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Biomedical subjects

Y Gonen

Publications and source records attributed to Y Gonen.

32 records · Page 2Linked to original sources
PubMed1991

Does the choice of catheter for embryo transfer influence the success rate of in-vitro fertilization?

The performance of two different transfer catheters has been evaluated in 193 consecutive embryo transfers. Forty pregnancies were achieved, corresponding to a pregnancy rate of 21% of all embryo transfers. The Frydman catheter was used in 123 attempts whereas 70 embryo transfers were performed with the Tom Cat catheter. The Tom Cat catheter yielded a significantly higher pregnancy rate than the Frydman catheter (28% versus 16%; P = 0.03). The mean number of embryos transferred per attempt was similar in the two groups (2.9 +/- 0.1 and 3.0 +/- 0.1 in the Tom Cat and Frydman groups respectively) as was the quality. When more than three embryos were transferred, a pregnancy rate of 37% per embryo transfer was achieved using the Tom Cat versus 20% using the Frydman catheters (P = 0.03). A higher frequency of difficult transfer procedures was observed when the Frydman catheter was used while the Tom Cat performed much better in difficult cases. An alternate use of the two catheters suggests a significantly better performance of the Tom Cat catheter in relation to the efficiency of establishing pregnancy.

Adult↗
PubMed1990

Transvaginal ultrasonically guided follicular aspiration: a comparative study with laparoscopically guided follicular aspiration.

This study, comparing transvaginal ultrasound-guided follicle aspiration with laparoscopic-guided follicle aspiration for in vitro fertilization confirms that the use of laparoscopy appears to have no advantage for oocyte recovery over the ultrasonically directed technique. The latter offers potential benefits of less trauma, less risk, less morbidity, avoidance of general anesthesia, decreased operating room and personnel time, decreased expense, and in general, greater acceptance.

Adult↗
PubMed1990

Prediction of implantation by the sonographic appearance of the endometrium during controlled ovarian stimulation for in vitro fertilization (IVF)

The texture and the thickness of the endometrium as assessed by transvaginal sonography were prospectively evaluated in 123 patients undergoing IVF treatment. Three different types of endometrial patterns could be distinguished: (A) an entirely homogenous, hyperechogenic endometrium; (B) an intermediate type characterized by the same reflectivity of ultrasound as the myometrium, with a nonprominent or absent central echogenic line; and (C) a multilayered endometrium consisting of prominent outer and midline hyperechogenic lines and inner hypoechogenic regions. On the day before oocyte retrieval, endometrial thickness was significantly greater in the group of patients who achieved pregnancy than in the group who did not (8.7 +/- 0.4 vs 7.5 +/- 0.2 mm, respectively; P less than 0.01) and significantly more patients had multilayered, pattern C, endometrium (75% in pregnant women vs 42.4% in nonpregnant women; P less than 0.01). No pregnancy occurred when the endometrial thickness was less than 6 mm. When type C endometrium greater than or equal to 6 mm thick was seen, the pregnancy rate per embryo transfer was 39%. When type A or B endometrial pattern was seen, the negative predictive value for the occurrence of pregnancy was 90.5%. Our results suggest that transvaginal sonographic evaluation of endometrial texture and thickness may be an indicator of the likelihood of achieving pregnancy.

Adult↗
PubMed1990

Gonadotropin suppression with oral contraceptives before in vitro fertilization.

One hundred eighty-one stimulation cycles in which gonadotropin suppression with oral contraceptives (OCs) preceded induction of follicle stimulation (study group) and 113 stimulation cycles without pituitary suppression (control group) were compared. The mean length of ovarian suppression was 35.3 +/- 0.9 days. No spontaneous luteinizing hormone (LH) surges occurred when the use of OC preceded ovarian hyperstimulation, whereas in the control group the incidence of LH surges was 19.5%. The mean amount of human menopausal gonadotropin required was significantly lower in the study group than in the control group (8.9 +/- 0.4 and 10.9 +/- 0.4 ampules, respectively). Significantly more follicles greater than or equal to 1.5 cm in diameter were seen on the day before oocyte retrieval and significantly more oocytes were retrieved per attempt in the group with OC pretreatment. Our data clearly demonstrate that OCs are useful in vitro fertilization stimulation protocols to facilitate scheduling of cycles and to prevent spontaneous LH surges.

