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ABSTRACT: To determine if fertilization by conventional oocyte insemination vs intracytoplasmic sperm injection (ICSI) causes any difference in the maximum number of blastomeres of fresh or frozen thawed embryos transferred.
Retrospective evaluation of all in vitro fertilization (IVF) cycles over a 10-year period in cycles having a 2 embryos transferred where the semen analysis was normal except for strict morphology which was allowed to be 2-5% normal. The percentage of the maximum number of blastomeres in any transfers was compared according to the method of insemination.
There were no differences in the maximum blastomere numbers in cycles where there was conventional insemination vs ICSI.
Though higher pregnancy rates have been found following the transfer of embryos derived from conventional oocyte insemination vs ICSI, and higher pregnancy rates were found following single embryo day 3 transfers with embryos with more blastomeres, the beneficial effect of conventional insemination does not seem to be related to forming embryos with more rapid cleavage.
Clinical and experimental obstetrics & gynecology 01/2010; 37(3):183-4. · 0.43 Impact Factor
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ABSTRACT: To carry out a retrospectively performed matched controlled study to determine the efficacy of pretreatment of sperm having low hypo-osmotic swelling (HOS) test scores with chymotrypsin galactose prior to intrauterine insemination (IUI) compared to IUI for other types of male factor problems. The women with male partners with low HOS scores were advised not to have unprotected intercourse.
All cycles having IUI with chymotrypsin treated sperm for low HOS scores were matched with the very next woman having IUI for sperm with other male factor problems but with normal HOS scores.
There was a significantly higher clinical pregnancy rate with chymotrypsin treated sperm (32.3% per IUI) vs. 21.9% for other male factor cases. The live birth rate per IUI cycle was not significantly different (21.2% vs. 15.4%).
These results now show that pretreatment of sperm with low HOS scores allows very good pregnancy rates following IUI as long as the couple is cautioned about unprotected intercourse. These data support the concept that sperm with low HOS test scores impair fertility by transferring a toxic factor from the sperm to the zona pellucida to the embryo membrane which impairs the embryos from implanting.
Clinical and experimental obstetrics & gynecology 01/2010; 37(3):187-9. · 0.43 Impact Factor
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ABSTRACT: There is an evidence that increased capillary permeability in the standing position is related to a deficit in the sympathetic nervous system. The leakage of this fluid leads to various clinical conditions which frequently puzzle the consulting physician because despite the frequency of this condition intelligent physicians and patients are unaware of the cause of their condition. One of the most common manifestations is the inability to lose weight despite proper dieting. A randomized study comparing the efficacy of a diuretic, a converting enzyme inhibitor, spironolactone and a sympathomimetic amine on weight loss in diet refractory women found that only the latter in the form of dextroamphetamine sulfate demonstrated significant weight reduction over a six month time span. In fact, the dextroamphetamine sulfate proved effective when given in the next 6 months to the three groups failing to respond for the first 6 months. The diagnosis of a deficit in sympathomimetic amines is established by demonstrating an abnormal clearance of a water load in the erect position and exclusion of other conditions that are associated with an abnormal free water clearance, e.g., hypothyroidism, renal or liver disease or congestive heart failure. The original definition of an abnormal water load test was excretion of <55% of a 1500 ml water load in 6h but we found that <75% defines a greater population who suffer from this problem. There are several conditions that have proven refractory to conventional theory that respond quickly and effectively to sympathomimetic amines. There have been many anecdotal reports of relieving interactable pain syndromes quickly and efficiently with sympathomimetic amine theory, despite failure with a multitude of other therapies. These include interstitial cystitis and pelvic pain that was attributed to endometriosis, gastrointestinal pain including esophagitis and gastroparesis, headaches, joint pain, fibromyalgia, and carpal tunnel syndrome. It is not clear if the improvement in pain is related to a decrease in fluid retention or a direct effect of the sympathomimetic amines on the sympathetic nervous system. Sympathomimetic amine theory has helped other conditions besides pain, e.g., chronic fatigue, vasomotor symptoms in young women not associated with decreased ovarian egg reserve, and chronic urticaria resistant to all other therapies. Thus, these studies strongly suggest that physicians be aware of this condition involving a deficit in the sympathetic nervous system when faced with various enigmatic complaints especially if standard therapy has not proven effective.
