[Show abstract][Hide abstract] ABSTRACT: Intrauterine insemination (IUI) has been used for the treatment of various causes of infertility, including unexplained infertility, male factor, and cervical factor. Some centers frequently use superovulation combined with IUI. The study presented herein attempted to evaluate the efficacy of IUI without superovulation in cases where all causes of infertility other than cervical or male factors have been eliminated. However, in the case of poor or absent cervical mucus, the use of controlled ovarian hyperstimulation (COH) may obscure the actual importance of the IUI, since it is possible that the poor cervical mucus is related to poor timing, inadequate follicular maturation, or low estradiol levels, which if corrected will obviate the need for IUI. In this study IUI was targeted for 36-40 h following the sera luteinizing hormone surge. A total of 108 patients were enrolled in this study: 47 with male factor, 61 with cervical factor. Patients were followed for a maximum of three cycles unless a pregnancy occurred within 3 months of treatment. Comparison of pregnancy rates (PRs) were based on diagnosis. The cumulative PRs per cycle for each of the three cycles studied were as follows: cervical factor--19.7, 36.8, and 36.8%; male factor--12.8, 29.3, and 38.3%. Thus, PRs were comparable for both groups after three treatment cycles. These data demonstrate that IUI is an effective therapy for cervical and/or male factor, even without superovulation.
Archives of Andrology 07/2009; 35(2):135-41. · 0.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although amniotic fluid concentrations of cancer antigen (CA) 125 rise during the first two trimesters of pregnancy, the serum concentrations of CA125 peak during the first trimester and drop to non-pregnant values in the second and third trimester. A previous hypothesis to explain this phenomenon was that in the early first trimester decidual CA125 gains access to the maternal compartment via 'tubal reflux' and subsequent absorption by peritoneal lymphatics. However, as pregnancy advances, the decidua capsularis fuses with the decidua parietalis, thus obliterating the endometrial cavity at 10-12 weeks; the Fallopian tubes thus become functionally obstructed. To test this hypothesis, we evaluated early first trimester CA125 concentrations in women conceiving by in-vitro fertilization (IVF) and embryo transfer with patent tubes (group 1) and in those conceiving by IVF and embryo transfer with bilateral tubal occlusion (group 2). We also compared those conceiving with human menopausal gonadotrophin therapy for ovulation induction without assisted reproduction (group 3) and those conceiving without fertility drugs in assisted reproduction (group 4). Mean CA125 concentrations were similar in groups 1-3; the mean CA125 concentration in group 4 was lower but this difference was not statistically significant, probably due to the small sample size. These data do not support the concept that tubal reflux explains the rise and fall of serum concentrations of CA125, since these were equal in IVF conceptions with or without tubal patency.
Human Reproduction 04/1995; 10(3):674-6. · 4.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Many previous studies evaluating various hormone levels in males with subnormal semen analyses were performed when the normal semen parameters were considerably higher than now. This study evaluated sera levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TET), free TET, and prolactin (PRL) in 60 males with oligospermia and decreased motility according to recent World Health Organization standards. Three separate groups were evaluated: group 1, motile density (MD) < 5 x 10(6)/mL (but not azoospermia); group 2, 5 < or = MD < 10 x 10(6)/mL; group 3, MD > 10 x 10(6)/mL, but % motility < 30%. There were no significant differences in mean FSH levels between groups. Overall FSH was increased in 47.1% of the cases. In contrast, mean LH levels were normal in all three groups. Only 17.3% of the entire group had elevated LH levels. The TET level was below normal in 32.3% of the entire group, with a fairly equal distribution between the three groups. Overall, only 7.8% had elevated PRL levels, with the highest percentage found in group 3 (22.2%). Only a small minority of patients with increased FSH had low TET levels compared to 48.0% of those with normal FSH. These data demonstrate that when using the lower semen parameters, the most common serum hormone abnormality is increased FSH; men with MD < 5 x 10(6)/mL do not have a higher incidence of elevated FSH than those with higher MDs.(ABSTRACT TRUNCATED AT 250 WORDS)
Archives of Andrology 01/1995; 35(1):57-61. · 0.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Previous data have suggested there is a higher incidence of luteinized unruptured follicle (LUF) syndrome (defined as failure to release any oocyte as determined by sonography) in gonadotropin-treated patients following human chorionic gonadotropin (hCG) versus the gonadotropin releasing hormone agonist (GnRH-a) leuprolide acetate. The present study was designed to determine if an ultra low-dose gonadotropin regimen, designed not to raise the serum estradiol level much above normal for non-stimulated cycles, might result in a decrease in LUF following hCG treatment, and even reduce the rate to that seen following leuprolide acetate. The hypothesis tested was that the higher estradiol levels might suppress the pre-ovulatory follicle stimulating hormone (FSH) surge which, in turn, would inhibit plasmin production, thus preventing detachment of the oocyte from the follicle. The data did show a reduced rate of LUF incidence with either hCG or leuprolide acetate in ultra low-dose human menopausal gonadotropin-(hMG-) treated patients compared to data from previous studies with conventional hMG/hCG therapy. Pregnancy rates were also similar following hCG or leuprolide acetate for release in low-dose hMG-treated patients. Preliminary data show that leuprolide acetate is superior to hCG for causing oocyte release when stimulation is with low-dose purified FSH, and possibly also that low-dose hMG is superior to low-dose purified FSH for producing superior pregnancy rates.
