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Biomedical subjects

T Falcone

Publications and source records attributed to T Falcone.

At least 55 records · Page 3Linked to original sources
PubMed1997

Importance of reactive oxygen species in the peritoneal fluid of women with endometriosis or idiopathic infertility.

OBJECTIVE: To determine whether reactive oxygen species in peritoneal fluid might be a factor in infertility. DESIGN: Prospective study. SETTING: Andrology laboratory and gynecology clinic at a tertiary care facility. PATIENT(S): Women with endometriosis (n = 15) or idiopathic infertility (n = 11) who underwent laparoscopy for infertility. Patients undergoing tubal ligation served as controls (n = 13). INTERVENTION(S): Aspiration of peritoneal fluid. MAIN OUTCOME MEASURE(S): Reactive oxygen species levels, presence of polymorphonuclear granulocytes, and leukocyte distribution in peritoneal fluid. RESULT(S): Reactive oxygen species were present in the peritoneal fluid of patients with endometriosis, idiopathic infertility, and tubal ligation. Levels of reactive oxygen species did not show a statistically significant difference between patients with endometriosis and the control group in either unprocessed or processed (cell-free) peritoneal fluid, but did differ significantly between patients with idiopathic infertility and controls in processed peritoneal fluid. Polymorphonuclear granulocytes (> 1 x 10(6)/mL) were not present in the peritoneal fluid of any patient. Macrophage concentrations of peritoneal fluid did not differ significantly between controls and patients with endometriosis or idiopathic infertility. CONCLUSION(S): Reactive oxygen species in the peritoneal fluid may not affect fertility directly in women with endometriosis; however, they may have a role in patients with idiopathic infertility.

Adult↗
PubMed1997

A study of ruptured tubal ectopic pregnancy.

OBJECTIVE: Ectopic pregnancy continues to be a leading cause of maternal morbidity and of reduced childbearing potential among women of reproductive age. Because of tubal rupture it is still the main cause of pregnancy-related death during the first trimester. The purpose of our study was to evaluate factors that may predispose a woman to rupture of a tubal ectopic pregnancy. METHODS: In this retrospective study of 693 ectopic pregnancies from three McGill University teaching hospitals, we compared risk factors, preoperative ultrasound, and serum hCG levels between cases with ruptured and unruptured tubal ectopic pregnancy. RESULTS: The age and the number of pregnancies among the two groups of women were similar. The gestational age of women with an unruptured tube was 6.9 +/- 1.9 weeks, and of those with a ruptured tube, the gestational age was 7.2 +/- 2.2 weeks. Tubal rupture was encountered more often in women with at least one child than in childless women. History of ectopic pregnancy was found in 35% of women with an unruptured tubal pregnancy and in 26% of those with a ruptured tube. Serum hCG levels at the time of treatment were not significantly different among the two groups of women. Eleven percent of women with a ruptured tube had serum beta-hCG levels of less that 100 IU/L. CONCLUSION: Tubal rupture is encountered more often in women with no history of ectopic pregnancy and in those with at least one child. This suggests that ectopic pregnancy is less suspected in these women. Tubal rupture is encountered less often in ampullary pregnancy and in small ectopic pregnancies. There is no correlation between serum beta-hCG levels and tubal rupture, and rupture can occur even when serum beta-hCG levels are very low.

Adult↗
PubMed1997

Sonohysterographic evaluation of uterine abnormalities noted on hysterosalpingography.

Transvaginal sonohysterography was performed on 40 consecutive patients with infertility or recurrent pregnancy loss and uterine abnormalities on hysterosalpingography. The findings were correlated with the hysterosalpingogram and subsequent diagnostic and/or operative hysteroscopy. Hysterosalpingography was incorrect in nine cases. Sonohysterography was more accurate than hysterosalpingography and provided more information about uterine abnormalities. Sonohysterography was in complete agreement with hysteroscopy. Diagnostic hysteroscopy can therefore be avoided if the sonohysterogram is normal. Sonohysterography also provides additional information on the relative proportion of the intracavitary and intramyometrial components of submucus myomas, as well as extracavitary myomas and the adnexae. This may help in planning the surgical procedure.

Abortion, Habitual↗
PubMed1997

Anatomical variation in the rudimentary horns of a unicornuate uterus: implications for laparoscopic surgery.

