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Y Englert

Publications and source records attributed to Y Englert.

At least 55 records · Page 3Linked to original sources
PubMed1998

Is matching between women and donors feasible to avoid cytomegalovirus infection in artificial insemination with donor semen?

Cytomegalovirus (CMV) is the most common cause of congenital infection responsible for neonatal mortality, morbidity and later sequelae. Primary infection in the first half of pregnancy seems to have the worst outcome. CMV has been frequently recovered from human semen. In the setting of artificial insemination with semen donors, matching recipients and donors for CMV antibodies with the purpose of reserving seronegative semen for seronegative women is a recommended strategy to avoid the risk of a primary maternal CMV infection during pregnancy. We have reviewed the CMV seroprevalence in semen donors and candidates for insemination in our centre, and compared it with the CMV seroprevalence of blood donors. Without matching for CMV antibodies, the risk of a seronegative recipient being inseminated with seropositive semen was 21%. The same risk calculated for blood donors was 17%. Matching semen donors and recipients for CMV antibodies is possible as, in our study, 48% of the recipients and 55% of the donors were seronegative. During serological follow-up of CMV seronegative individuals in the fertility centre, no seroconversion was observed among donors; two seroconversions occurred in recipients, but not in relationship to therapeutic inseminations.

Adult↗
PubMed1998

Oocyte donation: particular technical and ethical aspects.

This paper analyses the reasons that oocyte and sperm donation are experienced very differently by couples, despite their apparent similarity, and stresses the impact of the difficulties on donor recruitment in all oocyte donation programmes. The various types of donors (occasional, relational, in-vitro fertilization patient and professional) are described together with their motivations, resistance, advantages and disadvantages. The contradictory consequences with free or paid donation, the particular risks of oocyte donation (in comparison with sperm donation) both for the donor and for the recipient are highlighted. The problem of maintaining anonymity is then analysed in ethical terms but also in terms of technical efficacy. A strategy is described which, due to the decision of retaining anonymity, authorizes the sharing of oocytes between recipients. This has as a consequence, an increase in treatment efficacy by avoiding wastage of oocytes offered as a donation.

Confidentiality↗
PubMed1998

[Human in vitro fertilization: technics and ethics].

IVF is certainly one of the new medical technologies where ethical debates are the most frequent and heavy. Three illustrations will be presented: The improvement of ovulation induction techniques have increased the number of supernumerary embryos. How to deal with these embryos, on which principles and what do the patients think about it? Introduction in the early 90' of assisted fertilization techniques (ICSI) have largely extended IVF indications and improved the success++ rate. Nevertheless, it will be demonstrated that it's implementation was a hard process for which the creation of embryos for research was a crucial step, opening another passionate ethical debate. Oocyte donation which came true thanks to IVF, will give the opportunity to illustrate an unusual consequence of ethics on technical aspect; due to an ethical choice (anonymous donation) we have been able to improve by a factor 3 the clinical efficiency of our oocyte donation program. An example of enhancement of the technique due to ethics, a very important fact in the situation of shortage of oocytes for donation. In conclusion, it appears that the ethical debate does not only focus on the legitimacy of this "medicine of desire" but also demonstrate that the development as well as the daily practice of IVF makes a clear vision of ethical choices mandatory and indissociable of technical aspects themselves.

Attitude to Health↗
PubMed1998

[Re-evaluation of immunomodulator treatments for recurrent abortions].