[Show abstract][Hide abstract] ABSTRACT: One of the reasons for failure to conceive following human menopausal gonadotrophin (HMG) therapy may be due to non-release of oocytes from the follicles. We hypothesized that by using a gonadotrophin-releasing hormone agonist (GnRHa) for a short duration, endogenous release of luteinizing hormone and follicle stimulating hormone may enable oocyte release to occur, similar or superior to the effect of human chorionic gonadotrophin (HCG). This study attempted to compare the efficacy of HCG versus the GnRHa leuprolide acetate to release oocytes and achieve pregnancies and to compare the effectiveness of leuprolide acetate versus a combination of HCG with HMG to release oocytes. Unfortunately due to lack of prior data, many patients preferred to reject leuprolide acetate in favour of HCG, resulting in three times as many patients being treated with HCG in cycle 1; 78.2% of oocytes were released following leuprolide acetate versus only 55.7% with HCG. Interestingly, 87.5% of those females in whom oocyte release failed in cycle 1 with HCG did indeed release with leuprolide acetate in cycle 2, but none of these previous failures released with HCG in cycle 2. Pregnancy rates were equal in those women releasing oocytes, whether treated with HCG or leuprolide acetate. These preliminary data justify a larger randomized study.
Human Reproduction 05/1993; 8(4):568-71. · 4.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The study presented herein measured 17-hydroxyprogesterone (17-OHP) levels in women with ovarian failure who conceived by transfer of embryos which resulted from donor oocytes fertilization. A significant increase in 17-OHP during the first trimester was seen compared to baseline nonpregnant levels. The 17-OHP levels increased from a baseline average of 47.7 +/- 9.7 ng/dl to a first-trimester average of 175.8 +/- 80.6 ng/dl in the donor oocytes recipients vs. 63.0 +/- 38.0 ng/dl baseline to 295.0 +/- 83.9 ng/dl first-trimester in the control group. Initially these data may appear to contradict previous findings demonstrating a lack of 17-OHP secretion by the first-trimester placenta. However, by comparing the first-trimester progesterone (P) levels of normal pregnant women, and also measuring 17-OHP in patients with natural menopause and surgical menopause given exogenous P we concluded the following about the origin of first-trimester sera 17-OHP levels: hydroxylation of P to 17-OHP by the ovaries, some secretion by the first trimester placenta; and also increased adrenal conversion of P to 17-OHP. Contributing to the total serum 17-OHP level is the fact that there is cross-reactivity with P to 17-OHP.
Gynecologic and Obstetric Investigation 02/1993; 36(3):136-40. · 1.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A group of 32 women with at least 3 or more viable fetuses by sonography at approximately 8 weeks gestation were given the option of selective reduction. They were advised that this was a relatively new procedure but heretofore in a small series was not associated with a significant increase in fetal demise. Only 7 of 32 women chose this option. six of these 7 had triplets reduced to twins, 1 woman had quadruplets reduced to twins. Thirteen of 14 viable babies were successfully delivered at a mean of 36.8 weeks gestation; 2 of 7 (28.6%) delivered before 37 weeks. In contrast, 7 of 25 (24%) not having reduction lost all babies (6 triplets, 1 quadruplet). Four other women lost at least 1 of their gestations (total of 5 babies). Pre-term deliveries (< 37 weeks) occurred in 16 of 18 (88.8%) patients delivering at least 1 live baby, with a mean of 33.7 weeks gestation. Thus the high rate of total fetal loss and prematurity for multiple gestation and the low pregnancy wastage and pre-term delivery rate following selective reduction might make the latter a reasonable therapeutic option to patients interested in having the best chance of delivering healthy viable babies.