A case of laparoscopic excision of a rudimentary horn is presented. The anatomical features of this case are contrasted with others in the published literature. A 23 year old nulligravida presented with severe dysmenorrhoea and a pelvic mass. At laparoscopy a unicornuate uterus with a rudimentary horn was identified. The patient had stage III endometriosis. The rudimentary horn was attached to the unicornuate uterus by a band of tissue. The blood supply was identified within this band of tissue. The rudimentary horn was removed laparoscopically with no complications. There are two anatomical variations in the attachment of the rudimentary horn to the unicornuate uterus. Knowledge of both types is important to avoid complications such as bleeding and possible compromise of myometrial wall thickness.

Adult↗
PubMed1996

Variation in recovery of motile sperm after preparation by a simple Percoll gradient technique.

PURPOSE: Numerous techniques have been used to prepare sperm for assisted reproduction technology. Density-gradient centrifugation with Percoll is becoming a method of choice. This study reviewed the results of a simple two-layer discontinuous Percoll gradient. METHODS: We reviewed retrospectively results obtained from 208 semen specimens prepared for in vitro fertilization by a discontinuous Percoll gradient. RESULTS: Overall results (mean +/- SD) were a recovery of 21 +/- 16% of total sperm, recovery of 38 +/- 30% of motile sperm, and a motility in the final sperm preparation of 88 +/- 10%. Specimens with higher initial concentrations had higher motility in the final preparation. Higher total recovery and higher motility in the final preparation were found for specimens with a higher initial motility. CONCLUSIONS: This simple two-layer Percoll technique is rapid and inexpensive and reliably produces a final sperm preparation with desirable characteristics. Even though specimens with poor initial parameters yielded final preparations with excellent characteristics, fertilization rates were still related to the initial semen parameters.

Cell Survival↗
PubMed1996

Follicle size and implantation of embryos from in vitro fertilization.

OBJECTIVE: To determine the effect of increased follicle size at the time of hCG administration on the outcome of in vitro fertilization (IVF). METHODS: Fifty women immediately before 50 immediately after a protocol change were reviewed retrospectively. The criterion for hCG administration was changed from a leading follicle size of at least 17 mm to one of at least 20 mm (average of two dimensions). Changes in follicle size and number, oocytes recovered, fertilization rate, embryo development, implantation rate, and pregnancy rate were examined. Women over 40 years of age, those undergoing intracytoplasmic sperm injection, and those whose stimulation did not include GnRH agonists were excluded. RESULTS: The number of large follicles increased, but peak estradiol concentrations and number of oocytes recovered did not differ when hCG was administered at a follicular size of at least 20 mm. The numbers of oocytes fertilized, embryos replaced, and embryos cryopreserved were not statistically different. The percentage of cleaved fertilized oocytes was greater and the degree of embryo fragmentation smaller when hCG was administered at an increased follicular size. The implantation rate was higher and clinical and ongoing pregnancy rates tended to be higher when hCG was administered at a larger follicle size. CONCLUSION: The administration of hCG at a larger follicle size appears to have a beneficial effect on the outcome of IVF. Embryo quality-as reflected by decreased fragmentation, increased cleavage, and increased implantation rate-appears to be improved when hCG is delayed until two or more follicles reach at least 20 mm in diameter.

Adult↗
PubMed1996

Comparison of reoperation for moderate (stage III) and severe (stage IV) endometriosis-related infertility with in vitro fertilization-embryo transfer.

OBJECTIVE: To evaluate the efficacy of reoperation for stage III or IV endometriosis-related infertility versus IVF-ET. DESIGN: Retrospective analysis. SETTING: In vitro fertilization-embryo transfer unit and tertiary infertility clinic. PATIENTS: Twenty-three couples with stage III or IV endometriosis-related infertility undergoing IVF-ET and 18 women undergoing reoperation for stage III or IV disease, both groups undergoing treatment after failed initial surgery to restore fertility. RESULTS: The cumulative pregnancy rate (CPR) after reoperation for stage III or IV endometriosis-related infertility after 3, 7, and 9 months was 5.9 percent, 18.1 percent and 24.4 percent, respectively. The cumulative PR after one and two cycles of IVF-ET with stage III or IV endometriosis was 33.3 percent and 69.6 percent, respectively. The cumulative PR after one cycle of IVF-ET was higher than with reoperation 33.3 percent versus 24.4 percent. After two cycles the cumulative PR was significantly higher than reoperation 69.6 percent versus 24.4 percent. The mean number of oocytes retrieved was 8.5 +/- 4.6, the mean number of embryos was 4.8 +/- 2.9, and the fertilization rate was 64 percent +/- 21.8 percent. The PR per cycle, per oocyte retrieval and per ET was 38 percent, 42 percent, and 44 percent, respectively, with the implantation rate being 16 percent. The live birth rate per oocyte retrieval and per ET was 29.7 percent and 34.4 percent, respectively. No statistically significant difference could be demonstrated with regard to the fertilization, implantation, nor pregnancy or live birth rates, as compared with IVF-ET outcome with tubal infertility. CONCLUSION: If initial surgery fails to restore fertility in patients with moderate (stage III) or severe (stage IV) endometriosis-related infertility, IVF-ET is an effective alternative; reoperation for asymptomatic patients offers little added benefit.

