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At least 721 records · Page 40Linked to original sources

PubMed1992

Transvaginal embryo aspiration--a safe method for selective reduction in multiple pregnancies.

OBJECTIVE: To evaluate pregnancy outcome after transvaginal selective embryo aspiration and to compare the results with those reported previously with other techniques for selective abortion. DESIGN: Retrospective case series. SETTING: University-based in vitro fertilization (IVF) program. PATIENTS: Nineteen women with multiple pregnancy who conceived after ovulation induction or IVF/gamete intrafallopian transfer. INTERVENTION: Transvaginal ultrasound-guided aspiration of the embryo(s) was performed at 7 to 8 weeks of gestation. MAIN OUTCOME MEASURES: Early and late complications related to the procedure, outcome of pregnancy, and birth weight. RESULTS: In 18 cases, the initial number of embryos (3 to 7) was reduced to two. In 1 case, the number of embryos was reduced from 4 to 3. None of the remaining fetuses vanished after the procedure. One patient delivered at 25 weeks and all other patients delivered healthy, viable infants (a pregnancy loss rate of 5.3%). CONCLUSIONS: Transvaginal embryo aspiration in early gestation appears to be a simple and relatively safe procedure for selective termination in patients with high-order multiple pregnancy. The cumulative loss rate of selective termination procedures previously reported by others is three times higher than the loss encountered in our series. This earlier procedure may be more acceptable to patients from emotional and religious points of view.

Abortion, Induced↗

PubMed1990

Factors affecting the outcome of assisted conception.

In order to assess the major biological and clinical factors which influence the outcome of both IVF and GIFT, the results of a large GIFT series performed in this unit have been analysed over a time interval when two different policies have been in force as to the number of oocytes that should be transferred. The reason for using GIFT data, as opposed to IVF, is simply because it is more difficult to adversely affect the outcome of GIFT treatment, as opposed to IVF, and hence this allows more critical appraisal and interpretation of results. The GIFT series to be described was conducted between March 1986 and October 1987, when a flexible policy on the number of oocytes for transfer was in operation. Since then a fixed policy has been in force at the request of the Hospital's Ethics Committee and the Voluntary Licensing Authority (now the Interim Licensing Authority), whereby three, or exceptionally four, oocytes are transferred irrespective of individual patient's circumstances because of concern about the relative risk and sequelae of multiple pregnancy and selective reduction of pregnancy. I still believe, however, that some infertile couples have a lower chance of pregnancy with assisted, or natural conception and also a lower risk of multiple pregnancy and that it is therefore important to assess the biological and clinical factors influencing fecundity in order to formulate appropriate treatment policies.

Adult↗

PubMed1994

Prospective study of a modified gonadotropin-releasing hormone agonist long protocol in an in vitro fertilization program.

OBJECTIVE: To determine if pituitary suppression is still maintained if GnRH agonist (GnRH-a) is discontinued as gonadotropin stimulation is begun in a long protocol. DESIGN: Prospective, randomized study. SETTING: An outpatient IVF-GIFT program. PATIENTS: One hundred seventy-three patients entering an IVF-GIFT program. INTERVENTIONS: Gonadotropin-releasing hormone agonist in long protocol was either discontinued or continued as gonadotropin stimulation was begun. MAIN OUTCOME MEASURES: Luteinizing hormone (LH), E2, and P levels, egg numbers, fertilization rate, number of embryos transferred, day of gonadotropin stimulation, and pregnancy rates (PRs). RESULTS: Pituitary suppression was maintained although GnRH-a was discontinued as gonadotropin stimulation was begun. No spontaneous LH surge was seen, and PRs were increased in the IVF patients. CONCLUSION: This study indicates that the advantages gained from use of GnRH-a in the long protocol are not compromised by its early discontinuation.

Adult↗

PubMed1988

GIFT and IUI in the district general hospital.

