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1.
J Clin Endocrinol Metab ; 61(5): 990-2, 1985 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-3900126

RESUMEN

In mammals, insulin stimulates granulosa cell aromatase activity and steroid production and is a regulating factor of oocyte maturation. To assess the role of insulin in human follicular and oocyte maturation, human follicular fluid was obtained 32-36 h after hCG administration at the time of oocyte recovery for in vitro fertilization. Follicular fluid insulin levels, measured by RIA, ranged from undetectable (less than 2 microU/ml) to 65.4 microU/ml. In women treated with human menopausal gonadotropin (n = 21), clomiphene citrate (n = 4), and human menopausal gonadotropin/clomiphene citrate (n = 14), follicular fluid insulin concentrations were 18.0 +/- 4.3 (+/- SE), 10.2 +/- 4.2, and 12.0 +/- 3.8 microU/ml, respectively (P = NS). Similarly, there was no significant difference in follicular fluid insulin concentrations in follicles with mature (n = 33) or immature (n = 6) oocytes (13.3 +/- 2.7 vs. 24.7 +/- 9.5 microU/ml) or in oocytes which eventually did (n = 35) or did not (n = 4) fertilize (16.4 +/- 3.0 vs. 3.2 +/- 0.8 microU/ml). Follicular fluid insulin levels (n = 30) correlated positively with follicular fluid progesterone levels (P less than 0.05), but not with follicular fluid estradiol or androstenedione levels or the estradiol to androstenedione ratio. The relationship of follicular fluid insulin and progesterone levels suggests that, as in other mammals, follicular fluid insulin may have a physiological role in follicular maturation.


Asunto(s)
Insulina/metabolismo , Folículo Ovárico/metabolismo , Adulto , Androstenodiona/metabolismo , Líquidos Corporales/metabolismo , Estradiol/metabolismo , Femenino , Fertilización In Vitro , Humanos , Insulina/sangre , Oocitos/crecimiento & desarrollo , Progesterona/metabolismo
2.
Obstet Gynecol ; 83(5 Pt 2): 838-40, 1994 May.
Artículo en Inglés | MEDLINE | ID: mdl-8159369

RESUMEN

BACKGROUND: Uterine septa may be responsible for spontaneous abortion. Hysteroscopic metroplasty may improve pregnancy outcome. CASE: A patient with a history of hysteroscopic resection of a uterine septum presented in preterm labor. This was her second pregnancy following the procedure; the first resulted in a term vaginal delivery. This second pregnancy ended with a preterm cesarean delivery. A 3.5 x 3.5-cm fundal rupture was discovered during the cesarean. The metroplasty had been performed with the KTP laser under direct laparoscopic visualization. No surgical complications had occurred. CONCLUSIONS: Uterine rupture during a pregnancy may occur following hysteroscopic metroplasty, even when no complications occur at surgery and even if a normal pregnancy outcome follows the procedure. Physicians providing care for patients who have had hysteroscopic metroplasty should be aware of the potential for uterine rupture during pregnancy.


Asunto(s)
Complicaciones Posoperatorias , Rotura Uterina/etiología , Útero/cirugía , Adulto , Enfermedad Crónica , Femenino , Humanos , Histeroscopía , Embarazo , Útero/anomalías
3.
Obstet Gynecol ; 81(5 ( Pt 1)): 732-5, 1993 May.
Artículo en Inglés | MEDLINE | ID: mdl-8469462

RESUMEN

OBJECTIVE: To compare the ability of four chromotubation techniques to generate and maintain intrauterine pressures in the diagnosis of proximal tubal obstruction. METHODS: Sixteen extirpated uteri were used for this study. A pressure catheter was placed through the fundus into the endometrial cavity. Three cannulas were evaluated: 1) the Cohen cannula with hold and no-hold techniques, 2) the BARD cervical cannula (dual intrauterine and intracervical balloons), and 3) the Harris-Kronner uterine manipulator-injector catheter with an intrauterine balloon. Intrauterine pressures were monitored while warm saline was infused. The studies were performed with the tubes obstructed, and measurements of peak attainable intrauterine pressures were recorded. Data were analyzed by t test, with significance set at P < .05. RESULTS: Peak intrauterine pressures for the four groups were as follows: 1) Cohen cannula, not holding, 40.7 +/- 5.1 mmHg; 2) Cohen cannula, holding in place, 63.6 +/- 5.3 mmHg; 3) BARD cannula, 112.4 +/- 3.5 mmHg; and 4) Harris-Kronner cannula, 106.3 +/- 4.3 mmHg. The BARD and Harris-Kronner cannulas achieved significantly higher intrauterine pressures than either method of using the Cohen cannula (P < .001). There was no statistically significant difference between the BARD and Harris-Kronner cannulas. CONCLUSION: Significant differences in achievable intrauterine pressures were demonstrated among catheters in our in vitro model. Based on these findings, we believe that the BARD, Harris-Kronner, or other intrauterine balloon-type cannula should be used before diagnosing proximal tubal obstruction.