Abortion, Spontaneous↗
PubMed1990

Transient hyperprolactinemia is associated with a midcycle luteinizing hormone surge.

This study demonstrates that LH surge cycles in IVF patients were associated with significantly higher serum PRL concentrations than cycles in which a spontaneous LH surge did not occur. Our findings support the hypothesis of concomitant LH and PRL release at the time of the midcycle gonadotropin surge, as well as that of estrogen sensitization of pituitary lactotropes, and suggest a possible mechanism for transient midcycle hyperprolactinemia.

Chorionic Gonadotropin↗
PubMed1990

Sonographic determination of a possible adverse effect of clomiphene citrate on endometrial growth.

We recently demonstrated, using transvaginal sonography, that conception cycles in in-vitro fertilization (IVF) are associated with a significantly thicker endometrium at midcycle than non-conception cycles, suggesting that endometrial growth may influence implantation. In the present study, to examine whether the type of stimulation protocol affects endometrial development, we compared the sonographic appearance of the endometrium in 22 patients randomized to receive clomiphene citrate and human menopausal gonadotrophin (CC/HMG) and in 19 who received HMG alone. A significantly thicker endometrium was observed in the HMG patients compared to the CC/HMG group (P less than 0.005) throughout the follicular phase of the cycle, although serum concentrations of oestradiol (E2) did not differ in the two groups. Twenty-three patients (13 in the HMG group and 10 in the CC/HMG group) had previous IVF cycles with CC/HMG stimulation in which endometrial thickness was measured. A thin endometrium recurred with subsequent CC/HMG cycles while increased growth occurred with HMG only compared to previous CC/HMG cycles. Therefore, ultrasound examination of the endometrium in this study demonstrated that CC results in a thinner endometrium than HMG alone. We believe these findings may be of importance in improving pregnancy rates in IVF and possibly in other infertility therapy which involves the use of clomiphene citrate.

Clomiphene↗
PubMed1990

Use of gonadotropin-releasing hormone agonist to trigger follicular maturation for in vitro fertilization.

In spontaneous cycles both LH and FSH are secreted in a surge at midcycle. In in vitro fertilization (IVF) cycles, hCG administration results in elevation of LH-like activity only. The objective of this study was to compare the effectiveness of a single midcycle dose of GnRH agonist with hCG on follicular maturation. Eighteen IVF cycles in 14 women were randomized to receive either 0.5 mg leuprolide acetate or 5000 IU hCG at midcycle. Both groups underwent identical ovarian stimulation and cycle monitoring. On the day of GnRH agonist or hCG administration, estradiol concentrations and the number of follicles 1.5 cm or larger were the same in both groups. Mean serum LH and FSH levels were elevated for 34 h after GnRH agonist administration. In contrast, mean serum hCG levels were elevated for approximately 6 days after the administration of hCG, and serum FSH levels did not change. Mean luteal phase serum estradiol concentrations were lower in the GnRH agonist group than in the hCG group (P less than 0.02). No differences were observed in mean serum progesterone or PRL during the luteal phase or in the length of the luteal phase in the two groups. The mean number of oocytes retrieved and embryo number and quality did not differ between the two groups. Three of nine GnRH agonist cycles and none of nine hCG cycles resulted in clinical pregnancy (P = 0.1). The results of this study indicate that GnRH agonist is able to simulate a midcycle surge of gonadotropins, leading to follicular maturation and pregnancy. Further work is needed to determine whether there is any clinical advantage of GnRH agonist over hCG administration with regard to pregnancy rates.

