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Biomedical subjects

V Vlaisavljević

Publications and source records attributed to V Vlaisavljević.

At least 19 recordsLinked to original sources
PubMed2003

Measurement of perifollicular blood flow of the dominant preovulatory follicle using three-dimensional power Doppler.

OBJECTIVE: To establish whether we might predict the outcome of unstimulated in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles with quantitative indices of perifollicular blood flow assessed with three-dimensional (3D) reconstruction of power Doppler images. METHODS: This prospective study included an analysis of 52 unstimulated cycles. Color and power Doppler ultrasound examinations of a single dominant preovulatory follicle were performed on the day of oocyte pick-up. With 3D reconstruction and processing, quantitative indices were obtained i.e. the percentage of volume showing a flow signal (VFS) inside a 5-mm capsule of perifollicular tissue and the percentage of VFS of each of the three largest vessels in this capsule. These indices as well as pulsed Doppler indices were compared between the groups of cycles with different outcomes using a one-way ANOVA test. RESULTS: In nine cycles no oocyte was retrieved (Group A), in seven cycles no fertilization occurred (Group B) and in 30 cycles no implantation occurred (Group C). Six cycles resulted in pregnancy (Group D). There were no statistically significant differences in pulsed and power Doppler indices between these groups. However, the percentage of VFS in the capsule was higher than average in cycles with implantation (19.22 +/- 16.82 vs. 12.42 +/- 8.89, NS) and the percentage of VFS in the main vessel exhibited lower than average values in cycles with implantation (20.66 +/- 10.05 vs. 39.84 +/- 20.15), but only reached borderline statistical significance (F = 2.457, P = 0.074). CONCLUSION: It can be hypothesized that the follicles containing oocytes able to produce a pregnancy have a distinctive and more uniform perifollicular vascular network.

Adult↗
PubMed2001

Is there any benefit from the culture of a single oocyte to a blastocyst-stage embryo in unstimulated cycles?

BACKGROUND: The aim of the study was to test the influence of 2- and 5-day cultivation of a single oocyte on the pregnancy rate in a non-stimulated cycle. METHODS: A retrospective chart review of 391 consecutive patients undergoing IVF and intracytoplasmic sperm injection in unstimulated cycles was performed. The embryos were kept in MediCult universal IVF medium for day 2 transfers and in BlastAssist System for day 5 transfers. RESULTS: The oocyte recovery rate in the group for 2-day cultivation and in the group for 5-day cultivation was similar, being 79.4 (162/204) and 83.6% (154/187) respectively. The same is true of the fertilization rate (73.8 versus 77.7%). The blastulation rate was 52.8%. The embryo transfer rate per cycle was higher when day 2 embryos were transferred: 64.8% (105/162) compared with 35.7% (55/154) if blastocyst-stage embryos were transferred. The pregnancy rate per transferred embryo was higher when a blastocyst was transferred (40.0%) instead of a day 2 embryo (23.8%). CONCLUSION: The expected pregnancy rate calculated per embryo available on day 2 of cultivation was similar in both groups (23.8 versus 22.2%) and it was not affected by oocyte culture to the blastocyst stage.

Blastocyst↗
PubMed2001

Three protocols for monitoring follicle development in 587 unstimulated cycles of in vitro fertilization and intracytoplasmic sperm injection. A comparison.

OBJECTIVE: To test the adequacy of unstimulated cycles for intracytoplasmic sperm injection (ICSI) and in vitro fertilization (IVF) and to evaluate implantation and pregnancy rates in three monitoring protocols. STUDY DESIGN: A retrospective chart review of 587 patients undergoing IVF and ICSI in unstimulated cycles was performed. In the first group (protocol A), all cycles were monitored by ultrasound only. Human chorionic gonadotropin (hCG) was given when the mean follicle diameter reached 18 mm. In protocol B, hCG was given when serum estradiol (E2) or follicle diameter reached the critical value (0.91 nmol/L and 18 mm). With a smaller follicle diameter, the E2 level had to be higher, and vice versa. In protocol C, hCG was administered when the serum E2 was > 0.49 nmol/L and follicle diameter at least 15 mm. Cycles with positive luteinizing hormone in urine before hCG was given were cancelled. RESULTS: The cancellation rate was lower in protocol C (33/335, 9.8%) than protocol B (42/151, 27.8%) and A (41/101, 40.5%). In protocol C the pregnancy rate per cycle was higher with IVF (n = 219) and ICSI (n = 116) cycles (10.5% and 12.1%) than when protocol B was used (3.8% and 4.3%). The pregnancy rate per transfer was highest when protocol C was used in the IVF (23/105, 21.9%) and ICSI group (14/53, 26.4%). CONCLUSION: Unstimulated cycles monitored by serum E2, urinary luteinizing hormone and ultrasound can produce an acceptable pregnancy rate after IVF and ICSI.