Asunto(s)
Enfermedades de las Trompas Uterinas/diagnóstico , Pruebas de Obstrucción de las Trompas Uterinas/métodos , Cateterismo/instrumentación , Cateterismo/métodos , Constricción Patológica/diagnóstico , Pruebas de Obstrucción de las Trompas Uterinas/instrumentación , Femenino , Humanos , Técnicas In Vitro , Presión , Útero/fisiología
4.
Fertil Steril ; 49(1): 138-43, 1988 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-3335261

RESUMEN

Semen analysis was performed on 226 ejaculates by an integrated microcomputerized system employing the multiple-exposure photography (MEP) method. Mucus penetration tests were performed in vitro using commercial preparations of bovine cervical mucus. A highly significant (P less than 0.001) correlation between mucus penetration distance and sperm count (r = 0.582), motility (r = 0.357), velocity (r = 0.569), motile density (r = 0.582), motility index (r = 0.467), and morphology (r = 0.383) was observed. Increased percentages of immature germ cells (r = -0.318) and bent-tailed sperm (r = -0.221) were the most strongly correlated with mucus penetration. Approximately 10% to 15% of patients with otherwise normal semen parameters displayed poor penetration of mucus. Conversely, 5% to 40% of patients with abnormal semen parameters displayed excellent penetration of the mucus. Motile density and velocity demonstrated the strongest relationship with the outcome of the mucus penetration test. These results suggest that a significant subpopulation of patients can be identified as having inadequate (or adequate) penetration of mucus with otherwise normal (or abnormal) motility characteristics.


Asunto(s)
Moco del Cuello Uterino/fisiología , Motilidad Espermática , Interacciones Espermatozoide-Óvulo , Espermatozoides/fisiología , Animales , Bovinos , Femenino , Humanos , Técnicas In Vitro , Infertilidad Masculina/fisiopatología , Masculino , Valores de Referencia , Espermatozoides/anomalías
5.
Fertil Steril ; 52(1): 100-5, 1989 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-2744176

RESUMEN

Patients (155) were selected at random for fresh or cryopreserved semen and inseminated on the predicted day of ovulation. Semen analysis was performed using a microcomputerized multiple-exposure photography system. Frozen semen was used with either glycerol or TEST-yolk (TEST-buffered 20% egg yolk with 10% glycerol) as the cryoprotectant. Cryopreservation resulted in significant decreases in all semen parameters measured. Of these, velocity appeared to be the least effected. TEST-yolk provided significantly more protection against a reduction in velocity compared with glycerol. A total of 18, 17, and 27 patients conceived using fresh, glycerol, or TEST-yolk-preserved semen, respectively. For these same groups, a cumulative pregnancy rate of 52.9%, 27.1%, and 68.5%, respectively, was observed (not significant). The total number of motile sperm per insemination used for fresh artificial inseminations resulting in conception (132.4 X 10(6] was significantly greater than the number used for successful glycerol- and TEST-yolk-preserved semen (approximately 24 X 10(6]. These results demonstrate that although the number of motile sperm of cryopreserved ejaculates are dramatically reduced compared with the fresh counterparts, if a minimum criteria for ejaculate quality is established, the use of cryopreserved semen can offer a viable, effective, and relatively safe alternative to artificial insemination by donor with fresh semen.


Asunto(s)
Crioprotectores , Inseminación Artificial Heteróloga/métodos , Inseminación Artificial/métodos , Embarazo , Preservación de Semen , Semen/citología , Supervivencia Celular , Femenino , Fertilidad , Congelación , Humanos , Masculino , Motilidad Espermática , Espermatozoides/citología
6.
Fertil Steril ; 49(4): 704-12, 1988 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-3127248

RESUMEN

Lot differences in the biopotency of human menopausal gonadotropin (hMG) were evaluated and the potential biochemical basis was investigated. The in vivo biopotency of hMG was assessed by a unique bioassay that evaluates the number of ova shed in the cyclic hamster in response to hMG administration. Significant variation in hMG lots was observed using this assay. When subjected to chromatofocusing, hMG displayed five immunoreactive follicle-stimulating hormone (FSH) isohormones and nine luteinizing hormone (LH) isohormones. The relative distribution of FSH, but not LH isohormones, was slightly but significantly different between the lots tested. These data indicate that significant differences exist in the ability of commercially available hMG to stimulate follicular development and ovulation. The biochemical basis for these differences in in vivo biopotency remains to be elucidated.


