Biomedical subjects

Z Ben-Rafael

Publications and source records attributed to Z Ben-Rafael.

At least 37 records · Page 2Linked to original sources

PubMed2000

[Microlaparoscopy in diagnostic and operative gynecologic procedures].

A recent further development in laparoscopic surgery is microlaparoscoopy. The technique is identical to standard 10 mm laparoscopy except for the use of small, 2 mm scopes and trocars. We used this technique in 19 patients treated from June 1998 to February 1999. The advantages of microlaparoscopy are: smaller incisions, less risk of damage to pelvic organs and less postoperative pain. However, the use of microlaparoscopy for operative procedures is limited to simple operations due to the limited field of vision. We urge our colleagues to consider microlaparoscopy whenever diagnostic laparoscopy is needed.

Adult↗

PubMed2000

Prenatal sonographic diagnosis of laryngeal atresia in association with single umbilical artery.

Congenital laryngeal atresia is an extremely rare anomaly that in most cases is incompatible with life. About 50% of cases involve other major malformations. Prenatal sonographic diagnosis of this condition has been described only 6 times. We present a case in which prenatal sonographic examination at 21 weeks' menstrual age revealed enlarged, hyperechoic lungs, dilated upper airways, ascites, and a single umbilical artery. To our knowledge, this is the first reported case of the prenatal diagnosis of laryngeal atresia in association with a single umbilical artery.

Abnormalities, Multiple↗

PubMed2000

Modified hysterosalpingography during infertility work-up: use of contrast medium and saline to investigate mechanical factors.

OBJECTIVE: To evaluate the effectiveness of modified hysterosalpingography using <3 mL amount of contrast medium followed by injection of saline to minimize the adverse effects associated with the procedure. DESIGN: For modified hysterosalpingography, 1-2 mL of water-soluble contrast medium were injected to visualize the uterine cavity, followed by injection of 10 mL of saline to check tubal patency and spillage. A control group of patients underwent hysterosalpingography with undiluted contrast medium. SETTING: Teaching hospital. PATIENT(S): Seventy-eight infertile women [study (n = 40)/control (n = 38) groups]. INTERVENTION(S): Modified and standard hysterosalpingography. MAIN OUTCOME MEASURE(S): Assessment of uterine cavity, tubal patency, and sensation of pain during modified hysterosalpingography was compared with that during standard hysterosalpingography. RESULT(S): Uterine cavity and tubal patency were properly visualized during modified hysterosalpingography. Saline pushed the contrast medium successfully from the uterine cavity through the open fallopian tubes and into the pelvic cavity. The study group reported significantly less pain than did the control group. Between-group differences were statistically significant when pain perception (no pain vs. minimal pain vs. severe pain; no pain vs. any kind of pain) was analyzed by type of adnexal pathology (bilateral passage or unilateral passage). CONCLUSION(S): Modified hysterosalpingography was sufficient to diagnose tubal and pelvic mechanical factors. The procedure was associated with a significant reduction in self-reported pain and no medical complications.

Adult↗

PubMed2000

Double (consecutive) transfer of early embryos and blastocysts: aims and results.

OBJECTIVE: The aim of this study was to evaluate the consecutive transfer approach of early embryos and blastocyst(s). DESIGN: Case-control study. SETTING: Public assisted reproduction technology unit. PATIENT(S): The study population consisted of three groups. In Group 1, a double transfer was performed on 136 consecutive women, that is, a standard transfer of embryos on day 2 or 3, and a second transfer of a blastocyst(s). In Group 2, an early transfer of only two embryos and a second transfer of one blastocyst were performed on 29 women from group 1 who had more than three high-quality embryos available for early transfer. In Group 3, a single early transfer was performed on 139 consecutive women who received three high-quality embryos (controls). INTERVENTION(S): Early embryo transfer, extended culture of the spare embryos, and a second transfer of a blastocyst(s). MAIN OUTCOME MEASURE(S): Implantation and pregnancy rates. RESULTSs): No differences were detected among the three groups in either pregnancy or implantation rates (pregnancy: 36.8%, 41.4%, and 37.4%, respectively; implantation: 14.6%, 19.9%, and 19.8%, respectively). CONCLUSION(S): The double (consecutive) transfer of early embryos and blastocyst(s) does not offer any advantage over the traditional early transfer. This may be from the adverse effect of the second transfer on the implantation process.

