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Early, late, and sequential embryo transfer in in vitro fertilization program: A preliminary report
202
Citations from the Literature
Semen analysis data from fresh and cryopreserved donor ejaculates: Comparison of cryoprotectants and pregnancy rates Keel BA; Webster BW
Department of Obstetrics and Gynecology, University of Kansas School of Medicine, Wichita, KS; USA Fertility and Sterility/SZ/l (loO-105)/1989/ 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). used for The total number of motile sperm per insemination fresh artificial inseminations resulting in conception (132.4 x 106) was significantly greater than the number used for successful glycerol- and TEST-yolk-preserved serum (approximately 24 x 106). 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
Oral immunization with sperm antigens: Possible therapy for sperm antibodies? Congleton L; Potts W; Mathur S
Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC 29425; USA Fertility and Sterility/52/i (106-l 12)/1989/ Young adult male CD-l mice were given intraperitoneal injections (IP) of saline (controls) and pooled sperm or seminal plasma of two autoimmune infertile men and two nonautoimmune fertile men (n = 40 per treatment). Other mice received only an oral challenge with the same antigens (oral controls; n = 20 per treatment). Three weeks after the booster challenge (day 36), 20 mice in each group were orally immunized with the antigens, whereas the other 20 were not (IP controls). Cytotoxic antibody titers (immunoglobulin M) to human sperm were significantly higher in mice IP immunized with sperm or seminal plasma from autoimmune infertile men or orally immunized with autoimmune men’s sperm, in contrast to the controls. Oral challenge with sperm or seminal plasma of autoimmune infertile men after the IP immunization with the same resulted in significantly decreased cytotoxic sperm antibody titers (P < 0.001 versus oral or IP controls in sperm immunization; P < 0.001 versus IP controls in seminal plasma
Citations from the Literature
immunization). Fertility was unaffected by any mode of immunization. It is concluded that, in mice, sperm and seminal antigens from autoimmune infertile men are more immunogenic than those from nonautoimmune fertile men, and oral challenge with the former after an IP establishment of cytotoxic sperm immunity desensitizes the immune mice. These findings may have practical implications in the diagnosis and immunotherapy of infertile men with cytotoxic sperm antibodies.
Transfer of human sperm into the perivitelline space of human oocytes after zona-drilling or zona-puncture Ng S-C; Bongso A; Chang S-I; Sathananthan H; Ratnam S
Department of Obstetrics and Gynecology, National University of Singapore, National University Hospital, Singapore 051I; Singapore Fertility and Sterility/5211 (73-78)/1989/ To evaluate the transfer of sperm from severely oligozoospermit men into the perivitelline space of mature oocytes, zona-drilling with acid phosphate-buffered saline (PBS) and direct zona-puncture in the presence of cytochalasin D were studied. Zona-drilling also was done for eggs from patients with previous failed in vitro fertilization (IVF). Forty-seven eggs from seven patients with oligozoospermia and three patients with failed IVF had a mean of between 2.6 and 3.6 sperm transferred into the perivitelline space. In the group whose eggs had zona-drilling with acid PBS, 1 of 13 eggs fertilized from the oligozoospermic category, while there was no fertilization from the failed IVF category. Karyotyping of the unfertilized eggs after zona-drilling revealed a high incidence (215 and 317, respectively) of possible arrest at anaphase II after reinitiation of meiosis. In the group whose eggs were directly punctured through the zona in the presence of cytochalasin D, there was no fertilization in 23 undamaged eggs. Two of the 15 interpretable karyotypes were aneuploid, but this incidence is within that observed for our unfertilized eggs after IVF. Hence, the use of acid PBS for zona-drilling is not advised. Moreover, transfer of sperm from men with previous failed fertilization resulted in poor fertilization rates.