Recent reports on gamete intra-Fallopian transfer (GIFT) in hospitals without IVF support have been encouraging. We report on the use of GIFT and intrauterine insemination (IUI) at Northampton General Hospital, where capital costs for setting up the programme have been low. To date seven IUI and three GIFT treatments have been completed, resulting in three IUI positive pregnancy tests. One miscarried after several positive beta-HCGs and one GIFT pregnancy was achieved.

Adult↗

PubMed1992

The first oocyte donation pregnancy home-bred and delivered in Singapore to illustrate a simplified oocyte donation programme--no more embryo freezing, synchronisation or disruption of social life.

The wait for an oocyte donor is highly unpredictable and stressful. The recipients may have to remain contactable at all times. Even when a donor is present, their reproductive cycles may not be in synchrony to enable gamete or embryo replacement, and embryo freezing is required for the transfer of embryos in the subsequent cycle. After the release of the Guidelines for Assisted Reproductive Technique by the Ministry of Health we have established a simplified oocyte donation programme with which the need for synchronisation, embryo freezing and the disruption to the recipient couple's social life are eliminated. To illustrate, we report the first report of oocyte donation pregnancy home bred and delivered in Singapore.

Adult↗

PubMed1989

[Clomiphene as an inducer of multiple follicular growth].

In our IVF + ET & GIFT programs we gave 100 mg of clomiphene from cycle days 2 to 6 in 35 cycles of 32 infertile patients. Serum estradiol curves were made establishing 3 types of curves: 1. climbing curve which was subdivided in curve A (6 cycles) with more than 600 pg/mL of estradiol, more than 4 follicles of a mean size of 35 mm; curve B (13 cycles) with an estradiol range from 300 to 600 pg/mL, 2.9 follicles of 24 mm and curve C with less than 300 pg/mL of estradiol, 0.8 follicles of 22 mm. 2. Flat curve with minimum estradiol level and follicle size and 3. Irregular curve with atypic variations that probably reflect oocyte atresia and cyst formation. The progesterone level in the luteal phase was parallel to the estradiol. There was evidence of multiple follicular growth in 20 cycles (57%). Nine laparoscopies for ovum capture were made, collecting a mean of 1.2 oocytes per laparoscopy; they were fertilized in vitro and later transferred 4 embryos and 4 oocytes were transferred to the fallopian tubes. There was at most one mature oocyte per laparoscopy. No pregnancies were achieved. The clomiphene as a single agent, for its wide availability, might be choice for some women that show a good response, which might depend on several factors, but it cannot be considered the ideal single agent for programs that include ovum pick ups.

Adult↗

PubMed1989

Delayed occurrence of an LH surge after HCG administration during ovarian stimulation with gonadotrophins: effect of LHRH treatment.

Previous studies have shown the appearance of a spontaneous luteinizing hormone (LH) surge after human chorionic gonadotrophin (HCG) administration in human menopausal gonadotrophin (HMG)/HCG-stimulated menstrual cycles. In this report we investigated the effect of leuprolide acetate, a long-acting luteinizing hormone releasing hormone (LHRH) agonist, on the occurrence of these post-HCG rises in serum LH. Two groups of patients were included. Group 1: 10 patients receiving HCG as a part of an HMG/HCG protocol for induction of follicular development in an IVF/GIFT program and Group II: 10 patients treated as Group I, but receiving the LHRH agonist leuprolide acetate to inhibit gonadotrophin secretion prior to and during ovarian stimulation. In Group I, none of the patients showed a surge prior to HCG administration. However, an LH surge following HCG treatment was apparent in four patients (40%). Pregnant patients (2/10) had low mean levels (less than or equal to 2.5 mIU/ml LH) in the follicular phase and showed no LH surge after HCG. In Group II, baseline levels of serum LH were reduced significantly (mean, 1.4 +/- 0.1 mIU/ml; P less than 0.001) compared to Group I. No patient showed an LH surge either before or after HCG administration and the occurrence of pregnancy was higher (6/9 transfers) than in Group I. In spite of the differences in pregnancy rates, the combined therapy versus HMG therapy showed no significant difference in number of oocytes collected or serum oestradiol levels. This suggests that high levels of serum LH, whether prior to or after HCG administration, may have a detrimental effect on the establishment of pregnancy despite adequate follicular growth.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

A prospective controlled study of in-vitro fertilization, gamete intra-fallopian transfer and intrauterine insemination combined with superovulation.