Medical Hypotheses 02/2008; 70(3):671-7. · 1.39 Impact Factor
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ABSTRACT: To determine if treatment with sympathomimetic amines can effectively treat gastroparesis that was refractory to other medical therapy.
After failing a water load test, a 29-year-old female was treated with 20 mg/day of dextroamphetamine sulfate.
After several weeks of therapy she noted that most of her symptoms of gastroparesis subsided and she has remained symptom free for eight months.
Similar to its beneficial effect on chronic pelvic pain of both bladder and non bladder origin, refractory weight gain, esophageal pain, chronic fatigue syndrome, headaches and vasomotor symptoms, sympathomimetic amine therapy can also effectively treat gastroparesis refractory to other medical therapies at least in some cases.
Clinical and experimental obstetrics & gynecology 02/2007; 34(3):185-7. · 0.43 Impact Factor
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ABSTRACT: To corroborate or refute a previous case report from 20 years ago whether treatment with sympathomimetic amines is effective in controlling chronic urticaria.
All cases of chronic urticaria in our reproductive endocrinology and infertility practice were identified. All four had been treated with dextroamphetamine sulfate. Quickness and duration of response were then determined.
Four women were identified. All showed improvement within the first month. The marked improvement did not dissipate including two patients whose duration of improvement was 8.5 and 13 years, respectively.
Gynecologists should consider idiopathic edema as an etiology when facing chronic pelvic pain and urticaria. Since allergists and dermatologists do not seem to be aware of this treatment option, the initiation of therapy may need to come from the gynecologist.
Clinical and experimental obstetrics & gynecology 02/2006; 33(3):183-4. · 0.43 Impact Factor
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ABSTRACT: To describe a unique cause and therapy for vasomotor flushing.
Serum follicle stimulating hormone (FSH) and estradiol, renal and liver function studies and urinalysis were performed as well as a water load test.
All laboratory tests were normal but the water load test showed inadequate four-hour urine excretion when she was erect but normal when supine. Complete relief from vasomotor symptoms occurred shortly after treatment with sympathomimetic amines.
Idiopathic orthostatic cyclic edema can cause vasomotor flushing even with normal estrogen and serum FSH, and treatment of the edema state with the drug of choice dextroamphetamine sulfate can effectively control these symptoms.
Clinical and experimental obstetrics & gynecology 02/2006; 33(2):125-6. · 0.43 Impact Factor
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ABSTRACT: To evaluate the clinical significance of the grey zone range (50-59%) of the hypo-osmotic swelling test (HOST) on sperm samples.
Clinical and viable pregnancy rates and implantantion rates following in vitro fertilization-embryo transfer (IVF-ET) were determined in couples where the male partner scored between 50-59% on the HOST. The data were further evaluated according to the discrepancy between viability and HOST. Finally, the study assigned whether treating sperm with the protein digestive enzyme chymotrypsin had any effect on pregnancy outcome.
Pregnancy and implantation rates were comparable for couples with grey zone HOST scores with the normal IVF rate for the center. Having a large discrepancy between viability and HOST scores had no clinical significance nor did treatment with chymotrypsin.
In contrast to HOST scores < 50% where extremely poor implantation rates are noted, grey zone scores have no clinical significance.