Adult↗
PubMed1996

Flow cytometric evaluation of leukocyte subpopulations in the follicular fluids of infertile patients.

OBJECTIVES: To evaluate the leukocyte subpopulations present in follicular fluid (FF) of infertile patients undergoing IVF-ET for tubal factor, idiopathic infertility, and endometriosis. PATIENTS: Sixty patients undergoing IVF-ET with a tubal factor diagnosis (n = 35), idiopathic infertility (n = 13), and endometriosis (n = 12) had their subpopulations of FF leukocytes analyzed by flow cytometry. MAIN OUTCOME MEASURE: Nonblood-contaminated samples of FF were collected under sterile conditions and centrifuged. Cells were labeled with a panel of monoclonal antibodies: anti-CD3, -CD4, -CD8, -CD14, -CD20, -CD45, and -CD56, and analyzed by cytofluorometry. RESULTS: Follicular fluid leukocytes from patients with idiopathic infertility had a significantly higher proportion of T lymphocytes than tubal factor and endometriosis patients. Endometriosis patients had significantly higher proportions of natural killer (NK) cells, B lymphocytes, and monocytes compared with groups of idiopathic infertility and tubal factor. CONCLUSIONS: The differences observed in the leukocyte subpopulations from FF of patients with idiopathic infertility and endometriosis may affect folliculogenesis and oocyte maturation. Moreover, these modifications could be one of the factors altering their fertility.

Adult↗
PubMed1996

Sonohysterography to Evaluate Uterine Defects on Hysterosalpingography and Its Correlation with Hysteroscopy

Sonohysterography (SHG) may replace hysteroscopy as the standard method to evaluate intrauterine filling defects noted on hysterosalpingography (HSG). Twenty-six patients with evidence of intrauterine filling defects on HSG underwent SHG in the office with transvaginal ultrasonography before diagnostic or operative hysteroscopy. Polyps were identified in 11 women by SHG and were confirmed by hysteroscopy and histology. Adhesions seen on SHG in four women were also confirmed by hysteroscopy. Thus SHG not only correctly identified myomas in all six patients, but helped determine which ones could be resected by hysteroscopy and which might benefit from preoperative gonadotropin-releasing hormone analog treatment. Five patients with intrauterine filling defects on HSG were subsequently shown to have normal endometrial cavities at SHG and hysteroscopy. We believe SHG is a useful technique for evaluating patients with abnormal HSGs, reducing the requirement for more expensive and invasive diagnostic hysteroscopy. In addition, it provides more thorough assessment before operative hysteroscopy.

Journal Article↗
PubMed1996

Preferences for intracytoplasmic sperm injection versus donor insemination in severe male factor infertility: a preliminary report.

With the advent of intracytoplasmic sperm injection (ICSI), our programme noted a drop in the number of couples using donor insemination (DI) for severe male factor infertility. Over the first 8 months in which our infertility programme offered both treatments, 27 consecutive couples scheduled for ICSI and 15 consecutive couples scheduled for DI were evaluated Since all patients in our infertility programme beginning in-vitro fertilization (IVF) with planned ICSI or starting DI undergo a semi-structured psychological interview, the psychologist's clinical notes as well as the medical chart were reviewed and coded retrospectively to determine factors related to a couple's treatment choice. Couples who chose IVF-ICSI over DI had a higher occupational status and included husbands with higher educational levels. Their most common motivation was to have the husband's biological child (93% of couples in the ICSI group). The most common motivation for choosing DI (60% of DI couples) was that IVF was not financially affordable. Choice of treatment was not related to psychological adjustment, the husband having prior biological children, or his risk of passing on a genetic defect to offspring. These preliminary data raise the concern that, with the success of ICSI, DI may change in the USA from being an option dictated by semen quality to a second choice treatment utilized for economic reasons.

Adult↗
PubMed1996

Double cervix and vagina with a normal uterus: an unusual Mullerian anomaly.

A 34 year old woman presented with primary infertility and duplication of the cervix and vagina. Laparoscopy demonstrated a normal uterus and hysterosalpingography revealed a normal uterine cavity communicating with both cervices. This rare Mullerian anomaly is inconsistent with our current understanding of Mullerian development. An alternative embryological mechanism is reviewed to account for this and other anomalies which do not fit into existing classification systems.