Asunto(s)
Menotropinas/metabolismo , Animales , Bioensayo , Recuento de Células , Cromatografía en Gel , Cricetinae , Femenino , Hormona Folículo Estimulante/análisis , Hormona Luteinizante/análisis , Oocitos , Inducción de la Ovulación , Radioinmunoensayo
7.
Fertil Steril ; 43(5): 777-80, 1985 May.
Artículo en Inglés | MEDLINE | ID: mdl-3922802

RESUMEN

Results from 198 cycles of in vitro fertilization (IVF) were examined to identify factors in the subsequent development of polyspermy. Polyspermy occurred in 24 of 235 fertilized oocytes and was equally likely in mature and immature oocytes. No significant difference in polyspermy was demonstrated between the stimulation protocol using human menopausal gonadotropin (hMG) and those using clomiphene citrate (CC) or combined hMG/CC. The incidence of polyspermy was no different after insemination of oocytes with concentrations of progressively motile sperm ranging from 250,000 to 500,000. Although polyspermy continues to be a problem in IVF, we have been unable to identify possible predisposing mechanisms for its development.


Asunto(s)
Fertilización In Vitro , Fertilización , Clomifeno/uso terapéutico , Femenino , Humanos , Masculino , Menotropinas/uso terapéutico , Oocitos/crecimiento & desarrollo , Inducción de la Ovulación , Motilidad Espermática
8.
Fertil Steril ; 50(5): 727-31, 1988 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-3053255

RESUMEN

In an attempt to identify oocytes at risk for polypronuclear fertilization, follicular fluids were obtained retrospectively that contained oocytes that fertilized normally and abnormally. Whenever possible, each patient served as her own control during the same stimulation cycle. Twenty-six of 169 patients had oocytes that became polypronuclear, and of those 26, 21 had oocytes that fertilized and cleaved normally. Follicular fluids were analyzed for estradiol, progesterone, androstenedione, transferrin, and insulin. Insulin levels were noted to be significantly elevated (P less than 0.05) in the polypronuclear group when compropose that insulin, a known growth factor for granulosa cells cultured in vitro, when present in excessive concentrations may predispose to polypronuclear fertilization.


Asunto(s)
Fertilización , Hormonas/análisis , Folículo Ovárico/análisis , Poliploidía , Estradiol/análisis , Femenino , Humanos , Insulina/análisis , Progesterona/análisis , Transferrina/análisis
9.
Fertil Steril ; 43(3): 369-72, 1985 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-3920086

RESUMEN

Because of the failure to conceive after the first cycle of in vitro fertilization (IVF), many couples often undergo repeated attempts. However, choosing the best stimulation protocol in successive cycles of IVF in the same individual is hindered by the lack of information regarding outcome in successive cycles following utilization of the same or different stimulation protocols. Examination of repeated cycles of the same stimulation protocol in 33 women demonstrated that comparing women with an initial "A" estradiol (E2) pattern (daily E2 levels that continued to rise throughout the stimulation) and those with non-A E2 patterns (failure to have continually rising E2 levels throughout the stimulation), the former were significantly less likely to have a subsequent passed cycle (P = 0.007) and tended to be more likely to have a subsequent A cycle (P = 0.079). Changing the stimulation protocol resulted in a different E2 pattern in 15 of 20 subsequent cycles. Thus, it is suggested that after a cycle with an acceptable E2 pattern, successive cycles be performed with the same stimulation protocol. However, after an initial unacceptable E2 pattern, it may be more efficacious to utilize an alternate stimulation protocol.


Asunto(s)
Gonadotropina Coriónica/uso terapéutico , Clomifeno/uso terapéutico , Menotropinas/uso terapéutico , Inducción de la Ovulación/métodos , Estradiol/sangre , Femenino , Humanos , Ciclo Menstrual
10.
Fertil Steril ; 43(2): 251-4, 1985 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-3917949

RESUMEN

Classification of stimulated controlled follicular development cycles in programs for in vitro fertilization by the likelihood of culminating in a pregnancy would allow for increased efficacy in patient management and the distribution of care provider services. Analysis of human menopausal gonadotropin stimulations by the estradiol (E2) patterns identified trends suggesting superiority of one pattern, but no statistically significant difference was identified. Similarly, trends were identified in the Norfolk data for the height and pattern of E2 response, but no statistical significance was identified. While these observations may become significant with larger numbers, until that time, criteria for altering patient management based on the rise of follicular phase E2 levels should be reconsidered.


