one consecutive couples with infertility. INTERVENTIONS: Laparoscopically assisted GIFT during local anesthesia with i.v. sedation. MAIN OUTCOME MEASURES: Surgery time, recovery time, patient tolerance, PR, miscarriage rate, and complications. RESULTS: Cannulation of at least one fallopian tube was achieved successfully in all patients. The average surgery time was 64 +/- 12 minutes (mean +/- SD). The average recovery time was 92 +/- 30 minutes. The PR was 39% with an ongoing PR of 32%. There were no intraoperative or postoperative complications. CONCLUSION: Local anesthesia with IV sedation for GIFT using a two-puncture laparoscopic technique was well tolerated by the patients. Our ongoing PR of 32% compares very favorably with other series using general anesthesia.

Adult↗
PubMed1996

The effect of positive semen bacterial and Ureaplasma cultures on in-vitro fertilization success.

A total of 342 couples planning to undergo in-vitro fertilization (IVF) were examined for the presence of bacteria in semen prior to and during the procedure. Pregnancy rates were analysed retrospectively to ascertain any adverse affects if > 10000 colony forming units (CFU)/ml bacteria were detected in the semen sample. The most common bacteria isolated from semen were Enterococcus spp. (73%). The presence of these bacteria did not affect the pregnancy rate of the patients with positive cultures prior to (32%) or during (37%) the IVF procedure compared with those patients in whom no bacteria were detected (32%). Those patients with semen cultures positive for Escherichia coli prior to the IVF procedure, but which cleared after treatment had a higher pregnancy rate (60%) compared with those patients who were positive for E.coli at the time of the attempt. The group of patients with Staphylococcus aureus in the semen at the time of IVF also demonstrated a low pregnancy rate (17%). Of the patients. 36 (11%) had positive Ureaplasma cultures from the screening test carried out on the semen and 22% became pregnant after successful treatment. None of the three patients with persistently positive cultures became pregnant. In conclusion, the presence of Enterococcus in semen does not affect pregnancy rates following IVF. E.coli, S.aureus and Ureaplasma urealyticum may have a negative effect and should be treated.

Abortion, Spontaneous↗
PubMed1995

Prognostic indicators for in vitro fertilization success.

To examine possible prognostic indicators for success and multiple pregnancy in a free-standing in vitro fertilization program, a chart review study based on 160 oocyte retrievals was undertaken. Evaluated factors included the woman's age, diagnosis, baseline follicle-stimulating hormone levels, peak estradiol levels, estradiol patterns, cycle day of oocyte retrieval, oocyte quality, and number of embryos transferred. Factors associated with a higher pregnancy rate and a higher multiple pregnancy rate may include age less than or equal to 35; diagnosis of unexplained infertility; pattern A early estradiol response; oocyte retrieval on cycle day 16; 2 or fewer fractured oocytes at retrieval; and transfer of 4 or more embryos.

Adult↗
PubMed1993

Ovarian abscess following puncture of an endometrioma during ultrasound-guided oocyte retrieval.

A 34-year-old white female patient with 11 years of primary infertility due to endometriosis underwent ultrasound-guided oocyte retrieval for in-vitro fertilization. A right ovarian endometrioma was aspirated during oocyte retrieval. Two weeks after follicular aspiration, the patient developed acute abdominal pain and operative laparoscopy revealed a ruptured right ovarian abscess. She responded to laparoscopic drainage and intravenous antibiotics. The patient conceived during that cycle and has a single ongoing pregnancy.

Abscess↗
PubMed1991

The Lupron screening test: tailoring the use of leuprolide acetate in ovarian stimulation for in vitro fertilization.