Immunotherapy of spontaneous recurrent abortion is still a matter of controversy. Since 1985, 117 patients were treated in our center. Transfusions of paternal leucocytes (PL) were given to 56 patients and intravenous immunoglobulins (i.v.Ig) to 61 patients. The allocation of the two treatments was not randomised. Respectively 74% and 71% normal pregnancies were achieved. In two cases treated by paternal leucocytes, the appearance of anti-erythrocytes alloantibodies (anti c and anti Jkb + C) was noted. Two patients receiving i.v.Ig had a transient allergic reaction (urticaria). In the five patients presenting with spontaneous abortion in the setting of in vitro fecondation, four normal pregnancies were achieved. These encouraging results from a single center are still to be considered as preliminary but urge us on continuing this approach. One of the drawback of i.v.Ig is their cost. Use of paternal leucocytes constitutes an adequate alternative provided that a strict immunological selection of the father is performed to avoid lymphocyte or platelet alloimmunisation. Our results are discussed in the light of recent controlled studies emphasizing the importance of the placebo effect and in the light of the new concepts in pregnancy immunology (protective action of trophoblastic HLA-G and Th2 cytokines; antagonistic effect of endometrial NK cells.

Abortion, Habitual↗
PubMed1998

[Influence of environmental factors on fertility: example of the diminution of sperm quality].

This presentation summarizes the debate on the suggested progressive impairment of semen quality (the "sperm fall") in the last forty years in the developed countries. The various available data strongly suggesting an environmental toxic origin for the "sperm fall" will be presented as well as the most frequently suspected class of substances, the xenoestrogens.

Developed Countries↗
PubMed1997

Features of the Renin-angiotensin system in ascites and pleural effusion during severe ovarian hyperstimulation syndrome.

PURPOSE: The purpose of this work was to investigate the ovarian renin-angiotensin system (RAS) during severe ovarian hyperstimulation syndrome (OHSS) with ascites and pleural effusion. METHODS: Two patients who developed severe OHSS after ovarian stimulation for in vitro fertilization were investigated. Both patients presented ascites and pleural effusion. Blood, ascites, and pleural fluid were simultaneously sampled during therapeutic paracentesis and thoracocentesis. Renin activity, active renin, prorenin, and angiotensin II immunoreactivity (Ang II-ir) were measured simultaneously in plasma, ascites, and pleural fluid. RESULTS: Prorenin, renin activity, active renin, and Ang II-ir levels were much higher than normal plasmatic laboratory norms in the three compartments. Prorenin and Ang II-ir levels were the highest in the ascites, while they were in the same range in the pleural fluid and in the plasma. CONCLUSIONS: The present findings provide additional evidence for the ovarian origin of the prorenin and Ang II-ir in the ascites of severe OHSS.

Adult↗
PubMed1997

Increased angiotensin II in ascites during severe ovarian hyperstimulation syndrome: role of early pregnancy and ovarian gonadotropin stimulation.

OBJECTIVE: To investigate the implications of the ovarian renin-angiotensin system (RAS) in the pathophysiology of the ovarian hyperstimulation syndrome (OHSS) in relation to gonadotropin stimulation and early pregnancy. DESIGN: A controlled clinical study comparing blood and simultaneously sampled peritoneal fluid (PF) from patients with severe OHSS and from controls without OHSS. SETTING: University Hospitals. PATIENT(S): Eleven patients with severe OHSS, 8 patients with ascites of other origin, 9 patients with a first-trimester pregnancy, and 15 patients stimulated with gonadotropins for IVF. MAIN OUTCOME MEASURE(S): Angiotensin II immunoreactivity was measured in blood and PF and analyzed by high-performance liquid chromatography (HPLC) in ascites from OHSS. RESULT(S): Angiotensin II immunoreactivity (pg/mL; mean +/- SE) was highest in the ascites from pregnant OHSS (1,669 +/- 418), reaching levels 5 times higher than in the plasma (331 +/- 61) and 100 times higher than in control ascites (17 +/- 6.7). Angiotensin II immunoreactivity was elevated in the PF during early pregnancy (211 +/- 68) and after gonadotropin stimulation (244 +/- 41) and was higher than in the plasma in both groups. Analysis by HPLC showed that the majority of Ang II immunoreactivity in the ascites of OHSS was because of true Ang II. CONCLUSION(S): Severe forms of OHSS, especially those associated with pregnancy, are consistently characterized by huge concentrations of Ang II immunoreactivity in the ascites, proved to be true Ang II by HPLC analysis. This may be due to the synergistic effects of exogenous and endogenous hCG on the ovarian RAS.