Adult↗

PubMed2000

Follicle-stimulating hormone treatment for men with idiopathic oligoteratoasthenozoospermia before in vitro fertilization: the impact on sperm microstructure and fertilization potential.

OBJECTIVE: To assess the effect of FSH on sperm fertilization potential and sperm intracellular structure in men with oligoteratoasthenozoospermia and a proven low fertilization rate in IVF. DESIGN: Prospective, randomized, partial crossover study. SETTING: IVF Unit, Golda Campus, Rabin Medical Center, Petah Tikva, Israel. PATIENT(S): Forty normogonadotropic, normogonadal men with oligoteratoasthenozoospermia and at least one previous IVF attempt in which fertilization failed or the fertilization rate was <30%. INTERVENTION(S): The men were randomly assigned to treatment with daily injections of 75 IU of FSH or 150 IU of FSH for at least 60 days before IVF treatment. A control group of men underwent an IVF cycle without treatment and then were randomly assigned tojoin group 1A or 1B for an additional IVF cycle with treatment. MAIN OUTCOME MEASURE(S): LH, FSH, and testosterone levels during FSH treatment, evaluation of ultramorphologic changes in sperm by electron microscopy, and comparison of fertilization rates in the control and study groups. RESULT(S): After treatment with 75 IU or 150 IU of FSH, the mean fertilization rates were 19.7% and 20.5%, respectively, compared with a 5.8% fertilization rate in the study control cycles. CONCLUSION(S): Prolonged treatment with FSH results in a significant increase in fertilization rates. This effect may be related to improvements in subcellular components of the sperm.

Acrosome↗

PubMed2000

Predictive value of transvaginal sonography performed before routine diagnostic hysteroscopy for evaluation of infertility.

OBJECTIVE: To compare transvaginal sonography with hysteroscopy for the evaluation of intrauterine disorders. DESIGN: Clinical study. SETTING: Academic research environment. PATIENT(S): Patients who were undergoing initial evaluation for primary or secondary infertility or investigation after three failed IVF attempts. INTERVENTION(S): Transvaginal sonography was performed, followed by hysteroscopy, between January 1998 and April 1999. The endometrial findings at sonography were compared with those at hysteroscopy, which served as the gold standard. The characteristic sonographic features of intrauterine adhesions were defined. MAIN OUTCOME MEASURE(S): Intrauterine adhesions, endometrial polyps. RESULT(S): The sensitivity, specificity, and positive and negative predictive values for transvaginal sonography in detecting abnormal uterine cavities were 100%, 96.3%, 91.3%, and 100%, respectively. The corresponding values for the specific diagnoses of intrauterine adhesions and endometrial polyps were 80%, 100%, 100%, and 97%, and 71.4%, 100%, 100%, and 97.1%, respectively. On transvaginal sonography, intrauterine adhesions appeared as hyperechoic endometrial foci and were differentiated from endometrial polyps by their irregular shape and more precise localization. The performance of transvaginal sonography at midcycle (three-layer endometrium) rather than after menstrual cessation (endometrial thickness <3 mm) enabled better imaging of small intrauterine adhesions. CONCLUSION(S): A regular myometrial-endometrial interface and homogeneous endometrial structure on transvaginal sonography congruent with the phase of the menstrual cycle indicated a normal endometrium and precluded the need for diagnostic hysteroscopy. Transvaginal sonography may be used as the initial diagnostic procedure to select patients for hysteroscopy.

Adult↗

PubMed2000

Is diagnostic testicular fine needle aspiration necessary in azoospermic men before sperm aspiration/extraction for intracytoplasmic sperm injection cycles?

PURPOSE: To determine whether diagnostic testicular fine needle aspiration (TEFNA) sampling needs to be performed in azoospermic men prior to obtaining testicular sperm cells for IVF-ICSI procedures. METHODS: Ten azoospermic patients underwent TEFNA in 1993-1996. During 1997, all patients underwent testicular sperm aspiration (TESA) and/or testicular sperm extraction (TESE) to retrieve spermatozoa for IVF-ICSI cycles. The results of the two procedures performed in two separate hospitals were compared. RESULTS: Diagnostic TEFNA revealed spermatozoa in five patients; identical results in four were found during IVF-ICSI cycles. In three patients, only Sertoli cells were found on TEFNA, in two of them TESA/TESE showed identical results, and in one, two spermatozoa were detected by Cyto-SEM. In the remaining two patients, spermatids or spermatocytes were found on both procedures. CONCLUSIONS: There was a very good correlation between the diagnostic and therapeutic procedures. We suggest that in azoospermic patients, diagnostic TEFNA is valuable in order to avoid unnecessary controlled ovarian hyperstimulation in the female partner for IVF. In patients in whom spermatozoa are detected, cryopreservation may be performed for later IVF-ICSI cycles.