The relative effectiveness of in-vitro fertilization (IVF), gamete intra-Fallopian transfer (GIFT) and intrauterine insemination (IUI) combined with superovulation in the treatment of infertility were compared in 151 couples undergoing a single cycle of treatment. Treatment was selected as appropriate (IVF for tubal disease, GIFT or IUI/superovulation for nontubal infertility) but possible bias due to non-randomization was overcome by all couples having had favourable fertilization in a previous cycle of IVF. Furthermore, in a preliminary study of initial IVF treatment in 265 couples from whom the study patients were drawn, implantation and pregnancy rates in the diagnostic groups were similar. In the definitive study comparing IVF, GIFT and IUI/superovulation, the pregnancy rate observed with GIFT was highest (40%) but this was not significantly higher than with IVF (28%) or IUI/superovulation (20%). However, the implantation rate per egg transferred by GIFT (21%) was significantly higher than the implantation rate per embryo transferred by IVF (11%). Although the pregnancy rates with GIFT were not statistically greater than with IVF, a significant advantage is likely to be observed in larger groups in view of the better implantation rate. The lower pregnancy rates with IUI superovulation are to be expected because of limited ovarian stimulation, they are nevertheless of comparative interest.

Adult↗

PubMedDate not supplied

Management of a triplet gestation complicated by uterus didelphys.

BACKGROUND: Assisted reproductive technologies are making it possible for women to conceive when it was otherwise impossible. One of the side effects is multiple gestations. This may be especially disadvantageous when it occurs within an anomalous uterus. PATIENT AND METHODS: A 36-year-old women with the help of gamete intrafallopean transfer conceived triplets in a uterus didelphys. This pregnancy was further complicated by anencephaly of one of the triplets. The patient was managed by a combination of chorionic villi sampling and selective reduction that ended with the successful delivery of a term infant. CONCLUSION: Pregnancy reduction can be safely performed in a twin pregnancy on one side of a uterus didelphys. More reports will be required to determine whether this is the most optimal choice.

Adult↗

PubMed1989

Efficacy of the urinary hemagglutination test (Higonavis) and enzyme immunoassay (Ovustick) in detection of the spontaneous luteinizing hormone surge in an in vitro fertilization/gamete intrafallopian transfer (IVF/GIFT) program.

Fifty-eight treatment cycles in an in vitro fertilization/gamete intrafallopian transfer (IVF/GIFT) program were studied to compare the efficacy of two urinary methods, hemagglutination test (Higonavis) and enzyme immunoassay (Ovustick), in detection of spontaneous luteinizing hormone (LH) surge. If an isolated rise in urinary LH level was taken as indicative of LH surge, the false-positive rate was 36.7% for Higonavis and 10.2% for Ovustick. The difference was statistically significant (P less than 0.001). If only a sustained rise in urinary LH was taken to indicate LH surge, the false-positive rate was 6.1% for Higonavis and 0% for Ovustick. In the seven cycles with a spontaneous plasma LH surge, there was a positive correlation between the plasma LH levels and the two urinary assay methods in six cycles (85.7%). Compared to plasma LH, there was a mean delay of 17.4 hr by the Higonavis test and 15.6 hr by the Ovustick test. If a sustained rise in urinary LH levels was taken as indicative of LH surge, both methods are quite accurate but the Ovustick appeared to be more specific.

Evaluation Studies as Topic↗

PubMed2000

Comparison of culture and insemination techniques for equine oocyte transfer.