Adult↗
PubMed2001

Dependence of the in-vitro fertilization capacity of the oocyte on perifollicular flow in the preovulatory period of unstimulated cycles.

BACKGROUND: One method to economize on monitoring cycles for IVF and improving its outcome is follicular selection. The purpose of our study was to determine whether quantitative indices of perifollicular blood flow allow the prediction which follicles contain a fertilizable oocyte and which do not. METHODS: This prospective study included 178 unstimulated cycles for IVF in patients treated for tubal infertility, endometriosis and unknown causes of infertility that ended with follicular aspiration. All male partners had a normal spermiogram. Cycles were monitored using ultrasound folliculometry and estimation of serum estradiol concentrations. On the day of hCG administration (day 0), day +1 and prior to follicular aspiration (day +2), perifollicular blood flow was measured using color and pulsed Doppler. The pulsatility index (PI), resistance index (RI) and peak systolic velocity (PSV) between the group in which fertilization occurred (group A) and that in which no fertilization occurred (group B) were compared. Student's t-test and ANOVA were used for statistical analysis. RESULTS: The oocyte recovery rate was 71.5% and the fertilization rate 74.8%. Comparison of RI and PI between group A (N = 95) and group B (N = 32) revealed a decline in PI and RI after hCG administration in both groups. Only on day 0 was PI in group A significantly lower than that in group B. The difference in RI and PSV between the two groups was not statistically significant. ANOVA showed that there was no significant difference in serial Doppler measurements between the two groups. CONCLUSION: We confirmed an increased perifollicular blood flow in the preovulatory period. Quantitative indices of perifollicular blood flow are of limited value as parameters for cycle monitoring and decision-making in unstimulated cycles for IVF.

Adult↗
PubMed2000

Simplification of the clinical phase of IVF and ICSI treatment in programmed cycles.

OBJECTIVE: To evaluate the success of a protocol for controlled ovarian hyperstimulation allowing patient self-selection into groups for ovulation stimulation planned 8 weeks and more in advance following cycle synchronization, drug self-administration as well as a reduced number of folliculometries. METHODS: A total of 714 patients received the same stimulation protocol. In 260 cases GnRH-a was applied daily and in 454 as depot. In all patients FSH-HP was self-administered subcutaneously for ovarian stimulation. In 316 patients IVF and in 398 patients ICSI was performed. RESULTS: The delivery rate per started cycle was higher in patients receiving depot GnRH-a in the IVF and ICSI group (30.2 vs. 23.4) than in those receiving subcutaneous GnRH-a (20.2 vs. 22.1). CONCLUSION: Programming of the IVF/ICSI cycle greatly simplifies treatment. A comparison of pregnancy rate and delivery rate per cycle between depot and subcutaneous daily application of GnRh-a did not confirm any statistically significant difference.

Adult↗
PubMed1999

The preovulatory serum estradiol pattern in natural IVF/ICSI cycles.

PURPOSE: The aim of the study was to find whether inferences to the possible success of natural IVF/ICSI cycles could be drawn from the estradiol (E2) pattern. METHODS: Sixty-eight women who underwent oocyte recovery in 98 natural cycles were recruited for the study. Daily serum E2 was measured in the preovulatory phase (-3 to +2 day). The E2 pattern was compared among four groups: Group A, unsuccessful egg retrieval; Group B, no fertilization; Group C, no implantation; and Group D, implantation. RESULTS: There was no difference in mean E2 levels between groups. Only the ratio of E2 on day +1/E2 on day 0 was significantly lower in conception cycles in comparison with nonconception cycles. In cycles with a decreased E2 level on day +1, only the implantation rate was significantly higher in comparison with cycles with an increasing E2 level. CONCLUSIONS: From the E2 pattern it is possible to make inferences about the likelihood of implantation but not the fertilization or oocyte recovery success.

Adult↗
PubMed1999

Number of oocytes retrieved and resulting pregnancy. Risk factors for ovarian hyperstimulation syndrome.