Clinical and experimental obstetrics & gynecology 01/2002; 29(1):25-6. · 0.43 Impact Factor
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ABSTRACT: The hypo-osmotic swelling (HOS) test measures the functional integrity of the sperm membrane. Although, the sperm membrane is essential for the fertilization of oocytes, several clinical studies suggest that abnormally low HOS test scores do not predict poor or failed fertilization in human in-vitro fertilization trials. However, in-vivo and in-vitro studies clearly demonstrate that a low HOS score is associated with poor pregnancy rates suggesting this sperm defect causes implantation problems rather than fertilization problems. The problem of implantation could be caused by the supernumerary sperm attached to the zona pellucida. Supporting evidence for this theory was demonstrated by finding high pregnancy and implantation rates despite low HOS scores following intracytoplasmic sperm injection which avoids the presence of supernumerary sperm on the zona pellucida. These data thus support theories that some sperm abnormalities may reduce fertility potential by causing implantation disorders rather than problems with fertilization.
Medical Hypotheses 06/2001; 56(5):653-7. · 1.39 Impact Factor
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ABSTRACT: Although the transfer of fertilized donor oocytes is the most efficacious mode of conception for infertile women with hypergonadotrophism associated with incipient or apparent ovarian failure, there are many individuals who, for religious, ethical, or personal reasons, would prefer to try to conceive with their own oocytes. The three cases presented here represent extremes to date for (i) highest serum FSH concentration in a woman with incipient ovarian failure (n = 2), and (ii) the oldest woman with apparent overt ovarian failure (n = 1) to have successful pregnancies. All three cases were treated for only a short time with pharmacological dosages of ethinyl oestradiol with luteal phase support with progesterone. The peak FSH (mIU/ml) in cases 1 and 2 was 143 and 127 respectively. The precedents set in these cases can help physician-patient consultation when patients enquire whether there is a certain critical FSH concentration above which pregnancy is not possible or an age over which successful pregnancy could not be achieved even if ovulation despite ovarian failure was possible.
Human Reproduction 09/2000; 15(8):1709-12. · 4.47 Impact Factor
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ABSTRACT: A retrospective comparison of fresh vs frozen embryo pregnancy rates.
All frozen embryos transferred used in the analysis including deselected embryos from the oocyte retrieval cycle, and twice-frozen embryos.
Pregnancy and implantation rates following fresh or frozen embryo transfers were similar.
The similar outcomes despite the obvious disadvantages for the frozen-thawed embryo suggests that some other factor reduces the chance of embryo implantation on oocyte-retrieval cycles. An adverse affect of controlled ovarian hyperstimulation on the uterine environment is a strong possibility.
Clinical and experimental obstetrics & gynecology 02/2000; 27(3-4):173-5. · 0.43 Impact Factor
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ABSTRACT: Our purpose was to determine if controlled ovarian hyperstimulation adversely affects implantation.
A retrospective comparison of pregnancy rates (PRs) and implantation rates was made between oocyte recipients versus their donors, who shared half of the retrieved oocytes, and regular patients undergoing in vitro fertilization-embryo transfer (IVF-ET) who were not sharing eggs.
Higher implantation rates (39.0 vs 22.5%; P < 0.05) were found in recipients compared to donors in the stimulated cycle. However, no differences were seen in PRs or implantation rates in frozen ET cycles. The data for standard IVF patients were almost-identical to those for donors.
Superior implantation rates and PRs in oocyte recipients versus donors were not related to better oocyte quality for recipients because of egg sharing or to a better uterine environment because of similar results with frozen ET in all three groups. An adverse effect of the hyperstimulation regimen best explains the difference.
Journal of Assisted Reproduction and Genetics 09/1999; 16(8):416-20. · 1.84 Impact Factor
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ABSTRACT: To determine whether either the use of intracytoplasmic sperm injection (ICSI) or chymotrypsin-galactose pretreatment of sperm before IUI can improve pregnancy results in female partners of men with sperm with subnormal hypo-osmotic swelling test scores.
Randomized controlled study.
University-based private practice of an infertility center and IVF center.
Couples with infertility who presented during a specific time interval and in whom the male partner had a hypo-osmotic swelling score of < 50% in two consecutive cycles.
