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Biomedical subjects

W Ledger

Publications and source records attributed to W Ledger.

32 records · Page 2Linked to original sources
PubMed1995

A controlled assessment of the in vitro fertilization performance of British women of Indian origin compared with white women.

OBJECTIVE: To compare the reproductive performance of Indian versus white women in IVF. DESIGN: Controlled comparative clinical study. SETTING: In vitro fertilization center based in university department in large tertiary level hospital. PATIENTS: Results from first IVF treatment cycles in 44 Indian patients were compared with results from 88 white patients, matched by age and body mass index, over the same treatment year. The patients were selected from a prospectively collected IVF databank. INTERVENTIONS: Standard luteal-phase start long GnRH analogue regime. Ovarian stimulation with FSH and hMG. Transvaginal ultrasound-guided oocyte recovery. In vitro fertilization and ET following established protocols. MAIN OUTCOME MEASURES: Rates of abandoned cycles, egg retrievals, ETs, clinical pregnancies, miscarriages, and live births were compared in the first IVF treatment cycle. Cumulative pregnancy rates (PRs) over three cycles in the two groups of patients were also compared. RESULTS: More cycles were abandoned in the Indian than in the white group: 22.7% versus 9.1%. The Indian live birth rate per cycle was worse: 9.1% versus 22.7%. The performance of the two groups was otherwise similar: ovarian stimulation with hMG and FSH required 26.0 required 26.0 ampules in the Indian group versus 24.6 ampules in the white group, mean number of follicles on the day of egg retrieval 8.7 versus 8.7, mean number of eggs 5.9 versus 5.8, fertilization rate 82.4% versus 82.5%; ET rate 73.5% versus 82.5, mean number of embryos transferred 2.1 versus 1.8, and clinical PR per cycle started 18.2% versus 27.3%. CONCLUSIONS: Under the same IVF regime, Indians performed worse than whites at the stage of ovarian stimulation (higher rate of abandoned cycles for poor response) and in live birth rate. Cumulative conception and live birth rates also tended to be worse in Indians than in whites.

Adult↗
PubMed1994

The contribution of embryo cryopreservation to in-vitro fertilization/gamete intra-fallopian transfer: 8 years experience.

In this paper, the authors summarized their experience with embryo cryopreservation over an 8-year period. The results, therefore, reflect the long-term benefit of embryo cryopreservation to the overall in-vitro fertilization/gamete intra-Fallopian transfer (IVF/GIFT) programme and to the women who had embryos cryopreserved. The stable survival rate of thawed embryos and pregnancy rate, especially over the past 4 years, suggests that the results can reliably be used to evaluate the efficacy of the embryo cryopreservation programme. The ongoing pregnancy rate of frozen/thawed embryo transfer is 10.9%, comparable with the ongoing pregnancy rate of fresh IVF/embryo transfer in our unit over the same period. In addition to those factors known to affect the pregnancy rate in fresh IVF/GIFT cycles, such as age of the recipients and number of embryos transferred, the major factor affecting the efficacy of the cryopreservation programme is the number of oocytes retrieved in the initial stimulation cycle, and the number of embryos available for cryopreservation. The storage time of cryopreserved embryos will also have a significant effect on the realization of the total potential of embryo cryopreservation. Overall the contribution of cryopreservation to our IVF/GIFT programme is substantial, increasing pregnancy rate by 4%, while the greater net benefit, of course, is for the women who had embryos cryopreserved (pregnancy rate increased by 7%), especially for those who returned for frozen/thawed embryo transfer cycles (pregnancy rate increased by 11%).

Adult↗
PubMed1994

First meiotic division abnormalities in human oocytes: mechanism of trisomy formation.

Trisomy is the single most frequent type of chromosome abnormality in humans and has considerable impact on many aspects of human pathology. It arises most commonly through "nondisjunction" at maternal meiosis I, but the underlying mechanism of formation remains obscure. Analysis of 100 haploid oocytes at second meiotic metaphase shows that the only type of chromosome abnormality compatible with trisomy formation after fertilisation is the presence of single chromatids in addition to, or replacing, whole chromosomes. The mechanism resulting in the presence of single chromatids is considered to be precocious division of univalents or dyads at first meiotic anaphase.

Adult↗
PubMed1992

Effect of cyclofenil on hormonal dynamics, follicular development and cervical mucus in normal and oligomenorrhoeic women.

Cyclofenil is a triphenylethylene derivative, similar in structure to clomiphene citrate, which is used to induce ovulation in anovulatory women. The effects of cyclofenil on a group of 10 normal cyclic and 10 oligomenorrhoeic subjects were examined in a double blind controlled cross-over study. Both groups of women were administered either cyclofenil or, following a washout cycle, a placebo in two treatment cycles. Urinary oestrone and pregnanediol excretion were measured daily and ultrasound scans performed to assess follicular development. Frequent sampling of blood was performed on day 6 to study luteinizing hormone (LH) and follicle stimulating hormone (FSH) pulsatile release. Cervical mucus changes and sperm-cervical mucus interaction were studied after identification of the LH peak. There were no significant differences between cyclofenil and placebo cycles in the following: ovulation rates, daily urinary oestrone and pregnanediol excretion, the number or size of developing follicles, LH pulsatility (parameters studied: number of peaks, pulse interval, pulse amplitude, pulse area and mean nadir LH), mean FSH level on day 6, cervical mucus and sperm-cervical mucus interaction. In view of our inability to demonstrate an effect on any parameter of endocrine function in normal and oligomenorrhoeic women, these results throw doubt on the therapeutic value of cyclofenil in its present dosage and formulation.

Adult↗
PubMed1991

Cytogenetic analysis of unfertilized human oocytes.