This study was designed to test 3 approaches for insemination and transfer of oocytes to recipient mares. Oocytes were recovered transvaginally from naturally cycling donor mares 24 to 26 h after an intravenous injection of 2500 IU of hCG when follicles reached 35 mm in diameter. Multiple oocytes (1 to 4) were transferred surgically into the oviducts of 4 or 5 recipient mares per group. Three groups of transfers were compared: 1) transfer of oocytes cultured in vitro for 12 to 14 h postcollection with insemination of the recipient 2 h postsurgery; 2) transfer of oocytes into the oviduct within 1 h of collection, with completion of oocyte maturation occurring within the oviduct, and insemination of the recipient 14 to 16 h postsurgery; and 3) transfer of spermatozoa and oocytes (cultured 12 to 14 h in vitro) into the oviduct. Numbers of embryos detected by Day 16 of gestation were not different (P>0. 1) for groups 1, 2, and 3 (57%, 43% and 27%). Therefore, equine oocytes successfully completed the final stages of maturation within the oviduct, and sperm deposited within the oviduct were capable of fertilizing oocytes.

Animals↗

PubMed1989

Birth from replacement of frozen-thawed embryos after failure of gamete intra-fallopian transfer: a successful pregnancy case.

The patient was 8 years subfertile and had failed other forms of treatment when she was enrolled in the GIFT program. Of the total of 16 oocytes recovered 4 were transferred and the remaining 12 inseminated with her husband's sperm. Four resulting embryos were frozen. When she did not conceive, the 4 embryos were thawed 3 months later and replaced into her. She conceived and recently delivered a pair of twins. The protocol will be discussed in detail. Cryopreservation of embryos therefore may increase the patient's chance of pregnancy in a GIFT program.

Adult↗

PubMed1999

A possible effect of different light sources on pregnancy rates following gamete intra-fallopian transfer.

A retrospective study of 34 sequential gamete intra-Fallopian transfer (GIFT) procedures suggested a significant effect on pregnancy rates associated with the different laparoscopic light sources, with a pregnancy rate of 50% in 22 cycles using a halogen light source and 9% in 12 cycles using a xenon light source. Other explanatory variables were explored, but none was to have a significant effect on the pregnancy rate. Further investigation revealed that the xenon light source emitted more ultraviolet light than the conventional halogen light source--suggesting a possible detrimental effect of ultraviolet light on the gametes in the GIFT procedure.

Adult↗

PubMed1992

Hydatidiform mole with coexisting twin pregnancy after gamete intra-fallopian transfer.

The pregnancy of a 31-year-old infertility patient is described. After gamete intra-Fallopian transfer, her pregnancy evolved uneventfully until the 18th week of gestation, when vaginal bleeding occurred. Ultrasonographic findings suggested a molar pregnancy with two live fetuses. At 24 weeks gestation, two male infants were spontaneously delivered. Fetal (46 XY) and molar (46 XX) karyotypes and post-mortem findings were consistent with a bizygotic twin pregnancy associated with a complete hydatidiform mole. The pathogenesis and obstetrical management are discussed.

Adult↗

PubMed1993

Does elective cryopreservation of all embryos from women at risk of ovarian hyperstimulation syndrome reduce the incidence of the condition?