Adult↗
PubMed1990

Transvaginal ultrasound in selective embryo reduction for multiple pregnancy.

Ovulation induction for the treatment of infertility is known to carry the risk of inducing multiple gestations, with attendant high perinatal morbidity and mortality. Selective reduction of the number of fetuses in a multiple gestation to reduce this risk, using transvaginal ultrasound, is a recent technological development. Six patients (three with quadruplets and three with triplets) underwent selective embryo reduction in the first trimester using real-time transvaginal ultrasound. Potassium chloride was used for intrathoracic injection. One of the procedures was complicated by chorioamnionitis 48 hours later, necessitating termination of pregnancy. Transvaginal sonographically directed selective reduction represents an important addition to the management of unplanned multiple pregnancy resulting from infertility treatment. The procedure is not without risks, and these must be weighed against potential benefits.

Abortion, Induced↗
PubMed1989

The influence of transient hyperprolactinemia on hormonal parameters, oocyte recovery, and fertilization rates in in vitro fertilization.

A detrimental effect of transient elevation of plasma prolactin (PRL) during in vitro fertilization (IVF) has not been proven; however, treatment with a dopamine agonist has been suggested. The present study was undertaken to determine if transient, midcycle hyperprolactinemia exerted a deleterious effect on the number of oocytes retrieved or on fertilization of oocytes in vitro. Fifty-three infertile patients with midcycle hyperprolactinemia (PRL greater than 20 micrograms/liter) during ovarian hyperstimulation for IVF were compared with 53 matched controls who remained normoprolactinemic. Mean (+/- SE) serum PRL levels on the day after hCG were significantly higher in the study group (29.5 +/- 1 micrograms/liter) than in the control (13.1 +/- 0.5 microgram/liter) (P less than 0.0005), whereas the mean estradiol (E2) concentrations on the same day were not significantly different (4822 +/- 287 and 4492 +/- 269 pmol/liters, respectively). Fertilization rates (72 +/- 4 and 70 +/- 4%, respectively) and the mean number of oocytes recovered (4.2 +/- 0.3 and 3.7 +/- 0.3, respectively) did not differ between the two groups. No correlation was observed between serum PRL and E2 levels, fertilization rates, or the number of oocytes retrieved in either group. Eleven patients with elevated PRL levels as a result of ovarian hyperstimulation were treated with 2.5 mg bromocriptine daily during the next IVF cycle. Serum PRL levels were significantly lower in the treated (5.6 +/- 1.8 micrograms/liter) than in the untreated cycles (35.6 +/- 3.1 micrograms/liter) (P less than 0.0005), whereas serum E2 concentrations did not differ.(ABSTRACT TRUNCATED AT 250 WORDS)

Bromocriptine↗
PubMed1989

Does transient hyperprolactinemia during ovarian hyperstimulation interfere with conception or pregnancy outcome?

The significance of transiently increased serum prolactin (PRL) levels on pregnancy rates in in vitro fertilization (IVF) is unknown. The aim of this study was to evaluate PRL levels in IVF patients who conceived and in matched controls who did not. Thirty-seven IVF cycles resulting in pregnancy and 74 nonpregnant cycles were compared. Prolactin was measured before ovarian stimulation with clomiphene citrate, and human menopausal gonadotropin and estradiol (E2) and PRL were measured 8 hours after human chorionic gonadotropin (hCG) administration at midcycle. Before ovarian stimulation, serum PRL levels were not different in the pregnant and nonpregnant women (11.1 +/- 0.6 [mean +/- standard error] micrograms/l and 10.1 +/- 0.4 micrograms/l, respectively). After hCG, PRL levels were significantly higher in the pregnant women than in the nonpregnant women (20.8 +/- 1.6 and 16.0 +/- 0.9 micrograms/l, respectively; P less than 0.005) and more pregnant than nonpregnant women had elevated PRL levels (49% versus 28%, respectively; P less than 0.05). There was no correlation between PRL and E2 in either group. The abortion rate was not different between the women with elevated PRL (22.2%) and the normoprolactinemic women (31.6%). These results do not support treatment of transient hyperprolactinemia with dopamine agonists in IVF patients.