Biopsy, Needle↗

PubMed2000

Outcome of pregnancies derived from assisted reproductive technologies: IVF versus ICSI.

PURPOSE: To compare the course and outcome of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) pregnancies. METHODS: A retrospective study was conducted in a university-affiliated IVF unit with 200 patients who conceived in 1996-1997, 100 with ICSI and 100 with IVF. Data were retrieved from our prospectively created computerized database. In addition, all patients were interviewed by telephone, and the interviewing physician completed a detailed questionnaire. Findings for the IVF and ICSI pregnancies were compared. The main outcome measures were maternal age, implantation rate, early pregnancy complications, clinical abortion rate, multiple pregnancy delivery rate, gestational age at delivery, mode of delivery, and birth weight. RESULTS: In all, 238 children were born, including 104 singleton infants (45 IVF, 59 ICSI), 49 twin pairs (28 IVF, 21 ICSI), and 12 triplet sets (3 IVF, 9 ICSI). Statistically significant differences between the ICSI and IVF groups were noted for maternal age (31.3 +/- 4.4 vs. 33.4 +/- 4.8, respectively, P < 0.005) and clinical abortion rate (11% vs. 24%, respectively, P < 0.05). CONCLUSIONS: ICSI pregnancies in our series were characterized by a lower clinical abortion rate than IVF pregnancies, probably because of the mean younger age of the ICSI group.

Abortion, Spontaneous↗

PubMed2000

Sonographic visualization of normal-size ovaries during pregnancy.

OBJECTIVE: To assess the ability of ultrasound to detect ovaries of normal size during pregnancy METHODS: A prospective study of 329 women with a normal pregnancy course was undertaken; 68 were excluded from analysis because of an enlarged, cystic ovary. Of the remainder, 60 pregnancies were examined in the first trimester and 201 in the second or third trimester. The first group underwent transvaginal (TVS) and transabdominal (TAS) scanning. The second group underwent TAS examination only. RESULTS: In the first-trimester group, TVS identified both ovaries in 57 patients (95%) and transabdominal ultrasound in 20 (33.3%). In the second- and third-trimester patients, TAS visualized both ovaries in 33 patients (16.4%), and neither ovary in 120 (59.7%). Both ovaries were less visible with advancing gestational age. The right ovary showed a significant change in position during pregnancy, from about 1 cm (at 15-24 weeks) to 2.5 cm (at 30-41 weeks) cranial to the iliac spine. The left ovary was found 1 cm above the iliac spine throughout pregnancy. CONCLUSIONS: Transvaginal sonography is adequate for the visualization of both ovaries in the first trimester of pregnancy. With advanced gestational age, the ovaries were significantly less visible by TAS. Sonographic scanning of the ovaries in second and third trimester should be concentrated mainly at the level of the iliac spine. Poor sonographic visualization of both ovaries in late gestation may mandate the use of other imaging modalities.

Analysis of Variance↗

PubMed2000

Polycystic ovary syndrome: a single gene mutation or an evolving set of symptoms.

Polycystic ovary syndrome is one of the most common endocrinopathies among women. Nevertheless, there is no one single acceptable definition for this syndrome, its pathophysiology is not completely understood and its etiology remains an enigma. Several studies have examined the genetic basis of polycystic ovary syndrome with varying results, probably caused by the different criteria used to define the syndrome. These studies, together with studies that deal with reclassification of polycystic ovary syndrome, are described in the following review. Furthermore, a simplified alternative approach to this symptom complex is proposed.

Female↗

PubMed2000

Controlled ovarian hyperstimulation--a state of endothelial activation.