Asunto(s)
Gonadotropina Coriónica/administración & dosificación , Fertilización In Vitro , Menotropinas/administración & dosificación , Folículo Ovárico/crecimiento & desarrollo , Estradiol/sangre , Femenino , Humanos , Oocitos/crecimiento & desarrollo , Inducción de la Ovulación/métodos , Embarazo
11.
Fertil Steril ; 46(6): 1108-12, 1986 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-2946610

RESUMEN

Human menopausal gonadotropins (hMG) and clomiphene citrate (CC), either alone or in combination, are frequently used for in vitro fertilization (IVF) in an attempt to maximize the number of oocytes recovered and the number of embryos transferred. However, direct comparison of the relative efficacy of these protocols in the same institution has been limited. To evaluate this question, the authors examined the outcome of 304 consecutive women attempting IVF. One hundred eighty-one women received hMG, 42 received CC, and 81 received combination hMG/CC. The percentages of women undergoing laparoscopy were not different among the groups (69%, 71%, and 74%, respectively), nor were the rates of oocyte recovery (94%, 100%, and 100%). However, the percentage of women achieving oocyte fertilization (77%, 83%, and 93%) and embryo transfer (73%, 83%, and 90%) were significantly greater among those who had received hMG/CC stimulation. A comparison of hMG/CC with hMG and CC cycles revealed a statistically significant increase in the total number of developing follicles (4.5 +/- 0.3, 3.3 +/- 0.2, and 3.1 +/- 0.3, respectively; P = 0.0137), total oocytes recovered (4.1 +/- 0.3, 3.2 +/- 0.2, and 2.5 +/- 0.2; P = 0.0011), and embryos transferred (2.2 +/- 0.2, 1.4 +/- 0.2, and 1.4 +/- 0.2; P = 0.0013). However, there was no significant difference in the occurrence of ongoing pregnancies. Thus, in terms of the per-patient number of follicles, oocytes, and embryo transfers, combined hMG/CC stimulation appears to be superior to either hMG or CC alone. However, to date the combined regimen has not improved pregnancy rates.


Asunto(s)
Clomifeno/farmacología , Fertilización In Vitro/efectos de los fármacos , Menotropinas/farmacología , Clomifeno/administración & dosificación , Quimioterapia Combinada , Femenino , Humanos , Laparoscopía , Menotropinas/administración & dosificación , Ciclo Menstrual , Oocitos , Folículo Ovárico/fisiología , Estimulación Química
16.
J Reprod Fertil ; 81(1): 213-20, 1987 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-3668951

RESUMEN

Ejaculates (164) were obtained from 17 donors serving on an artificial insemination by donor panel. Semen analysis was performed before and after freezing by an integrated microcomputerized system employing the multiple-exposure photography (MEP) method. Sperm count, motility, velocity, motility index (MI; product of the sperm velocity and percentage of motile spermatozoa) and motile density (MD) were determined for each ejaculate. After the initial evaluation the ejaculates were frozen in liquid nitrogen, thawed 24 h later, and assessed for post-thaw motility, velocity, MI and MD. The mean +/- s.e. sperm count and volume for this group of donors was 148 +/- 4 x 10(6)/ml and 3.1 +/- 0.1 ml, respectively. Mean +/- s.e. values obtained from the prefreeze analysis were: motility = 64 +/- 1%, velocity = 30 +/- 0.4 microns/sec, MI = 19 +/- 0.5 microns/sec and MD = 94 +/- 3 x 10(6)/ml. Post-thaw analysis revealed a significant reduction (P less than 0.01) in all values measured. Motility was reduced to 27 +/- 1%, MI was reduced to 5 +/- 0.3 microns/sec, and MD was reduced to 33 +/- 1 x 10(6)/ml. Velocity was the least affected by cryopreservation, being reduced to 21 +/- 0.5 microns/sec (P less than 0.01). Cryopreservation resulted in a marked shift in the frequency distribution of sperm motility and motility index towards subnormal values while in the majority of ejaculates velocity and motile density were maintained in the normal range. Significant differences were noted amongst donors in the percentage change of the various semen measures as a result of cryopreservation. When within-subject coefficients of variation were calculated, velocity was the least variable parameter.(ABSTRACT TRUNCATED AT 250 WORDS)


Asunto(s)
Congelación , Motilidad Espermática , Recuento de Células , Humanos , Masculino , Espermatozoides/citología
17.
J In Vitro Fert Embryo Transf ; 7(5): 249-53, 1990 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-2254687