Adult↗
PubMed1996

The relationship between insulin sensitivity and insulin-like growth factor-binding protein-1.

Insulin has been shown to regulate insulin-like growth factor-binding protein-1 (IGFBP-1) in vivo and in vitro. Insulin resistance is a feature of the polycystic ovary syndrome (PCOS). We have studied the relationship between insulin sensitivity (S1) and the circulating concentration of IGFBP-1 in a group of young women and in some who had PCOS. A case-control study has been carried out comparing reproductively normal women with women with PCOS (defined as women with oligo- or amenorrhea associated with androgen excess). Fifteen women with clinical PCOS and ten age- and weight-matched controls were studied. S1 was measured by the frequently sampled intravenous glucose tolerance test (FSIGT) using the minimal model technique. IGFBP-1, insulin-like growth factor-I (IGF-I) and growth hormone levels were measured before and during the FSIGT. Circulating testosterone, dehydroepiandrosterone (DHEA) and its sulfate (DHEAS) levels were measured while the subjects were fasting. S1 and IGFBP-1 levels were significantly lower in the PCOS group than in controls (S1/10(-5) min-1/pM] mean +/- SE 3.8 +/- 0.8 vs. 8.5 +/- 1.3, p < 0.03; IGFBP-1 [ng/ml] mean +/- SE 26.6 +/- 4.2 vs. 56.0 +/- 5.9, p < 0.005). In women with PCOS, IGFBP-1 concentrations related negatively to the body mass index (BMI) (r = -0.77, p < 0.003) and positively to S1 (r = 0.76, p < 0.003). S1 remained a significant predictor of IGFBP-1 concentrations when controlled for BMI (combined r2 = 0.35, p < 0.05). No relationship was found between androgen levels and IGFBP-1. Insulin sensitivity contributed to the difference in IGFBP-1 levels found in women with PCOS. Whether the reduced concentrations of IGFBP-1 play a role in the pathophysiology of PCOS is uncertain, but it may act to alter delivery of IGF to peripheral tissues in insulin-resistant individuals.

Androstenedione↗
PubMed1996

Endometriosis: medical and surgical intervention.

Pregnancy rates with endometriosis-associated infertility may be improved by laparoscopic surgery or laparotomy for moderate to severe disease. Surgery for minimal to mild disease does not increase pregnancy rates. Medical treatment has not been shown to increase fecundity for any stage of the disease. Pregnancy rates with assisted reproductive technology for endometriosis appear to be comparable with those for tubal disease that are also treated with assisted reproductive technology. Medical and surgical treatments for pelvic pain with endometriosis are both effective, but surgery avoids the side-effects associated with drugs and may result in a lower recurrence rate.

Combined Modality Therapy↗
PubMed1995

Excision of ovarian dermoid cyst by laparoscopy and by laparotomy.

OBJECTIVES: Our purpose was to evaluate the efficacy of laparoscopic ovarian dermoid cystectomy and to compare the operative course, postoperative course, and complications between the laparoscopy and the laparotomy techniques. STUDY DESIGN: The safety and efficacy of laparoscopic ovarian dermoid cystectomy were evaluated in 40 women. Twenty-nine of 40 patients underwent laparoscopic excision of a solitary dermoid cyst without any additional procedure. The operative course, the postoperative course, and complications among these 29 women were compared with those of 26 other women who underwent a similar procedure by laparotomy. RESULTS: Spillage of the cyst's content did not lead to any complication. The operating time in the laparoscopy group was 73.5 +/- 4.7 minutes and in the laparotomy group it was 41.4 +/- 2.9 minutes. The duration of hospitalization was significantly shorter in the laparoscopy group (0.7 +/- 0.2 days) than in the laparotomy group (3.8 +/- 0.1 days). CONCLUSIONS: Although ovarian dermoid cystectomy by laparoscopy is associated with a longer operating time than by laparotomy, the duration of hospitalization is shorter and recovery is faster. Spillage of the contents of the dermoid cyst does not lead to any complication; perhaps this is due to the liberal irrigation of the peritoneal cavity.

Adult↗
PubMed1995

The effect of cervical loop electrosurgical excision on subsequent pregnancy outcome: North American experience.