OBJECTIVE: To test whether the risk of developing clinically significant ovarian hyperstimulation syndrome (OHSS) is related to the number of oocytes retrieved by puncture and the resulting pregnancy and to determine the most suitable cutoff limit of the number of oocytes in predicting OHSS. STUDY DESIGN: The study included 973 patients who underwent ovarian stimulation for in vitro fertilization or intracytoplasmic sperm injection. Using the classification of Schenker and Weinstein, we identified patients who developed moderate and severe OHSS. By multiple logistic regression we established the risk of moderate or severe OHSS development in relation to the number of oocytes retrieved and the resulting pregnancy. A receiver operator characteristic curve was constructed to describe the relation between sensitivity and the false positive rate for the number of oocytes retrieved in the prediction of OHSS. RESULTS: We identified 35 (3.6%) patients who developed OHSS, 8 (0.8%) severe and 27 (2.8%) moderate. The risk of developing OHSS increased with the number of oocytes retrieved (odds ratio = 1.14) and with pregnancy (odds ratio = 1.14). The most suitable limit for predicting OHSS was 10 oocytes, with 81.9% specificity and 48.6% sensitivity. The risk of OHSS development in cycles with < or = 10 oocytes and no conception was 1.31% and, with conception, 5.12%. The risk of OHSS development in cycles with > 10 oocytes and no conception was 4.43% and with conception, 15.93%. CONCLUSION: The risk of OHSS development increases with the number of oocytes retrieved and with pregnancy. The most suitable limit for predicting OHSS is 10 oocytes; however, due to low sensitivity, it is also necessary to consider other factors when establishing the increased risk of OHSS.

Adult↗
PubMed1991

Selective reduction after gamete intrafallopian transfer.

Selective reduction was performed in a patient with triplet pregnancy in the 9th week of gestation. Selective reduction of the fetuses to two was performed by puncture using vaginal ultrasound probe. No complications occurred and the patient was delivered of healthy twins.

Abortion, Induced↗
PubMed1988

Differentiation of solid breast tumors on the basis of their primary echographic characteristics as revealed by real-time scanning of the uncompressed breast.

The visualization of 144 clinically manifest or mammographically visible solid breast tumors was achieved with a hand-held, real-time linear array scanner (5MHz) and open water bath technique. On the basis of descriptive echographic signs and their combination, all 60 patients with benign tumors and 84 patients with malignant tumors were divided into three groups. Each of these groups was based on the combination of the most typical signs for benign or malignant tumors. These combinations make diagnostic criteria lax (presence of two signs--description of shape and border), moderate (combination of size and shape and description of internal echoes) and strict (presence of all previous criteria and characteristics of the tissue behind the tumor). The results are presented in the form of separate ROC curves. The comparison of both curves shows a significantly higher specificity in the determination of malignant tumors than in determination of benign tumors irrespective of the chosen level of diagnostic criteria. On the other hand a comparison of the sensitivity of the method, on the same levels of diagnostic criteria, shows higher values in benign breast tumors.

Breast Diseases↗
PubMedDate not supplied

Treatment of varicocele and male fertility.

Ninety-six patients with varicocele were followed for 4 years in a prospective randomized study. Seventeen patients were excluded from the study in accordance with exclusion criteria. In 26 patients varicocele was treated surgically and 12 patients were treated either by sclerosation or embolization. Forty-one patients with varicocele had no therapy. In 54 patients oligoasthenozoospermia and in 25 normozoospermia was certified. In the group of patients without treatment, the pregnancy rate in the women was higher (22/41, or 53.7%) than in the group receiving treatment (13/38, or 34.2%). The difference was not statistically significant. After therapy, sperm concentration increased and sperm motility improved also. The differences were not statistically significant. The study showed that varicocele therapy bears no influence on male fertility.

Embolization, Therapeutic↗
PubMedDate not supplied

[Evaluation of embryotoxicity of materials used in the IVF laboratory].

It has been established that the quality of water for the preparation of culture media has an essential influence on the percentage of two cell-stage mouse embryos developing successfully until the blastocyst stage. The quality of media prepared with bidistilled water (p less than 0.001) is inferior to that prepared with bidestilled demineralized water (p less than 0.02). Best results were attained by using the medium prepared with Nanopure water (Barnstead), in which 73.2% of embryos developed into blastocysts. There was no statistically significant difference between this medium and the commercial liquid medium (Sigma), in which 83.1% of embryos developed into blastocysts. The age of the medium and the percentage of added serum have no statistically significant influence on the outcome of the test. Contact of the medium with the syringe containing a black rubber piston proved explicitly embryotoxic (p less than 0.001).