Adult↗
PubMed1997

Prorenin and active renin concentrations in plasma and ascites during severe ovarian hyperstimulation syndrome.

The pathophysiology of ovarian hyperstimulation syndrome (OHSS) remains unclear. Several lines of evidence indicate that OHSS is associated with a stimulation of the renin-angiotensin system (RAS), but its functional significance as well as its role in the pathogenesis of the syndrome are not yet determined. OHSS is associated with high plasma and ascitic concentrations of total renin, renin activity (RA) and angiotensin II (Ang II). Their ovarian or renal origin is, however, still a matter of debate. To clarify these issues further, total renin, active renin, prorenin, RA and aldosterone were measured in plasma and ascites of nine patients who developed severe OHSS after in-vitro fertilization. Blood and ascites were sampled simultaneously during therapeutic paracentesis. Total renin and prorenin concentrations were significantly higher in the ascites (mean concentration +/- SE respectively of 5920 +/- 1430 mIU/l and 5250 +/- 1350 mIU/l) than in the plasma (respectively 3060 +/- 740 mIU/l and 2000 +/- 460 mIU/l) (P = 0.020 and 0.017 respectively). Conversely, active renin and RA concentrations tended to be lower, although not statistically significantly so in the ascites (respectively 670 +/- 190 mIU/l and 47 +/- 11 ng Ang I/ml/h) than in the plasma (respectively 1060 +/- 370 mIU/l and 75 +/- 21 ng Ang I/ml/h). Aldosterone concentrations were significantly higher in the serum (2609 +/- 374 pg/ml) than in the ascites (2025 +/- 347 pg/ml) (P = 0.015). The concentration gradient between plasma and ascites for total renin and prorenin supports the hypothesis of their ovarian origin in ascites and, to a large extent, in plasma, while it is likely that the high plasma active renin and RA concentrations reflect a peripheral activation of the RAS. In conclusion, the present findings are consistent with a marked stimulation of both ovarian and renal RAS during OHSS.

Adult↗
PubMed1997

Glass wool column filtration, an advantageous way of preparing semen samples for intracytoplasmic sperm injection: an auto-controlled randomized study.

The characteristics of the glass wool filtration technique for the preparation of semen samples in an intracytoplasmic sperm injection programme (ICSI) were compared with a two-layer Percoll density gradient procedure. Half of each of 25 semen samples were prepared by each technique. The oocytes from each patient were randomly injected, half with spermatozoa prepared by glass wool filtration and half with Percoll-separated spermatozoa from the same semen sample. The percentage of recovered motile spermatozoa, the total motile sperm count, the percentage of morphologically normal forms, the fertilization rate, the cleavage rate and embryo quality obtained with both preparations were analysed. The 95% confidence intervals obtained through the Altman-Bland analysis showed that the percentage of motile spermatozoa recovered was 3.5-9.9% higher with the glass wool filtration technique, and this was highly correlated (r = 0.92, P = 0.0001) to the method. Similarly, the total number of spermatozoa available for ICSI was 0.18 x 10(6)-2.44 x 10(6) higher with the glass wool column and was highly correlated to the method (r = 0.956, P = 0.0001). Also, the percentage of normal forms was 1.25-3.31% higher after glass wool filtration but was poorly correlated to the method (r = 0.47, P = 0.017). Out of 100 metaphase II oocytes injected with glass wool-extracted spermatozoa, 77 fertilized and 72 cleaved. Out of 97 metaphase II oocytes injected with Percoll-selected spermatozoa, 71 fertilized and 69 cleaved. These results were not statistically different. The mean +/- SEM embryo quality score for the glass wool group (2.90 +/- 0.27) was the same as that for the Percoll group (2.80 +/- 0.24). No fertilization failures occurred and 11 patients (44% per oocyte retrieval) became pregnant. It was concluded that glass wool filtration for semen preparation in an ICSI programme offers higher sperm recovery and sperm morphology of superior quality than with the classic two-layer Percoll gradient method, without affecting the fertilization rate and embryo quality.