OBJECTIVE: Our purpose was to determine pregnancy outcome and parturition in women who were treated by loop electrosurgical excision for squamous intraepithelial lesions. STUDY DESIGN: A series of 574 consecutive women of reproductive age (15 to 44 years old) were treated by loop electroexcision for low- and high-grade squamous intraepithelial lesions. The incidence of pregnancies was determined in these women within a 3-year period after therapy by comparing the "observed" number of pregnancies with the "expected" number of pregnancies in the study population, assuming that fertility rates in these women were the same as in the untreated general female population. Pregnancy outcome was correlated in the 53 women who were delivered of an infant with the posttreatment appearance of the cervix and birth weight with maternal smoking. RESULTS: The incidence of pregnancy in the study population was 8.5 per 100 woman years compared with 7.4 per 100 woman years in the untreated central population. Fifty-three women had 54 pregnancies, of which 46 (84%) were live births either at term (40) or between 37 and 39 weeks of gestation (6), and three patients are at present at 24, 34, and 36 weeks of gestation. There were two stillbirths and three first-trimester spontaneous abortions. Premature delivery was not observed. External os stenosis (one case), shortening of the cervix (one case), and repeat electroexcision (four cases) had no adverse effect on pregnancy and parturition. Smoking > or = 10 cigarettes per day before and during pregnancy, rather than loop electrosurgical excision per se, was associated with lower-birth-weight babies than those of nonsmokers (p < 0.01). CONCLUSION: Loop electrosurgical excision to a maximum depth of 1.5 cm and a mean frontal diameter of 1.8 cm does not appear to have adverse effects on subsequent pregnancy outcome and parturition.

Adolescent↗
PubMed1995

Identification of immunoreactive inhibin in human and baboon fetal serum at term as free alpha-subunit(s).

Immunoreactive inhibin (i-inhibin) in the serum of the baboon fetus is high at midgestation and decreases toward term. Human cord serum also contains immunoreactive inhibin, but bioactive inhibin is nondetectable or very low. In the present study we report that baboon fetal serum is also inactive in the sheep anterior pituitary FSH bioassay. Furthermore, both fetal baboon serum and term human cord serum are inactive in two enzyme-linked immunosorbent assays (ELISAs) that use a monoclonal antibody (R-I) against the alpha-subunit of human inhibin as the capturing agent and a monoclonal antibody (E-4) against the beta A-subunit as a detection/quantification agent (ELISA-A), or the E-4 antibody as the capturing agent and a R-1 F(ab) fragment as the detection/quantification agent (ELISA-B). Recombinant human inhibin A was reactive in both ELISAs. Human cord serum inhibited recombinant human inhibin activity in the ELISA-A, but not in the ELISA-B. An immunoaffinity column to which the R-1 antibody had been coupled extracted i-inhibin activity from both baboon fetal heart serum and human cord serum. Together, these results suggest that the i-inhibin in fetal serum is the free alpha-subunit, with little, if any, dimeric inhibin present. Western blot analysis confirmed that the i-inhibin activity extracted by the R-1 immunoaffinity column from baboon fetal serum can be attributed to a free alpha-subunit(s).

Animals↗
PubMed1994

The effect of antisperm autoantibodies in male or female partners undergoing in vitro fertilization-embryo transfer.

OBJECTIVE: To evaluate the effects of sperm bound autoantibodies on the outcome of IVF-ET. DESIGN: Couples with positive antisperm autoantibodies as determined by the immunobead test were retrospectively classified into two groups: group A, consisting of 15 couples with positive antisperm antibodies in the female sera; and group B, consisting of 16 couples with sperm antibodies bound to motile spermatozoa from the male partner. Both groups were subclassified according to pregnancy outcome, i.e., pregnant and nonpregnant cycles. PATIENTS: Thirty-one couples with positive antisperm autoantibodies were compared with 312 couples with tubal infertility undergoing IVF-ET. RESULTS: No significant correlation could be shown between the mean percent binding of any specific immunoglobulin (Ig) class (G, A, and M) nor localization of sperm binding with regard to fertilization and embryonic development among pregnant and nonpregnant cycles within groups A and B. The mean fertilization rate was 59% in the control group, compared with 62% in group A and 52% in group B. Overall, the pregnancy rate (PR) in IVF-ET cycles with positive sperm autoantibodies did not demonstrate a decreasing trend compared with controls. The PR per cycle, per oocyte retrieval, and per ET was higher in group A (47%, 50%, and 53%, respectively) compared with group B (32%, 33%, and 37%) and to controls (27%, 31%, and 34%). The implantation rate was lowest in the control group (10%) compared with the study groups (group A, 20% and group B, 14%). CONCLUSION: In vitro fertilization-embryo transfer is not significantly affected by the presence of sperm autoantibodies in female sera used to supplement the culture media or antibodies bound to inseminated sperm.

Adult↗