RESUMEN

A computer program was developed for the IBM personal computer to be used for in vitro fertilization and gamete intrafallopian transfer clinics. This program, written in BASIC, allows input, editing, updating, sorting, and printing of patient data. Statistical functions permit summation of patient data based on various combinations of user-defined treatment cycles, diagnoses, and protocols, thus making possible comparison of pregnancy and other patient data between and among various treatment groups and diagnoses. The statistical information can be continually updated and revised when new data become available on patients (such as confirmation of pregnancy by ultrasound or live births) and at the end of each cycle. The formats used are useful in assimilating individual clinic data for various surveys and other reporting requirements. The program can be easily modified by anyone with minimal training in the BASIC programming language.


Asunto(s)
Instituciones de Atención Ambulatoria , Sistemas de Administración de Bases de Datos , Fertilización In Vitro , Femenino , Transferencia Intrafalopiana del Gameto , Humanos , Microcomputadores
18.
Arch Androl ; 19(1): 33-41, 1987.
Artículo en Inglés | MEDLINE | ID: mdl-3426338

RESUMEN

One hundred seventy-eight ejaculates obtained from infertility patients were evaluated by routine semen analysis and by a bovine cervical mucus penetration test (BCMPT). A significant correlation (p less than 0.01) was observed between mucus penetration and both sperm count (r = 0.349) and sperm motility (r = 0.394). One hundred fifty-two of 178 patients (85%) had normal sperm counts (greater than 20 x 10(6)/ml). Of these patients, 68% had good (greater than 30 mm), 26% had questionable (21-30 mm), and 7% had abnormal (less than 20 mm) penetration values. One hundred sixty-one of 178 patients (90%) had normal sperm motilities (greater than 40%). Of these patients, 71% had good, 25% had questionable, and 4% had abnormal penetration values. Conversely, 46% and 18% of patients with abnormal sperm count and motility, respectively, had normal penetration values (greater than 30 mm). A significant relationship (p less than 0.05) was observed between the BCMPT and pregnancy problems not apparent by semen analysis data, and may prove to be a useful adjunct to the use of routine semen analysis in evaluating male fertility.


Asunto(s)
Moco del Cuello Uterino/metabolismo , Infertilidad Masculina/fisiopatología , Semen/análisis , Recuento de Espermatozoides , Motilidad Espermática , Animales , Bovinos , Femenino , Humanos , Técnicas In Vitro , Masculino , Embarazo
19.
J In Vitro Fert Embryo Transf ; 4(2): 98-102, 1987 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-3598308

RESUMEN

There is transferrin-like protein present in the follicular fluid of stimulated ovarian cycles. The transferrin concentration correlates with the follicular morphologic maturity and steroidogenesis, varies among follicles, and often exceeds serum concentrations. An intermediate range of transferrin concentration is associated with the highest likelihood of oocyte fertilization in vitro. The biological significance of these observations may relate to an optimum degree of follicle maturation.


Asunto(s)
Líquidos Corporales/análisis , Folículo Ovárico/análisis , Transferrina/análisis , Femenino , Fertilización In Vitro , Hormonas Esteroides Gonadales/análisis , Humanos , Ciclo Menstrual , Oocitos/fisiología , Transferrina/fisiología
20.
J In Vitro Fert Embryo Transf ; 4(1): 34-9, 1987 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-3108425

RESUMEN

Various protocols have been utilized for stimulation of multiple ovarian follicles in patients undergoing in vitro fertilization-embryo transfer (IVF-ET). Previous studies have suggested that the combination of clomiphene citrate (CC) and human menopausal gonadotropins (hMG) is superior to either CC or hMG alone in terms of follicular development, oocyte recovery, and embryo transfer. However, no significant increase in viable pregnancy rates has been reported with any of the protocols. This report examines five different CC/hMG protocols. While differences were seen in terms of serum estradiol response and fertilization rates of mature oocytes among the various protocols, no significant differences were found in terms of follicular development, oocyte recovery, embryo transfer, or pregnancy. The pregnancy rate in IVF-ET appears unaffected by variations in the dose and timing of CC and hMG in a combination protocol.


Asunto(s)
Clomifeno/administración & dosificación , Transferencia de Embrión , Fertilización In Vitro/efectos de los fármacos , Menotropinas/administración & dosificación , Adulto , Clomifeno/farmacología , Estradiol/sangre , Femenino , Humanos , Menotropinas/farmacología , Folículo Ovárico/efectos de los fármacos , Folículo Ovárico/fisiología , Ovario/efectos de los fármacos
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