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PubMed1989

Immunoreactive renin variations during fertile and infertile hyperstimulated cycles with in-vitro fertilization and embryo transfer or gamete intra-fallopian transfer.

The concentrations of prorenin (PR) and active renin (AR) were determined sequentially during ovarian hyperstimulated cycles for in-vitro fertilization-embryo transfer or gamete intra-Fallopian transfer. AR and PR increased during the early luteal phase and PR was highly correlated with the progesterone concentration. In fertile cycles, AR increased more rapidly after HCG injection and AR and PR levels were significantly higher during the late luteal phase. These results confirm the role of the renin angiotensin system in ovarian physiology.

Adult↗
PubMed1990

Assisted fertilization in infertile women with patent fallopian tubes. A comparison of in-vitro fertilization, gamete intra-fallopian transfer and tubal embryo stage transfer.

A comparison of the relative efficacy of in-vitro fertilization with uterine embryo transfer (IVF), tubal embryo stage transfer (TEST) and gamete intra-Fallopian transfer (GIFT) was performed in infertile patients with patent Fallopian tubes. A total of 150 couples with unexplained infertility, peritoneal endometriosis or reduced semen quality were included in the study. The three groups were comparable with regard to age distribution, indications, semen parameters, stimulation regimens, response to stimulation and numbers of oocytes retrieved. In the IVF and TEST groups there was no cleavage in 24% and a cleavage rate of only 47.6%. The highest cleavage rate was obtained in the endometriosis patients. The pregnancy rate was highest in the two groups in which in-vitro fertilization was performed, IVF = 45.7%, TEST = 37.9%, GIFT = 26.2%. To obtain one live intrauterine fetus, more oocytes had to be transferred in the GIFT group compared to the number of embryos in the IVF group, 14.4 versus 6.2, P less than 0.05. Due to a high success rate of IVF but at the same time a high frequency of no cleavage in cases of unexplained infertility or male subfertility, we recommend IVF as the primary procedure in infertile couples with patent Fallopian tubes.

Adult↗
PubMed1993

Pregnancy and implantation rates in normal replacement versus stimulated cycles.

The relative importance that endometrial development and embryo quality have on implantation rates achieved with assisted reproductive technology (ART) is the subject of controversy. Ovarian stimulation has been repeatedly mentioned as having a detrimental effect on endometrial receptivity (Paulson et al., 1990, Fertil. Steril., 53, 870-874). We compared pregnancy and implantation rates achieved with ART during stimulated cycles and hormonal replacement cycles, in patients matched for the following criteria: age < 35 years for the patient donating oocytes; transfer of at least two good quality embryos/oocytes and good quality transfer. All transfer cases performed during hormonal replacement cycles were done with donated oocytes. Comparison of results between techniques was not attempted due to potential differences in populations. The pregnancy and implantation rates achieved with each technique during stimulated and hormonal replacement cycles were not statistically different. In contradiction to previous results, our data suggest that differences in uterine receptivity between stimulated and hormonal replacement cycles in the age group studied are not of critical importance in embryo implantation. Good embryo quality appears to be the dominant factor in determining the success of ART.

Adult↗
PubMed1993

Analysis of the risk factors with regard to the occurrence of ectopic pregnancy after medically assisted procreation.

In a retrospective study (1985-1989) based on data from the Centre for Reproductive Medicine in Brussels, a total of 23 ectopic pregnancies (2.24%) occurred after 3800 embryo, zygote or gamete transfers. This number was low compared with the data published elsewhere. Tubal damage was a major risk factor towards developing an ectopic pregnancy after in-vitro fertilization and embryo transfer. The number of ectopic pregnancies after the association of clomiphene citrate and human menopausal gonadotrophin (HMG) was significantly higher in patients with tubal (7.8%) and non-tubal indications (2.1%) compared with those stimulated with gonadotrophin-releasing hormone (GnRH) and HMG (2.18% and 0.84%, respectively). The number of replaced embryos was not associated with the rate of ectopic pregnancy and neither did transfer technique (intra-uterine or intra-Fallopian transfer) influence the ectopic pregnancy rate.

Adult↗
PubMed1992

The spontaneous LH surge in ovarian hyperstimulation for assisted reproductive technology.