Cytogenetic studies were carried out on 180 oocytes that appeared unfertilized after in-vitro fertilization. The majority of the 135 that were informative had grossly haploid second meiotic metaphases, two were grossly diploid, and five had a variety of different abnormalities. Twenty-one oocytes were abnormally fertilized and included prematurely condensed sperm chromosomes. The frequency of this phenomenon varied according to the stimulation protocol, those oocytes maturing longer in vivo showing less propensity to abnormal fertilizations. Thirteen per cent of the analysable haploid metaphases were hyperhaploid but none contained extra whole chromosomes. The extra components were a single chromatid (one case), or two single chromatids replacing a whole chromosome (four cases). The data suggest that the chromatids arose as a result of premature centromere division at meiosis I, and that this may be a major mechanism for trisomy formation rather than non-disjunction of whole bivalents at meiosis I, as generally believed.

Cells, Cultured↗
PubMed1988

The role of infection in the etiology of preterm birth.

The hypothesis that infection induces or is a precursor to preterm birth or premature rupture of the membranes was examined in a prospective study of 193 randomly selected pregnant women. We investigated the prognostic significance of factors that suggest infection of the uterine cavity before pregnancy, such as a history of pelvic inflammatory disease, a history of intrauterine contraceptive device (IUD) use, multiple sex partners, and the presence of antisperm antibodies, in relation to premature rupture of the membranes and preterm birth. Sexual activity, a potential vehicle for bacterial exchange, was also charted throughout pregnancy via monthly interviews. We performed immunologic tests on each patient and obtained cultures of the cervix for aerobic and anaerobic bacteria and chlamydia at the first visit, occurring at six to 14 weeks' gestation, and again at 36 weeks. The results suggest that infection may indeed play a causative role in premature rupture of the membranes or preterm birth. A strong correlation was found between preterm birth and both a history of pelvic inflammatory disease (P = .004) and a history of IUD use (P = .0015). Amnionitis was associated with the presence of immunoglobulin G (IgG) antisperm antibodies (P = .02), as well as with a history of pelvic inflammatory disease (P = .0006). There was also a correlation between premature rupture of the membranes and a history of multiple sex partners (P = .02). This collective evidence implicates preexisting infection of the uterine cavity as a predisposing factor in premature rupture of the membranes, preterm delivery, and amnionitis.

Chorioamnionitis↗
PubMed1983

Prophylactic cefoxitin in cesarean section.

The effectiveness of prophylactic cefoxitin in preventing postcesarean section infection was studied in a high risk population. One hundred women were evaluated, and on a random double-blind basis 50 received placebo and 50 received cefoxitin. There were three doses of drug given intravenously, either placebo or 1 gram of cefoxitin at the time of cord clamping and again four and eight hours later. Those receiving cefoxitin had significantly less postoperative infections, fewer had bacteremia and there was less postoperative fever as measured by the fever index. The patient with the most protracted infection in this study received cefoxitin. Problems with the use of systemic antibiotic prophylaxis in preventing postcesarean section infection are discussed. Cefoxitin is an effective agent to use in patients undergoing cesarean section who are at high risk for infection.

Adult↗
PubMed1983

Diagnosis and treatment of salpingitis.

The diagnosis of acute salpingitis no longer requires the patient to have fever, bilateral adnexal tenderness and/or swelling, leukocytosis and an elevated sedimentation rate. New criteria have been formulated. There is increasing awareness of the potential role of Chlamydia and increasing use of antibiotics effective against that organism.

Anti-Bacterial Agents↗
PubMed1983

Surgical treatment for salpingo-oophoritis patients.

In the past, the established methods of surgical treatment for salpingo-oophoritis were extraperitoneal drainage of a pelvic abscess or total abdominal and bilateral salpingo-oophorectomy. Increasing awareness of the role of anaerobic bacteria and changes in antibiotic-prescription patterns have modified the clinical response of some patients. In patients with a unilateral tuboovarian abscess, unilateral removal of the adnexa suffices.

Animals↗
PubMed1982

Evidence for microbial transfer by spermatozoa.

Ovulatory-phase cervical mucus columns demonstrate that microorganisms migrate in the cervical mucus with moving spermatozoa. Cultures obtained from the distal end of the mucus column after spermatozoal migration was complete yielded the same aerobic and anaerobic microbial isolates that were originally recovered from the seminal fluid. Exogenous aerobic bacteria added to the seminal fluid. Exogenous aerobic bacteria added to the seminal fluid also appeared at the top of the mucus column. After removal of the spermatozoa, no bacteria were observed migrating through the mucus. It is concluded that spermatozoa may provide a vehicle for bacteria present in the seminal fluid prior to ejaculation and for those already present in the cervix or vagina. The significance of this finding is discussed, and one mechanism for the development of salpingo-oophoritis in the female is proposed.

Bacteria↗
PubMed1980

Bacteremia in post-Cesarean section endomyometritis: differential response to therapy.

Presented are blood culture results obtained from 200 patients with post-cesarean section endomyometritis treated with either penicillin-gentamicin or clindamycin-gentamicin. Their clinical course is correlated to their blood culture results by the fever index. Fifty-three percent of the 60 organisms isolated from 48 patients were anaerobic bacteria. Patients from whose blood cultures anaerobic bacteria were recovered had higher fever indexes than did those with aerobic isolates (P less than .05). Clindamycin-gentamicin patients from whose blood cultures anaerobic organisms were isolated had less febrile morbidity than did comparable penicillin-gentamicin patients. Patients with Bacteroides fragilis bacteremia had the highest fever indexes overall. Therefore, patients with post-cesarean section endomyometritis have less febrile morbidity if they are initially treated with a drug effective against anaerobic bacteria, especially B fragilis.

Anti-Bacterial Agents↗