STUDY OBJECTIVE: To evaluate the prognostic and therapeutic value of a Lupron (leuprolide acetate; Tap Pharmaceuticals, North Chicago, IL) screening test before ovarian stimulation for in vitro fertilization (IVF). DESIGN: Prospective. SETTING: Outpatient IVF program. PATIENTS: Eighty patients exhibited four early estradiol (E2) patterns. Patients with pattern A and B remained on a flare-up ovarian stimulation protocol. Patients with pattern C were randomized to three ovarian stimulation protocols. Patients with pattern D were treated with the flare-up protocol using a high pure follicle-stimulating hormone (FSH) dose. RESULTS: Patterns, A, B, C, and D occurred in 44%, 16%, 25%, and 15% of the patients, respectively. The E2 pattern recurred in 77% of subsequent IVF cycles. Pattern A and B patients achieved a 41% (23/56) and 22% (5/23) ongoing pregnancy rate (PR) per stimulated cycle. An early luteal phase Lupron protocol had the best ongoing PR per stimulated cycle (10/27, 37%) in patients with a pattern C response. Pattern D patients had a 20% (5/25) ongoing PR per stimulated cycle. CONCLUSION: The Lupron screening test allows prospective selection of stimulation protocols in ovulatory patients undergoing IVF. Early E2 patterns A and B should be treated with the flare-up protocol. Pattern C patients benefit from the luteal phase Lupron protocol and pattern D patients benefit from a high pure FSH flare-up protocol.

Adult↗
PubMed1990

Prognostic value of the early serum estradiol response to leuprolide acetate in in vitro fertilization.

One hundred in vitro fertilization (IVF)-stimulated cycles were analyzed to evaluate the prognostic value of the early follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) response to the agonist action of leuprolide acetate. Four distinct early E2 response patterns were found. Pattern A (n = 41) showed a prompt elevation of E2, followed by a fall by cycle day 4. Pattern B (n = 16) showed a delayed elevation of E2, followed by a fall by cycle day 6. Pattern C (n = 19) showed a persistent elevation of E2. Pattern D (n = 18) lacked the early E2 response. The clinical pregnancy rates per cycle for patterns A, B, C, and D were 46%, 38%, 16%, and 6%, respectively. A baseline serum FSH level greater than 20 mIU/mL was associated with a lower clinical pregnancy rate, although not statistically significant. Baseline serum LH levels and stimulated FSH and LH levels did not predict IVF outcome. We conclude that the early E2 response pattern to leuprolide acetate is the best early prognostic indicator of IVF outcome.

Biomarkers↗
PubMed1990

Follicular phase gonadotropin-releasing hormone agonist and human gonadotropins: a better alternative for ovulation induction in in vitro fertilization.

Leuprolide acetate was used in 189 in vitro fertilization (IVF) cycles. Patients were allocated prospectively into two groups: In group A (96 cycles), leuprolide acetate was started on the 2nd menstrual cycle day of the actual IVF attempt. In group B (93 cycles), leuprolide acetate was started on the 3rd luteal phase day of the preceding IVF cycle. Ovulation was induced with a combination of pure follicle-stimulating hormone (FSH) and human menopausal gonadotropins (hMG), starting on or before the 5th cycle day, respectively. Leuprolide acetate and gonadotropins were continued until the day of human chorionic gonadotropin (hCG) administration. Follicular aspiration was carried out either by laparoscopy or by transvaginal ultrasound guidance. Group A required a lower number of FSH and hMG ampules than group B; nevertheless, there was no difference in the number of follicles, percentage of preovulatory oocytes or fertilization rate between the groups. The number of embryos transferred was 3.3 and 3.4, respectively. A significantly higher pregnancy rate was observed in group A (40.6% versus 27.7%) and a lower miscarriage rate (22.8% versus 36%) than in group B. In short, this study suggests that there is no need to administer leuprolide acetate routinely during the luteal phase of the preceding IVF cycle.

Abortion, Spontaneous↗
PubMed1989

Effect of maternal age and number of in vitro fertilization procedures on pregnancy outcome.

Five hundred twelve patients underwent 1,101 oocyte retrievals for in vitro fertilization (IVF) from July 1, 1985 to June 30, 1988. Eighty-four percent of all oocyte retrievals went on to transfer. The mean number of oocyte retrievals was 2.2 per patient, and the mean number of embryo transfers (ET) was 1.8 per patient. The pregnancy rate was 23% per retrieval, 27% per ET, and 49% per patient. There were 77 (31%) spontaneous abortions and five (2%) ectopic pregnancies. Linear regression analysis of the effect of women's age on the ongoing pregnancy rate per ET showed a highly significant negative linear correlation between age and ongoing pregnancy rate (P less than 0.005). Ongoing pregnancy rate per ET for patients younger than 30 years of age was 26%, as compared with 9% for patients aged 37 years (P less than 0.01). Patients aged 40 years or greater had a 50% miscarriage rate, compared with 29% in patients under the age of 40 (P greater than 0.05). The clinical pregnancy rate per ET for patients undergoing one to seven attempts was 25%, 29%, 28%, 33%, 35%, 30%, and two out of five, respectively. We conclude that women's age has a negative effect on IVF success that is more pronounced after the age of 36, and the pregnancy rate per ET is similar for at least seven attempts.