Chorionic Gonadotropin↗
PubMed1989

Endometrial thickness and growth during ovarian stimulation: a possible predictor of implantation in in vitro fertilization.

The present study was undertaken to evaluate endometrial thickness and the amount of endometrial growth (delta) in patients who conceived during in vitro fertilization (IVF) (n = 36) compared with matched women who did not conceive (n = 72). Estradiol (E2) and endometrial thickness were measured daily from cycle day 10 to the day after human chorionic gonadotropin (hCG). Mean endometrial thickness and E2 levels on cycle day 10 did not differ. On the day before ovum retrieval, significantly thicker endometrium was observed in the pregnant than in the nonpregnant women (8.6 +/- 0.3 [SEM] and 7.1 +/- 0.3 mm, respectively; P less than 0.0005), whereas the mean E2 levels did not differ. The delta endometrial growth was greater in the women who conceived than in the nonpregnant group (4.3 +/- 0.2 and 2.5 +/- 0.2 mm, respectively; P less than 0.0005). The fertilization rate and serum E2 levels did not correlate with endometrial thickness nor with delta endometrial growth. Our data suggest that the amount of endometrial growth during ovarian hyperstimulation and the endometrial thickness on the day before oocyte retrieval deserve further study as possible predictive parameters for implantation.

Embryo Implantation↗
PubMed1984

Maternal permanent bradycardia: pregnancy and delivery.

Presented are six women with permanent bradycardia without myocardial involvement. Four women were asymptomatic, and two had repeated Adams-Stokes attacks and required the use of permanent pacemakers. All six women had 18 pregnancies with 15 deliveries of normal infants. During pregnancy and delivery all patients remained asymptomatic (functional capacity 1). The various cardiologic and obstetric aspects of these patients are discussed, and it is concluded that pregnancy and delivery in women with permanent bradycardia is possible, and their outcome is no different from that of normal, healthy women. However, cases with associated myocardial disease carry an increased risk and should therefore be carefully monitored during pregnancy and delivery.

Adult↗
PubMed1983

Continuous subcutaneous insulin infusion. Improved blood glucose in pregnant diabetics.

The effect of continuous subcutaneous insulin infusion (c.s.i.i.) on the control of blood-glucose concentration and outcome of pregnancy was assessed in two pregnant diabetics (class B and class C White classification) who were poorly controlled with conventional insulin therapy. The insulin pump was carried in a holster and enabled the patients to ambulate freely. The patients were able to refill the syringe, to augment the infusion rate at mealtime and to change the implantation site of the needle weekly, and thus, were able to leave the hospital. Daily glucose profiles were assessed 1-3 times a week, and the infusion rate was readjusted accordingly. Twenty-four hours glucose profiles were obtained from both patients during inpatient conventional insulin regimens, and then, during c.s.i.i. which was maintained for 41 and 145 days, respectively. Mean 24 hours glucose concentrations were reduced from 156 to 113 mg/100 ml, mean fasting glucose from 152 to 106 mg/100 ml, and mean diurnal variation (maximal excursion) from 75 to 65 mg/100 ml. The favourable results achieved with the c.s.i.i. enabled both patients to reach the 18th week of gestation and to deliver healthy non-macrosomic infants, who had uneventful and morbid-free neonatal periods. Since the c.s.i.i. supplies insulin in a more physiological manner than twice daily regimens, better control of blood sugar and body fuel metabolism may be achieved. By extending the therapy to the early stages of pregnancy, or if possible to pre-conceptional period, reduced perinatal mortality and morbidity may be anticipated.

Adult↗