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ABSTRACT: To estimate the influence of fetal growth restriction (FGR) on neonatal morbidity and mortality among premature discordant twin neonates.
Our medical records (2002-2007) of preterm twins born at 24-37 weeks' gestation were reviewed. Significant discordance was defined as >15% difference in birth weight. Small for gestational age (SGA) was defined as birth weight <10(th) percentile, and appropriate for gestational age (AGA) was between the 10(th) and 90(th) percentile, according to a twin and sex-adjusted gestational age nomogram. The SGA/AGA group comprised of one SGA twin and its AGA pair (30 pairs). Another group of non-SGA discordant twins was also evaluated (n=40 pairs, AGA/AGA). The morbidity and mortality rates were compared between the groups.
Of the selected outcome variables, the only ones in which the incidence was significantly lower for SGA neonates than their AGA pairs were respiratory distress syndrome (5 vs. 11, P=0.014), apnea (1 vs. 9, P=0.004) and the need for respiratory support (5 vs. 14, P=0.002). Anemia, erythropoietin therapy and hyperbilirubinemia were significantly higher in the SGA twin. All selected outcome variables had similar rates within the AGA/AGA pairs.
FGR among premature discordant twin pairs is associated with significantly lower rates of respiratory morbidity and higher anemia and erythropoietin therapy rates. Overall morbidity is similar for discordant non-FGR twin pairs.
Journal of Perinatal Medicine 05/2011; 39(3):317-22. · 1.70 Impact Factor
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ABSTRACT: The incidence of musculoskeletal tumors during pregnancy is very low. The aim of this study was to summarize our experience in treating a large cohort of pregnant patients diagnosed with these rare tumors.
Women diagnosed with musculoskeletal tumors during pregnancy or immediately after delivery were identified retrospectively in our database between 1996 and 2006. Relevant maternal and neonatal data were collected.
Twenty patients, 8 with bone sarcomas (BS) and 12 with soft tissue sarcomas (STS) were identified. Two women were treated by wide excision of mass during pregnancy. In all other cases oncological treatment was delayed until delivery or termination of pregnancy. Vaginal delivery was possible in 9 patients, cesarean section was performed in 7, spontaneous abortion occurred in 1, and 3 underwent termination of pregnancy. Three newborns were premature, but normal growth and development were observed. Different techniques of fertility preservation were used in our patients. Five patients with BS and 5 patients with STS received preoperative chemotherapy, with different grades of toxicity. The degree of tumor necrosis tended to correlate with dose-intensity of chemotherapy. Seven patients with BS received adjuvant chemotherapy. Two patients with STS received adjuvant chemotherapy, two - radiotherapy, and four - both modalities. Median disease-free survival was 15.1 months, median overall survival - 25.4 months.
Musculoskeletal tumors diagnosed during pregnancy, or after delivery, do not appear to have a significant impact on the prognosis. A multidisciplinary team should tailor the oncological approach individually.
Gynecologic and Obstetric Investigation 02/2008; 65(2):89-95. · 1.28 Impact Factor
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ABSTRACT: Purpose: To assess the comparative efficacy of IVF medium (MediCult, with 5.2 mM glucose) and a glucose/phosphate-free medium, P1 (Irvine Scientific), and to investigate the influence of increasing the serum supplementation (synthetic serum substitute; SSS; Irvine Scientific) to P1 on embryo development and implantation.
Methods: Patients were randomly assigned to IVF medium (Group 1, cycles n = 172) or P1 supplemented with 10% SSS (Group 2, cycles n = 229) according to the medium scheduled for use on the day of oocyte retrieval. Another 555 IVF consequent cycles (Group 3) were performed using increased SSS concentrations (20%) in P1 medium.
Results and Conclusion: In this large series of IVF cycles, we herein demonstrate that significantly higher pregnancy and implantation rates were found when embryos were cultured in glucose/phosphate-free medium P1 supplemented with 20% SSS compared to supplementation with the lower SSS concentration and with IVF medium.
Journal of Assisted Reproduction and Genetics 10/2001; 18(11):588-592. · 1.84 Impact Factor
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ABSTRACT: Purpose:Purpose:
In vitro fertilization had been previously suggested by us as a means of rescue for patients with imminent ovarian hyperstimulation syndrome (OHSS) during treatment with human menopausal gonadotropin (hMG). We evaluated the pregnancy rate of rescued IVF cycles.In vitro fertilization had been previously suggested by us as a means of rescue for patients with imminent ovarian hyperstimulation syndrome (OHSS) during treatment with human menopausal gonadotropin (hMG). We evaluated the pregnancy rate of rescued IVF cycles.
Methods:Methods:
During the years 1994–1995, women treated with hMG and at risk of developing OHSS were referred to our IVF unit. Their estradiol level was above 1500 pg/ml, and eight or more follicles were observed by ultrasonography In all the patients. These high responders were offered the option to undergo ovum aspiration. We report the pregnancy rate in this group of patients.During the years 1994–1995, women treated with hMG and at risk of developing OHSS were referred to our IVF unit. Their estradiol level was above 1500 pg/ml, and eight or more follicles were observed by ultrasonography In all the patients. These high responders were offered the option to undergo ovum aspiration. We report the pregnancy rate in this group of patients.
Results:Results:
Thirty-nine women were referred to our unit for rescue IVF. Two were uneligible due to high progesterone concentrations. Thirty-seven women underwent ovum pickup and 32 had embryo transfer. The clinical pregnancy rate was 40% (13/32). Only two women had clinical OHSS.Thirty-nine women were referred to our unit for rescue IVF. Two were uneligible due to high progesterone concentrations. Thirty-seven women underwent ovum pickup and 32 had embryo transfer. The clinical pregnancy rate was 40% (13/32). Only two women had clinical OHSS.