Cell Separation↗
PubMed1997

[Oocyte donation: ethical aspects related to the donor].

This paper analyses the reasons that brings couples to apprehend very differently the oocyte and sperm donation and highlights the difficulty of donor recruitment in those programs. The various types of donors (occasional, relational, IVF patient and professional) are described with their motivations, resistances, advantages and disadvantages. The contradictory consequences between free or paid donation, the particular risks of eggs donation (in comparison to sperm donation) for the donor as for the recipient are also highlighted. The problem of anonymity is also analysed in ethical terms but also in terms of technical efficacy: it is shown that anonymity, by authorizing sharing oocytes between recipients increases treatment efficacy by avoiding wasting this rare and precious resource of oocytes offered as a donation.

Attitude to Health↗
PubMed1996

Quality control in IVF with mouse bioassays: a four years' experience.

OBJECTIVE: We analyzed retrospectively the relevance of 4 years of quality control on homemade culture medium with the mouse IVF and zygote bioassay. DESIGN: In vitro or in vivo fertilized mouse oocytes were cultured in each batch of medium. Two-cell-stage and expanded blastocyst development was recorded for each batch of medium. Data on fertilization and embryo quality obtained in human in vitro fertilization were recorded for each batch. IVF treatment cycles for male infertility and cycles with sperm microinjection were excluded. RESULTS: Human oocyte fertilization dropped from 60 to 54%, respectively, from 57 to 41% in a significant way (P < 0.05 resp. P < 0.01) and the human mean embryo score decreased from 4.17 +/- 1.21 to 3.69 +/- 1.06 (P < 0.05) when media were used with a low two-cell-stage development (< or = 75%) for the mouse zygote or mouse IVF bioassay. The pregnancy rate was not affected. CONCLUSIONS: Media with high scores in mouse bioassays show higher fertilization rates and better embryo quality when used for human IVF.

Animals↗
PubMed1996

Bioactive angiotensin (1-8) is the main component of angiotensin II immunoreactivity in human follicular fluid.

The ovarian renin-angiotensin system is involved in various aspects of human reproduction. As immunoreactive measurement of angiotensin II (ANG II) in follicular fluid (FF) relates to several angiotensin peptides with different biological activities, HPLC was used to characterize the molecular forms of the ANG II immunoreactivity in human FF. Samples of FF, obtained from gonadotropin-stimulated patients for in vitro fertilization, were collected at the time of oocyte retrieval. The C-terminal 2-8 heptapeptide was never detected. HPLC analysis revealed for the first time that the major component of the ANG II-IR in human FF was the biologically active octapeptide ANG II.

Angiotensin II↗
PubMed1996

Is the subzonal-insemination procedure an efficient technique in the treatment of extreme oligoasthenoteratozoospermia?

OBJECTIVES: The present study evaluates the usefulness of the sub-zonal insemination (SUZI) for patients with previous IVF failures or affected by severe oligoasthenoteratozoospermia and the necessity of pre-treatment semen analysis. DESIGN: Twenty-five patients underwent 43 cycles of either SUZI or alternate SUZI/IVF procedures according to semen characteristics. RESULTS: Among the 571 retrieved oocytes, 398 were microinjected and 173 were treated by IVF. Among the microinjected oocytes, 19% fertilized (12% 2PN: 7% 3PN) and 96% of the 2PN oocytes developed into embryos. Thirty-one embryo transfers were performed, 8 pregnancies were obtained and 7 embryos were cryopreserved. The 2 PN rates in SUZI and IVF procedures in the same cycle were not significantly different. The analysis of the different semen samples obtained before and during the treatment reveals that the semen quality varies in such a way that the decision of the adequate microinjection strategy to follow should only be taken according to the semen quality at the day of treatment. CONCLUSION: SUZI is not a satisfactory technique for treatment neither in case of previous IVF failures nor for severe oligoasthenoteratozoospermia.

Adult↗