Controls were treated by conventional IUI. Members of the treatment group were given an option of treatment of sperm with chymotrypsin-galactose before undergoing IUI or of undergoing IVF-ET with ICSI.
Pregnancy rate (PR) per patient and per cycle.
None of the 14 control patients conceived despite 38 IUI cycles, whereas conception occurred for 4 (50%) of 8 couples in whom sperm was pretreated with chymotrypsin-galactose and for 2 (50%) of 4 couples who underwent ICSI. Patients who had enzymatic sperm treatment underwent 12 IUI cycles and 4 ICSI cycles; the PR per cycle was 33.3% in the former and 50% in the latter.
These data suggest that treating sperm with chymotrypsin-galactose before IUI or injecting only one sperm into the oocyte overcomes to some degree the block to successful pregnancy seen in women whose male partners have subnormal hypo-osmotic swelling tests.
Fertility and Sterility 09/1997; 68(3):549-51. · 3.56 Impact Factor
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ABSTRACT: To evaluate whether oligoasthenozoospermia may lead to a higher spontaneous abortion (SAB) rate once a pregnancy is established by IVF-ET.
Retrospective clinical observational study.
University-based IVF program.
Three hundred sixty-four couples with normal semen parameters who underwent IVF-ET with conventional sperm incubation; 70 couples with oligoasthenozoospermia but without marked abnormal sperm morphology (< 4% normal forms using strict criteria) who underwent ET after IVF with conventional sperm incubation; and 20 couples with oligoasthenozoospermia but without abnormal sperm morphology who underwent ET after IVF with intracytoplasmic sperm injection (ICSI).
Implantation rate, clinical pregnancy rate, SAB rate, and delivery rate after IVF-ET.
Despite similar pregnancy and implantation rates per ET, as a result of a higher SAB rate (40.0% versus 11.7%), the delivery rates were lower in the female partners of men with oligoasthenozoospermia. Similar patients who used ICSI had a 0% SAB rate.
Oligoasthenozoospermia should be considered a possible risk factor for SAB in IVF achieved pregnancies. Further studies are needed to determine whether ICSI reduces the risk of SAB associated with oligoasthenozoospermia.
Fertility and Sterility 09/1997; 68(3):545-8. · 3.56 Impact Factor
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ABSTRACT: The objective of this study was retrospectively to evaluate both in-vitro fertilization (IVF) and non-IVF cycles in which the male partner had been taking calcium channel blockers, either to confirm or refute previous data from another centre, suggesting that these drugs cause a severe but reversible subfertility problem in the male. These drugs were found to inhibit expression of mannose-ligand binding receptors, thus preventing spermatozoa from attaching to the zona pellucida; they were postulated to cause failed fertilization based on one case having this defect, in whom a return to normal was achieved after stopping the drug. However, the couple did not undergo a cycle with IVF to see if fertilization now occurred. The data presented here demonstrated fertilization in all patients having IVF who were taking calcium channel blockers. The subsequent pregnancy rate per transfer was 17.4%. Also, five out of 11 (45.4%) non-IVF patients conceived after correction of various female factors. Failure of the other six patients to conceive could be explained by other confounding factors, especially oligoasthenozoospermia. Taking into consideration other data suggesting poor fertilization when this mannose-ligand binding receptor abnormality was demonstrated, we propose the possibility that this defect, when not associated with calcium channel blockers, may be associated with some other cryptic factor that causes poor fertilization. According to our hypothesis, calcium channel blockers might cause the problem in mannose expression but also adversely affect some other factor that is deficient when non-drug related abnormalities in mannose-ligand binding expression are found.
Human Reproduction 08/1997; 12(7):1480-2. · 4.47 Impact Factor
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Fertility and Sterility 04/1997; 67(3):590-1. · 3.56 Impact Factor
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ABSTRACT: To compare the pregnancy rates (PRs) after transfer of cryopreserved embryos in patients who have damage to the functional integrity of the sperm membrane as measured by the hypo-osmotic swelling test to those without this defect.