OBJECTIVES: To analyse the incidence and factors associated with the ovarian hyperstimulation syndrome (OHS) in our IVF/GIFT programme before and after the introduction of a strategy to cryopreserve all embryos from women judged to be at risk. DESIGN: Two hundred forty-one consecutive IVF/GIFT cycles from January to December 1989. SETTING: Specialist fertility unit, Manchester, UK. INTERVENTIONS: Pituitary suppression was effected by a daily subcutaneous injection of buserelin (500 micrograms) beginning 7 days before the expected menses. The ovarian stimulation was with variable amounts of human menopausal gonadotrophin. Ovulation was induced with 10,000 i.u. human chorionic gonadotrophin (hCG). From January to May (period A), gametes/embryos were replaced and 2000 i.u. hCG given, irrespective of the serum oestradiol (E2) concentration. From June to December (period B), all the embryos from women with an E2 > 3500 pg/ml on the day of ovulatory trigger were electively cryopreserved. MAIN OUTCOME MEASURES: Serum E2, features of moderate or severe OHS, clinical pregnancies. RESULTS: The OHS occurred in 10/105 (9.5%) and 12/136 (8.8%) cycles in periods A and B, respectively. Fewer women (6% versus 60%, P < 0.05) who had their embryos cryopreserved developed severe OHS compared with women with an E2 > 3500 pg/ml who became pregnant after gamete/embryo transfer in period A. The main factors associated with the development of OHS were serum E2 concentrations > 3500 pg/ml, whether gamete/embryos were replaced and the additional hCG given, the occurrence of a pregnancy and the presence of polycystic ovary disease. CONCLUSION: The elective cryopreservation of all embryos from women with high E2 levels reduced the severity, but not the incidence of symptomatic OHS.

Adult↗

PubMed1992

Heterotopic pregnancy associated with gamete intra-fallopian transfer.

Recent reports in the literature have focused on the increased risk of heterotopic pregnancy after the transfer of multiple concepti or oocytes. In an international collaborative patient registry between 1985 and 1989, 601 clinical pregnancies resulted from 2092 gamete intra-Fallopian transfer (GIFT) retrieval cycles. Five of the pregnancies were heterotopic (0.83%). After surgical intervention, all five cases of combined gestation resulted in live birth from intrauterine pregnancies. Routine vaginal ultrasonographic examination of the adnexa in patients who conceive after GIFT may help early diagnosis of heterotopic pregnancy. If the diagnosis is made early, conservative treatment may preserve the future fecundity of the patient and more intrauterine pregnancies may be salvaged.

Female↗

PubMed1994

Refinements in the methodology of injection for transvaginal gamete intra-fallopian transfer.

Eighty-seven volunteer patients with non-tubal infertility initially intending to undergo gamete intra-Fallopian tube transfer (GIFT) via a transabdominal route were re-scheduled for ultrasound-guided transvaginal GIFT which was performed using a Jansen-Anderson tubal transfer set. Emphasis was placed on (i) definite ultrasound confirmation of the transfer catheter within the Fallopian tube, (ii) low transfer volumes (50 microliters), (iii) high sperm transfer densities and (iv) slow injection of gametes. Transvaginal Fallopian tube catheterization was possible in 83 patients (95.4%). Twenty-three of 83 (27.7%) patients conceived (clinical pregnancy). The viable ongoing pregnancy rate was 20.5%. These results compare favourably to those previously reported for both transvaginal and transabdominal GIFT. This study suggested that the fluid dynamics of gamete injection following transvaginal Fallopian tube catheterization are different to those following transabdominal methods. Further study is necessary to define the optimal methodology for transvaginal GIFT and to enhance the ability of the procedure to produce pregnancy rates comparable to transabdominal GIFT.

Adult↗

PubMed1997

Ovarian hyperstimulation syndrome.

A case of severe ovarian hyperstimulation syndrome (OHSS) prompted us to review our experience of the condition, and to critically evaluate its clinical associations and treatment. Severe OHSS complicated 1.8% of gamete intra-Fallopian transfer (GIFT) cycles, but none of the ovulation induction and artificial insemination by husband (OI/AIH) cycles. It is difficult to establish whether the higher pregnancy rate observed with OHSS was attributable to pregnancy increasing the risk of OHSS, or if it was the development of OHSS which increased the likelihood of pregnancy. Monitoring serum oestradiol levels and ultrasonographic evaluation of growing follicles may be helpful in identifying women at risk. Strategies for reducing the risk of developing severe OHSS were considered.

Adult↗