Thirty-seven patients who underwent assisted reproductive technology programme, in vitro fertilisation or embryo transfer and gamete intra-fallopian transfer, were randomised into two groups in order to evaluate frequency of premature spontaneous LH surge when stimulated with different type of hMG. An hMG (FSH:LH = 1:1) was administered for eighteen patients (group A) and the different highly purified hMG (FSH:LH = 19:1) was administered for nineteen patients (group B). Blood samples are drawn from day 3 of the cycle until hCG administration, and serum LH level are measured in the frozen samples. There were no statistical difference in the total amount of hMG used before hCG injection, days of hMG injection and the number of oocytes retrieved between two groups. The premature spontaneous LH surge occurred only one patient in group A (5.6%), but more frequent LH surge was observed in group B (42.1%) (p < 0.05). It is suggested that the different FSH/LH ratio may be the reason for the difference of the incidence of premature spontaneous LH surge.

Chorionic Gonadotropin↗
PubMed1991

[Multifactorial analysis of patients with endometriosis in an institutional program of assisted reproduction].

It is a retrospective and transverse study with an analysis of results from patients submitted to intrauterine insemination (IIU), intratubal gamete transfer (GIFT) and in vitro fertilization and embryo transfer (FIVTE), at the Clinic of Assisted Reproduction, Instituto Nacional de Perinatología in Mexico City. From 134 cycles of patients submitted to IIU, 113 corresponded to women with diagnosis of sterility from non determined cause, and 21 to cases with endometriosis, and at least one permeable tube. From the first group, 22 pregnancies were obtained, for a monthly fertility rate of 19.4%; and from the second one, 12 pregnancies with a fertility rate of 56%. This, which is very high , may be explained by the relatively small number of cases in the second group, or else, by the influence of a previous medical treatment for endometriosis; the square Chi analysis shows a P less than 0.01 in the two groups. In the GIFT and FIVTE cases, from which 35 cycles were analyzed, per each procedure, there were 10 pregnancies, 9 for GIFT and one for FIVTE; the amount is very limited in order to obtain conclusions, but it seems that there is a proportional tendency in GIFT to less amount of pregnancies in women with endometriosis. The analysis of hormonal follow up did not show differences in the groups, and the averages may be useful to determine, early, the cancellation, or not, of an stimulation cycle. Finally, in FIVTE cases there is a diminution of fertilization index in women with endometriosis (53%), as compared with the cases without disease (80%).(ABSTRACT TRUNCATED AT 250 WORDS)

Cross-Sectional Studies↗
PubMed1988

[Immunoradiometric assay for active renin and plasma prorenin during cycles stimulated by IVFET or GIFT].

Prorenin (PR) an inactive high molecular weight form of renin normally circulates in human plasma at a concentration of about 10 times that of active renin (AR) and this proenzyme seems to be linked to the reproductive function. It has been demonstrated that AR and PR are present at high concentrations in follicular fluid when the ovaries are stimulated with gonadotropins and that the PR plasma levels increase steadily after hCG injection with a correlation between blood PR and the number of developing follicles and corpora lutea. From September 1986 we studied the profile of immunoreactive active renin (AR) and prorenin (PR) in plasma during hyperstimulated cycles for IVFET or GIFT. All women were treated with a protocol combining GnRH analog (Decaptyl Ipsen Biotech, Paris France) and human menopausal gonadotropins until injection of 5,000 IU hCG. AR has been assayed in frozen samples by specific immunoradiometry (Renin RIA code 79 795, Pasteur Diagnostic, France) using two complementary monoclonal antibodies. A second assay of total renin was carried out after trypsin activation which revealed the inactive form. Progesterone (P), estradiol (E2) were measured by radioimmuno-assays. During the follicular phase, from day 1 of hMG administration to the day before hCG, no significant difference could be found between two groups, 63 pregnant or 60 nonpregnant cycles matched for age and number of oocytes retrieved, for E2, P, PR and AR. During the periovulatory period (D - 1, Do = day of hCG injection and D 1) no difference could be found for E2, P and PR (tabl. 1). In the 2 groups the mean E2 levels increased after hCG injection, as well as P and PR. But a significant difference appeared for AR which increased in the plasma immediately after hCG administration in the pregnant group whereas it decreased in the non-pregnant group (+2.5 vs -2 pg/ml) the mean variation between Do and D + 1 being significantly different in fertile cycles and in nonfertile cycles.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1992

Local anesthesia with conscious sedation for laparoscopic intrafallopian transfer.