Abortion, Spontaneous↗
PubMed1988

Effects of charcoal-extracted serum as a growth medium supplement on in vitro development of mouse embryos.

Two-cell mouse embryos (N = 952) were cultured in modified Ham's F-10 medium supplemented with 15% charcoal-extracted serum or 15% nonextracted serum from 17 patients. Each sample was assayed independently and all experiments run in duplicate. Ten nonextracted samples inhibited development to the blastocyst stage compared to controls in F-10 alone. Charcoal extraction significantly improved (P less than 0.05) development compared to nonextracted serum in eight of these samples. Seven samples supported development and no difference was noted between F-10 alone and extracted and nonextracted serum-supplemented media in this group. In conclusion, charcoal extraction significantly reversed the "embryotoxic" effects of some sera in the two-cell mouse embryo model.

Animals↗
PubMed1987

Transurethral ultrasound-guided oocyte retrieval for in vitro fertilization.

Thirty-nine follicular aspirations for in vitro fertilization were performed in 30 patients. Oocyte retrieval was performed by laparoscopy in 21 cases and ultrasound-guided transurethral aspiration in 18 cases. All procedures were performed by the same ovarian stimulation protocol and the same aspirating needle. In the laparoscopy group 150 oocytes were recovered from 177 follicles aspirated (85%). The fertilization rate was 69% (104/150) and cleavage rate, excluding triploidy, was 82% (85/104) for oocytes obtained by laparoscopy. Five clinical pregnancies occurred in the laparoscopy group for a pregnancy rate of 24% per cycle and 25% per transfer. In the transurethral ultrasound-guided group 77 oocytes were recovered from 103 follicles aspirated (75%). The fertilization rate was 79% (61/77) and cleavage rate, excluding triploidy, was 90% (55/61). Three pregnancies occurred for a pregnancy rate of 17% per cycle and 18% per transfer. None of these differences were statistically significant. Transurethral ultrasound-guided oocyte retrieval is a feasible alternative to laparoscopy for in vitro fertilization.

Female↗
PubMed1987

The value of oocyte reinsemination in human in vitro fertilization.

The value of oocyte reinsemination in human in vitro fertilization (IVF) was evaluated in this study. Two groups of 25 cycles each were studied. In group 1 cycles, insemination of mature/questionably mature oocytes (judged by cumulus and corona cell appearance) at 6.5 hours postcollection yielded a fertilization rate of 42.3%. This value was significantly lower than that obtained with reinsemination (70.8%). In group 2, questionably mature oocytes were treated as immature and inseminated 24 to 30 hours postcollection. The fertilization rate of mature eggs in group 2 was 68.2%, with a reinsemination success rate of 40%. Triploidy rates and cleavage rates of mature eggs, fertilized either at initial insemination or reinsemination and of fertilized immature eggs, were similar within group 1 and group 2 cycles. In group 1, two pregnancies resulted from transfer of embryos arising solely from successful reinsemination, with one infant delivered. These results indicate that reinsemination offers a useful adjunct for IVF in cases where fertilization failure occurs.

Embryo Transfer↗
PubMed1987

In vitro fertilization and birth after ultrasonically guided transurethral aspiration of oocytes.

We have described an in vitro fertilization and embryo transfer accomplished by ultrasonically guided transurethral transvesical oocyte aspiration. Follicular aspiration using ultrasonography is a suitable alternative to traditional laparoscopic methods, and may have several advantages, including avoidance of surgical and general anesthesia complications. Further experience with this technique will clarify the benefits and/or risks, and this work is continuing.

Biopsy, Needle↗