PROBLEM: To aim of the study was to investigate whether controlled ovarian hyperstimulation (COH) causes endothelial activation and whether there is a correlation between endothelial activation and serum sex-steroid levels. METHOD OF STUDY: The study population consisted of 14 consecutive patients undergoing our routine IVF long gonadotropin-releasing hormone-analog protocol. Blood was drawn three times during the COH cycle: (1) day when adequate suppression was obtained (Day-S); (2) on the day of or the day prior to hCG administration (Day-hCG); and (3) on the day of ovum pick-up (Day-OPU). The levels of sex steroids and plasma soluble endothelial (E)-selectin were compared among the time points. Soluble E-selectin was measured with a commercial sandwich enzyme-linked immunosorbent assay. RESULTS: Soluble E-selectin levels were significantly higher on Day-OPU than Day-S and Day-hCG, whereas no difference was observed between Day-hCG and Day-S. No significant correlations were found between soluble E-selectin level and patient age, number of gonadotropin ampoules used, number of oocytes retrieved, or serum estradiol, progesterone and human chorionic gonadotropin levels. CONCLUSIONS: Human chorionic gonadotropin administration leads to endothelial activation regardless of the degree of ovarian response. Further studies are required to elucidate the relationship between COH and endothelial activation. These findings may lead to new strategies for predicting and preventing complications of COH, such as severe ovarian hyperstimulation syndrome.

Adult↗

PubMed2000

Severe unilateral hydrothorax as the only manifestation of the ovarian hyperstimulation syndrome.

BACKGROUND: Unilateral hydrothorax is rarely the sole manifestation of the ovarian hyperstimulation syndrome (OHSS) and is suggestive of the severity of the disease. CASE: A 35-year-old woman presented with mild dyspnea 2 weeks after ovarian stimulation with hMG and hCG and IVF-ET. Chest X-ray revealed a large pleural effusion on the right side. Three consecutive thoracocenteses were needed to drain a total of 6,800 cm(3) of fluid. Following drainage, the respiratory symptoms disappeared. An uneventful pregnancy is in progress. CONCLUSIONS: Thoracocentesis is safe and efficient for the treatment of hydrothorax and may be repeated as often as necessary. Clinicians should be aware of the possibility of unilateral hydrothorax as the sole symptom of OHSS.

Adult↗

PubMed2000

Hyperemesis gravidarum during Ramadan.

During Ramadan, adult Muslims fast from dawn to dusk. We frequently encounter young pregnant Muslim women with hyperemesis gravidarum who fast during this holy month. We have investigated whether there is an association between the prolonged fasting during Ramadan and excessive vomiting during pregnancy. Possible psychologic and physiologic explanations are presented and discussed.

Fasting↗

PubMed2000

Gonadotropin stimulation following GnRH-a priming for poor responders in in vitro fertilization-embryo transfer programs.

The effect of gonadotropin-releasing hormone agonist (GnRH-a) administration before gonadotropin superovulation on the stimulation characteristics of poor responder patients was assessed in an in vitro fertilization (IVF) program. Thirty consecutive patients who had exhibited low ovarian response (fewer than four retrieved oocytes) in at least two previous IVF cycles (control cycles, n = 60), were eligible for the study. GnRH-a (nafarelin) was administered daily for 7-10 days from the mid-luteal phase of the previous cycle until the first day of menstruation. Menotropin treatment was commenced on cycle day 3 (with no additional GnRH-a) (study cycles, n = 39). A significantly higher number of oocytes was retrieved (p < 0.0002) and a higher number of embryos transferred (p < 0.003) in the study cycles than in the control cycles. No cases of premature luteinizing hormone surge were recorded. Pregnancy rates per embryo transfer and per cycle were 10.4% and 7.7% for the study cycles and 2.8% and 1.6% for the control cycles, respectively. GnRH-a, administered prior to gonadotropin treatment, should be an additional option of ovulation induction protocol for poor responders in IVF programs.

Administration, Intranasal↗

PubMed2000

Natural-cycle in vitro fertilization in women aged over 44 years.