Local anesthesia with conscious sedation is well accepted by patients and provides scheduling flexibility, cost containment, patient safety, and ease of recovery. We believe the technique should be offered to selected patients undergoing intrafallopian transfer. By adhering to specific guidelines for surgical technique and monitoring, the procedure is a safe and acceptable alternative to general anesthesia for laparoscopic intrafallopian transfers.

Adult↗
PubMed1993

Elevated serum inhibin levels and suppressed luteinizing hormone surge in young patients stimulated with gonadotropins.

The physiological role of inhibin and its relation to other sex hormones (estradiol, progesterone, follicle stimulating hormone (FSH) and luteinizing hormone (LH)) has been investigated during gonadotropin-stimulated cycles of 38 in vitro fertilization-embryo transfer/gamete intrafallopian transfer (IVF-ET/GIFT) patients. Human menopausal gonadotropin (hMG) was given from day 3 of the cycle until 1 day before ovulation induction with human chorionic gonadotropin (hCG). Blood samples were taken twice daily and hormone measurements performed by radioimmunoassay or enzyme immunoassay. Patients were divided into two groups: Group A comprised patients < 35 years of age (n = 20) and Group B included patients > or = 35 years of age (n = 18). The pregnancy rate was significantly higher in Group A. During the follicular phase, serum inhibin level rose gradually in both groups but the values were higher in Group A (significantly between days -2 and 0). During the early luteal phase serum inhibin concentrations were similar in both groups. Estradiol pattern did not differ in the two groups. Estradiol pattern did not differ in the two groups. Whilst serum estradiol level did not increase significantly after day 0, serum inhibin concentration reached its peak value 1 day later, on day +1. Serum progesterone was higher in Group A between days +1 and +4 (significantly on days +1, +3 and +4). Serum FSH increased slowly in both groups and did not correlate with serum inhibin concentration. Basal LH concentrations were similar between days -6 and -2 in both groups. Around the time of ovulation induction (day -1, 0 and +1) serum LH was lower in Group A (significantly on day 0).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Assessing congenital anomalies after preimplantation genetic diagnosis.

BACKGROUND: Preimplantation genetic diagnosis is an exciting advance in prenatal diagnosis. However, the safety of embryo biopsy must be determined with respect to both pregnancy rate and cogenital anomalies. ANALYSIS: Too few pregnancies have been reported to allow meaningful inferences to be drawn, for which reason data on pregnancy losses and anomalies after conventional IVF were first reviewed. Loss rates are approximately 25%, and anomaly rates are not increased over that observed in the general population. Unfortunately, considerable methodological problems exist in published surveys: lack of proper controls, failure to take into account potential confounding variables, anomaly surveillance that is inconsistent with respect to the vigor with which anomalies are sought, inclusion or exclusion of minor anomalies, inclusion or exclusion of anomalies evident only on ultrasound, and even inclusion or exclusion of anomalies present in terminated pregnancies. We recommend prospective surveillance for major anomalies, defined as those causing death, major handicap or requiring surgery. Prospective surveillance ideally dictates collection of intake information at the time pregnancy is diagnosed, surveillance during pregnancy to exclude teratogenic influences, and systematic neonatal anomaly surveillance.

Abortion, Spontaneous↗
PubMed1991

Cryopreservation of human embryos at the pronucleate, early cleavage, or expanded blastocyst stages.

Supernumerary embryos following treatment by IVF or GIFT were cryopreserved at the pronucleate, early cleavage or expanded blastocyst stages. The success of embryo cryopreservation at these stages was evaluated in terms of (i) the proportion of embryos surviving the freeze/thaw procedure; (ii) the proportion of patients reaching embryo replacement; and (iii) the incidence of pregnancy per replacement. Significantly more embryos survived when frozen/thawed at the pronucleate (44/61; 72%) or early cleavage stages (48/80; 60%), than at the expanded blastocyst stage (13/34; 38%). A significantly higher proportion of patients had embryo replacements when embryos were frozen/thawed at the pronucleate (17/19; 89%) or early cleavage stages (21/24; 88%), than at the expanded blastocyst stage (9/17; 53%). Following replacement of frozen/thawed pronucleate and early cleavage stage embryos, clinical pregnancy rates of 8/17 (47%) and 3/21 (14%) clinical pregnancies were achieved, respectively. No pregnancies were achieved following replacement of frozen/thawed expanded blastocysts.

Blastocyst↗