Animals↗
PubMedDate not supplied

[Results of the IVF/GIFT program in Maribor].

The results of the IVF/GIFT programme for 1989 in Maribor are presented. During this period 4 clinical pregnancies were attended by the IVF procedure and one by GIFT and ZIFT each. In the IVF procedure the highest percentage of pregnancies was obtained in the group of women with the tubal factor of infertility (n = 34) where 4 clinical pregnancies on 22 ET were registered (18.1%). Cycle synchronisation with contraceptives, followed by stimulation with CC-HMG proved to be the most successful protocol for the cycle stimulation. With this protocol, pregnancy was attained in 4 of 19 stimulated cycles (21.0%). In the spontaneous cycles (n = 17) no pregnancy was registered.

Adult↗
PubMedDate not supplied

[Diagnosis of breast cancer in the gynecology department].

Breast examinations were performed in 4199 women by a simultaneous carrying out of clinical investigation, thermography and mammography, and, if needed, also by ultrasonic examination and aspiration cytology. A total of 169 women were referred to treatment and biopsy. Among them, 78 had breast cancer. In 6 patients ca in situ intraductale was discovered, while the disease was limited to the breast with negative lymph nodes in the axilla in 48 (61.5%) patients. Mammography proved more successful than clinical investigation. Its sensitivity amounted to 92% and that of clinical investigation only to 69%. The cost of a complete diagnostic process (on the first of April, 1986) was 5.717 dinars, which means that the cost of a diagnosed carcinoma was 307.765 dinars.

Adult↗
PubMedDate not supplied

[Breast cysts--diagnosis and therapy].

The authors present the results of the diagnosis of 1405 cases of macroscopically evident breast cysts. Only 15% patients were younger than 40 and only 6% older than 55 years. All lesions were cytologically analysed. The results were classified as negative in 1120 (79.9%), suspect in 27 (1.9%) and positive in 6 (0.4%) of cases. In 18% (n = 252) of cases aspirates were not adequate for cytologic evaluation. During a five-year follow-up period no new cyst was confirmed in 69.2% of cases, while in 30.8% of cases new cysts were diagnosed in yearly examinations during the observed period. Five (2.6%) intracystic proliferations were selected from the 190 cysts studied by means of pneumocystography. In the group presented three intracystic cancers were diagnosed by the combination of different diagnostic methods. The authors conclude that the introduction of ultrasound in breast cyst diagnostic work has reduced indications for pneumocystography and the cytologic evaluation of aspirates.

Adult↗
PubMedDate not supplied

[Sex hormone binding globulin in stimulated cycles].

Ovulation was stimulated in 56 cycles, namely in 16 cycles with clomiphene, in 19 with clomiphene and HCG, and in 16 cycles with clomiphene, HMG and HCG. In three women there was no LH or estradiol increase following ovulation stimulation with clomiphene, but in two women stimulated by the two remaining methods there was a spontaneous LH peak before the application of HCG. Using the radioimmunologic method once a day the concentrations of LH, estradiol and SHBG in serum were determined. The concentrations of SHBG in serum do not change in all three methods of ovulation stimulation. The mean concentrations of SHBG vary between 47 and 54 mumol/l during the entire preovulatory phase of the stimulated cycle. All of these cycles were ovulatory since the preovulatory E2 peak is clearly expressed in all three methods of ovulation stimulation.

Chorionic Gonadotropin↗
PubMedDate not supplied

[Analysis of the levels of gonadotropins and testosterone in the serum and sperm of patients with varicocele].

In 26 patients with clinical varicocele, in 20 patients with "subclinical" varicocele, and in 90 clinically normal patients, measurements of the plasma follicle stimulating hormone (FSH), luteinising hormone (LH), prolactin (PRL) and testosterone were made. In 13 patients pre-operative and post-operative measurements were also performed. The difference in the serum testosterone values in patients with varicocele and in those without varicocele was not statistically significant. The level of FSH and LH markedly higher in the group of patients with subclinical varicocele than in the group with clinically expressed varicocele (p less than 0.05). The difference in the values of FSH, LH, PRL and testosterone in the serum and seminal plasma of clinically normal patients with thermographically verified scrotal hyperthermia due to the reflux into the pampiniform plexus and in those with euthermia was not statistically significant if the quality of the semen was similar.

Gonadotropins, Pituitary↗