Prospective clinical study.
University-associated IVF center.
Fifty-four patients enrolled in a matched prospective study to evaluate the effects of low HOS scores (<50%) on PRs after IVF-ET were followed to determine the PR after transfer of cryopreserved embryos.
Clinical PRs and implantation rates.
Fourteen patients with low hypo-osmotic swelling test scores underwent 21 frozen ET cycles, achieved for clinical pregnancies for a PR per cycle of 19.0% and an implantation rate of 7.1%. Twelve patients with normal hypo-osmotic swelling test scores underwent 21 frozen ET cycles, achieved five preganancies for a clinical PR per cycle of 23.8% and an implantation rate of 9.3%.
Previous studies have demonstrated an adverse effect of low hypo-osmotic swelling test scores on PRs after IVF-ET despite normal fertilization. This adverse effect was not found in the transfer of cryopreserved embryos from males with hypo-osmotic swelling test scores. Further investigation is required to determine how cryopreservation improves the chances of implantation of these embryos.
Fertility and Sterility 07/1996; 65(6):1241-4. · 3.56 Impact Factor
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Fertility and Sterility 04/1996; 65(3):675-7. · 3.56 Impact Factor
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ABSTRACT: To determine the incidence of antisperm antibodies (ASA) in female sera from infertile couples or those suffering from recurrent abortions. Also to determine if the pregnancy and/or abortion rates are any higher in those positive versus those negative for ASA.
All registered patients had sera drawn and ASA measured by indirect immunobead test on initial study. Pregnancy and abortion rates were determined for patients undergoing in vivo or in vitro therapy.
There was a low incidence of ASA in patients having in vivo or in vitro treatment. There was no decrease in pregnancy rates (PRs) or increase in spontaneous abortions (SAB) in those positive for ASA.
Antisperm antibodies in female sera do not seem to be etiologic in causing infertility or SAB. Future studies might consider changing the antigen source from donor sperm to husband's sperm.
American journal of reproductive immunology (New York, N.Y.: 1989) 02/1995; 33(1):131-3. · 3.05 Impact Factor
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ABSTRACT: To determine if chymotrypsin-galactose (CG) treatment of sperm bound with antisperm antibodies (ASA) improves pregnancy rates (PRs) following in vitro fertilization (IVF).
Patients with > 50% ASA who failed to conceive despite six intrauterine insemination (IUI) cycles were included. Initially the sperm treatments were randomized with CG vs culture medium; subsequently only CG treatment was used.
There was a significantly lower fertilization rate in those patients inseminated with sperm incubated in culture medium vs CG (27% vs 47%, P < .05 t-test). Similarly, a higher percentage of patients receiving culture medium treatment of sperm had failed fertilization (45%) compared to CG (11%). Though the clinical PRs were higher with CG (21%) tham medium (9.5%), there was no statistical difference.
Though the percentage of sperm bound with antibodies are not reduced, we hypothesize that the CG treatment improves fertility by possibly mitigating the antagonistic action of these antibodies.
American journal of reproductive immunology (New York, N.Y.: 1989) 02/1995; 33(2):149-54. · 3.05 Impact Factor
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ABSTRACT: To determine the impact of the presence of antisperm antibodies (ASAs) in the cervical mucus of female partners in couples with unexplained poor postcoital tests (PCT). Furthermore, the efficacy of intrauterine insemination (IUI) in these same patients was determined by pregnancy rates (PRs).
Pregnancy rates following IUI in patients with infertility and poor postcoital tests, whether the cervical mucus was positive or negative for ASAs, were evaluated.
The 6-month PRs were similar in the ASA negative (40.5%) versus the positive (42.4%) group.
It appears that the antifertility effect of ASA may be mainly the immobilization of sperm in the cervical mucus, and thus, performing IUI may effectively correct the problem.
American journal of reproductive immunology (New York, N.Y.: 1989) 09/1994; 32(1):38-42. · 3.05 Impact Factor