Women who are 44 years of age or more are usually denied infertility treatment because of their low response to ovarian stimulation and the extremely low pregnancy rate that can be achieved. The object of this study was to assess the place of natural-cycle in vitro fertilization (IVF) in this population. From January 1996 to September 1997, all consecutive women aged 44-47 years who approached our unit seeking infertility treatment with their own oocytes were enrolled in the study. After a counselling session in which the advantage of egg donation was discussed, women who still wished to try to conceive by utilizing their own oocytes were treated according to the following protocol. Ultrasound and hormonal surveillance was carried out starting 5 days prior to the presumed ovulation day, based on previous menstrual history. Ovum pick-up was timed either by detection of the luteinizing hormone surge or by human chorionic gonadotropin administration. In total, 48 treatment cycles were conducted in 20 women. Oocyte retrieval was successful in 22 cycles. Fertilization and cleavage rates of 48% and 100%, respectively, were detected. Nine of the 12 embryos transferred were defined as grade A. One chemical and one ongoing pregnancy were achieved. We conclude that, despite the fact that high-quality embryos can be obtained in this population, the likelihood of pregnancy is low.

Adult↗

PubMed2000

Pregnancy potential of embryos from in vitro fertilization compared to intracytoplasmic sperm injection.

The aim of this study was to investigate whether equally high-quality embryos derived from standard in vitro fertilization (IVF) or from intracytoplasmic sperm injection (ICSI) differ in pregnancy potential. We evaluated all consecutive cycles from January 1996 to December 1997, in which only high-quality embryos were transferred. A total of 171 IVF and 148 ICSI cycle procedures, conducted in 153 and 130 women respectively, met with the inclusion criteria. A higher clinical pregnancy rate was recorded for the IVF group than the ICSI group (35% versus 29% respectively), although the difference did not achieve statistical significance. This result was detected despite the significantly higher mean age of the IVF patients compared with the ICSI patients (35 +/- 4.9 years and 33 +/- 5.2 years respectively). Controlling for the effect of patient age using linear regression analysis yielded a significantly higher clinical pregnancy rate for IVF therapy. In conclusion, IVF is associated with a significantly higher clinical pregnancy rate than ICSI even when high-quality, morphologically comparable embryos are utilized.

Adult↗

PubMed2000

The rationale for requesting a second consecutive sperm ejaculate for assisted reproductive technology.

We assessed the value of requesting a second semen sample provided within 1 hour of the first in cases of unacceptable ejaculate quality (compared to previous occasions) or very poor semen characteristics. The study population consisted of 109 males with severe oligo-terato-astenospermic (OTA) syndrome in an assisted reproduction program. Semen volume, sperm count and sperm motility were recorded in the first and second samples with a Makler Counting Chamber before sperm processing, and total motile sperm in the ejaculate was calculated. Differences in sperm parameters between the consecutive samples were determined by paired-sample t test. In 36 cases (33%) the second sample was found to be superior in quality to the first and was therefore used for the fertilization process. Of the 12/109 cases in which the first ejaculate demonstrated no motile sperm, five (41%) had detectable motile sperm in the second (total 0.1 x 10(6), 0.2 x 10(6), 0.3 x 10(6), 8.4 x 10(6) and 20.8 x 10(6)). We conclude that a request for second ejaculate immediately after the first in males with poor semen quality or no detectable motile sperm can yield a better sample in a significant percentage of cases. Using this method, clinicians can avoid the utilization of elaborate sperm processing techniques and the need for unnecessary micromanipulative fertilization.

Ejaculation↗

PubMed2000

Pregnancy outcome in women with primary renal disease.

BACKGROUND: The preconception and intraconception parameters that are relevant to outcome in women with underlying renal disease remain controversial. OBJECTIVES: To analyze the types and frequencies of short- and long-term (2 years after delivery) maternal and neonatal complications in 38 patients with primary renal disease (46 pregnancies), most of them with mild renal insufficiency. METHODS: Logistic regression models were formulated to predict successful outcome. RESULTS: Successful pregnancy outcome (live, healthy infant without severe handicap 2 years after delivery) was observed in 98% of the patients with primary renal disease. Factors found to be significantly predictive of successful outcome were absence of pre-existing hypertension, in addition to low preconception serum uric acid level. CONCLUSIONS: Most women with primary renal disease who receive proper prenatal care have a successful pregnancy outcome. Worse pregnancy outcome was observed in women with moderate or severe renal failure. Fitted logistic models may provide useful guidelines for counseling women with preexisting renal disease about their prospects for a successful pregnancy in terms of immediate and long-term maternal and neonatal outcome.

Female↗