Journal of Perinatal Medicine 01/1993; 21(4):299-302. · 1.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Placental protein 14 (PP14) can be measured in the serum by radioimmunoassay. The level rises from mid to late luteal phase in a manner similar to the endometrial biopsy. A study was initiated to determine if a clinical association could be found between the late luteal phase serum PP14 level and subsequent pregnancy and spontaneous abortion rate. No difference was found in the preconception PP14 level in patients conceiving versus those not conceiving, nor in those aborting versus those not aborting. A trend toward higher levels in conception versus non-conception cycles was noted, but a large patient group will be needed to demonstrate statistical significance.
International journal of fertility and menopausal studies 01/1993; 38(1):34-6.
[Show abstract][Hide abstract] ABSTRACT: This study was designed to measure the average serum estradiol (E2) levels in the first trimester for women whose serum progesterone (P) levels were carefully maintained at normal levels by the use of exogenous P, and to compare the mean serum E2 levels in women who aborted with those in women who did not. The study group consisted of 94 pregnant women supported with exogenous natural P therapy from the luteal phase through the first trimester. Beginning at week 5, and continuing through the first trimester, the mean serum E2 levels for nonaborters were significantly higher than those for aborters.
Gynecologic and Obstetric Investigation 02/1992; 34(4):206-10. · 1.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A group of infertile women who had luteal phase defects (LPD), but in whom follicular maturation was deemed normal, were treated with progesterone until the endometrial biopsy was corrected. At the time the corrected biopsy was obtained, serum was taken and the progestogen-dependent endometrial protein (PEP) concentration was determined. Serum PEP concentration in patients who successfully conceived was 102.5 +/- 62.6% units/mL, while PEP concentrations in patients who failed to conceive were 57.9 +/- 34.4% (P = .003). In patients whose PEP value was more than two standard deviations below the corresponding mean control PEP, pregnancy was achieved in 6/17 (35.3%). The conception rate was significantly greater (25/35, 71.4%) in patients with values higher than this. Thus, the PEP concentration in serum may identify a group of patients with persistent LPD despite apparent normalization of the morphology of late secretory phase endometrium, which might explain some cases of cryptic, unexplained infertility.
International journal of fertility 01/1992; 37(6):350-3.
[Show abstract][Hide abstract] ABSTRACT: The progestagen-associated endometrial protein (PEP) level rises from the early to the late luteal phase. A study was performed in infertile women where late luteal phase endometrial biopsies and serum PEP levels were obtained. The objective of the study was to evaluate the correlation between the PEP levels and the endometrial biopsies and to determine if subnormal PEP levels could be improved by the same therapies used to correct endometrial defects. There was a poor correlation between PEP levels and endometrial biopsies (r = 0.17). Similarly, there was no significant correlation between PEP levels and levels of the following hormones: mid- and late-luteal phase progesterone (P) (r = 0.186 and 0.282 respectively), mid-luteal phase 17-hydroxyprogesterone (17-OHP) (r = 0.139) and mid-luteal phase oestradiol (r = 0.135). Furthermore, there was no correlation between PEP levels and the dosage of progesterone used in therapy (r = 0.07). There were no statistically significant differences in PEP values (U/ml) depending on whether any fertility drug was taken. Thus our data suggest that progesterone may only have a permissive role, with some other factor(s) controlling the actual rise and fall of PEP.
Human Reproduction 05/1991; 6(4):511-4. · 4.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Weekly serum levels of 17-hydroxyprogesterone (17-OHP) levels and serum progesterone (P) levels were measured in 378 pregnant women. Normal levels of 17-OHP were established in women taking ovulation-inducing drugs (OVID) versus those conceiving on normal cycles. Weekly levels of 17-OHP were measured in women who aborted and were compared with the established norms. The levels of 17-OHP in aborters were lower than in normals for their specific category established in nonaborters. These results suggest that a failing corpus luteum may contribute to some abortions. Careful attention to 17-OHP levels dropping below normal during the first trimester may alert the clinician to the need to increase progesterone exogenously and possibly prevent an abortion.
International journal of fertility 01/1990; 35(2):112-5.