Conclusions:Conclusions:
We suggest that rescue IVF may be considered in hMG cycles of high responders with imminent OHSS. Rescue IVF offers a high rate of conception, avoids high-order multiple pregnancy, and appears not to increase the risk of OHSS in these women.We suggest that rescue IVF may be considered in hMG cycles of high responders with imminent OHSS. Rescue IVF offers a high rate of conception, avoids high-order multiple pregnancy, and appears not to increase the risk of OHSS in these women.
Journal of Assisted Reproduction and Genetics 10/1999; 16(10):520-522. · 1.84 Impact Factor
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ABSTRACT: To compare the efficacy of 2 sperm-retrieval procedures, testicular sperm extraction (TESE) and testicular sperm aspiration (TESA), during the same procedure using the same subjects as their own controls. The presence of mature testicular sperm cells and motility were evaluated in 87 men with nonobstructive azoospermia (NOA) by means of multifocal TESE and multifocal TESA, which were performed during the same procedure using the same subjects as their own controls. Sperm cells were recovered by TESE in 54 cases, but by TESA in only 36 cases. There were significantly more cases (n = 20) in which sperm cells were recovered by TESE only, compared with 2 cases in whom cells were recovered by TESA only (McNemar's test, P < .001). The mean number of locations in each testis in which sperm cells were detected was significantly higher in the TESE group. In significantly more cases (n = 27), motility was observed in TESE material only, compared with 3 cases in which motility was present in material extracted by TESA only (McNemar's test, P < .001). Mean number of locations in each testis with motile sperm cells was significantly higher in the TESE group. The TESE procedure yielded significantly more sperm cells, as was also reflected by the difference in number of straws with cryopreserved sperm. This comparative prospective clinical study revealed that multifocal TESE is more efficient than multifocal TESA for sperm detection and recovery in men with NOA and should be the procedure of choice for sperm retrieval for them.
Journal of Andrology 27(1):28-33. · 2.97 Impact Factor
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ABSTRACT: The aim of this comparative clinical study was to examine whether the fertilizing potential of frozen-thawed testicular sperm in the most severe cases of hypospermatogenesis is reduced compared with fresh testicular sperm. The results could determine the necessity of using fresh testicular sperm cells, which mandates involving the spouse by performing simultaneous in vitro fertilization intracytoplasmic sperm injection (IVF-ICSI) treatment in this subgroup of nonobstructive azoospermia (NOA) patients. We studied 13 couples in which the husband was diagnosed as having NOA and few motile testicular sperm cells or only immotile testicular sperm cells were isolated by testicular sperm extraction (TESE). Each couple underwent both an ICSI cycle, in which fresh testicular sperm that were retrieved shortly beforehand were injected, and a consecutive cycle, which used frozen-thawed sperm that were retrieved in the original TESE procedure but were cryopreserved and stored until use. We found that motility was lost during the freezing and thawing process in some cases, which resulted in significantly more cycles with only immotile sperm cells for injection in the frozen-thawed sperm group (38.5%) than in the fresh sperm group (7.7%; P < .05). Availability of only immotile sperm cells significantly reduced fertilization rates in both fresh and frozen-thawed groups, but the respective overall fertilization rate (44.9% vs 41.1%) and quality of embryos and pregnancy rate (18.2% vs 15.4%) were not significantly different between groups. Implantation rates were more favorable in the fresh sperm group (10.5% vs 5.9%), but not significantly so. We conclude that, although cryopreservation does impair motility, which results in significantly more cycles with only immotile sperm cells for ICSI in the most severe forms of hypospermatogenesis, fertilization and pregnancy rates are not significantly compromised.
Journal of Andrology 26(6):772-8. · 2.97 Impact Factor
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ABSTRACT: To assess the endometrial thickness, hormonal status and pregnancy rates with clomiphene citrate (CC) vs. letrozole in frozen-thawed embryo transfer protocols.
Nineteen patients who had previously undergone in vitro fertilization (IVF) with embryo cryopreservation were prospectively and randomly enrolled in a randomized, controlled trial. Nine patients were treated with CC, 100 mg per day, from day 3 to day 7 of the cycle, and 10 patients were treated with letrozole, 2.5 mg per day, on the same cycle days. beta-Human chorionic gonadotropin (beta-hCG) was administrated when the leading follicular size was > or = 18 mm. Endometrial thickness was measured on cycle day 8, beta-hCG day, transfer day and 7 days after embryo transfer. Estradiol levels were determined on the day of beta-hCG administration.
Patients' ages and number of previous unsuccessful IVF cycles were similar between the 2 groups. Endometrial thickness was significantly higher in the letrozole group as compared to the CC group on the day of beta-hCG administration (9.1 +/- 3.6 vs. 6.9 +/- 1.2 mm, p<0.05), on the day of embryo transfer (10 +/- 1.7 vs. 7.6 +/- 1.4 mm, p<0.05) and 7 days after embryo transfer (12.2 +/- 0.4 vs. 9.0 +/- 3.0 mm, p<0.05). Estradiol levels in the letrozole group were significantly lower than in the CC group on the beta-hCG day (231 +/- 132 vs. 515 +/- 363 pg/L, p<0.05). Pregnancy was not achieved in either group.
Endometrial thickness is improved by letrozole as compared to CC in frozen-thawed embryo transfer cycles. Further investigation is needed to assess pregnancy and implantation rates.
The Journal of reproductive medicine 55(3-4):134-8. · 0.87 Impact Factor