Early, late, and sequential embryo transfer in in vitro fertilization program: A preliminary report Caspi E; Ron-El R; Golan R; Herman A; Nachum H
Department of Obstetrics and Gynecology, Assaf Harofe Medical Centre, Zerifin 70300; Israel Fertility and Sterility/52/i (146-148)/1989/ The timing of ET was evaluated by transferring four embryos at 44 to 48 hours, 68 to 72 hours, or equally dividing and sequentially transferring at 44 to 48 and 68 to 72 hours after insemination. Fifty-one patients were randomly allocated to one of the above protocols. The mean number of blastomeres of embryos transferred at 68 to 72 hours after insemination was significantly (P < 0.0001) higher than those transferred at 44 to 48 hours. The number of embryos with good morphology was similar in all study groups. The preg-
Citations from the Literature nancy rate was similar in the three protocol groups, 53% at 44 to 48 hours, 59% at 64 to 72 hours, and 41% by sequential transfer. There probably is no advantage in delaying the transfer or dividing the embryos into two sequential transfers. It seems that sequential transfer is not associated with any harmful effect.
Follicular stimulation for high tech pregnancies: Are we playing it safe? Fishel S; Jackson P
Department of Obstetrics and Gynaecology, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH; United Kingdom BR. MED. J/298/6694 (309-311)/1989/ The techniques for in vitro fertilisation have changed and improved at a great rate. The finding that the incidence of pregnancy increases in proportion to the number of conceptuses replaced, up to at least three, generated widespread interest in the use of follicular stimulants in the hope of obtaining many follicles and many conceptuses (or, as in the case of some units, oocytes for anonymous donation). Improvements in the efficiency of freezing techniques led to the more general use of these potent follicular stimulants, with the aim of having a stock of frozen conceptuses preserved for the couple. Almost invariably the minimum ‘blanket’ follicle stimulation is now provided by gonadotrophins (menotrophin), with or without an antioestrogen (clomiphene or tamoxifen). Women with ovulatory problems require more potent follicular stimulants. An outline of the development of such follicle stimulant treatments is shown in the box.
CLINICAL GYNECOLOGY Heuristic determination of relevant diagnostic procedures in a medical expert system for gynecology Small SL; Muechler EK
Department of Computer Science and the Decision Systems Laboratory, University of Pittsburgh, Pittsburgh, PA; USA American Journal of Obstetrics and Gynecology /161/l (1724) /1989/ Many professions including medicine have standard operating procedures for the performance of their tasks. In the construction of expert systems, knowledge engineers have exploited this fact in devising heuristic rules that mimic the standard practice among such personnel (i.e., experts). This article suggests that the expert system designer should not stop at the level of the standard operating procedure heuristic but should instead investigate the reasons that the standard procedures have become standard. Because the experts in a field often do not understand the reasons for the standard operating procedures of their profession, this effort not only rewards the system designer but the expert as well. Because medical training does not always emphasize the logical reasoning underlying certain standard operating procedures, the ability to perform this reasoning is especially important in medicine. Further, a medical expert system for consultation or education would make a valuable impact by incorporating such knowledge and inference rules. This article investigates the development of a computerized medical expert system that applies the principles of artificial intelligence by limiting the number of questions and tests to find the solution for an ill-defined complex problem. Finally, we describe a logic program that tests the basic ideas.
Gynecologic health care of women with disabilities Beckmann CRB; Gittler M; Barzansky BM; Beckmann CA
Department of Obstetrics and Gynecology, Illinois, Chicago, IL; USA
The importance of ultrasonography in infertile women with ‘forgotten’ intrauterine contraceptive devices Ron-El R; Weinraub Z; Langer R; Bukovsky I; Caspi E
Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, 70300; Israel American Journal of Obstetrics and Gynecology/l61/1 (21 l212)/1989/ Seven cases in which an unknown intrauterine contraceptive device in situ was the cause of infertility were referred to our Infertility Clinic after each patient had been told by her physician that she no longer had an intrauterine contraceptive device. In some cases, there were lapses in the infertility workup that might explain how the cause of infertility of an intrauterine contraceptive device in situ was missed. In other cases, a thorough investigation was made and infertility treatment was started without the existence of an intrauterine contraceptive device in situ being diagnosed.
203
University of
Obstetrics and Gynecology /74/l (75-79) /1989/ Information about their gynecologic health care was obtained from 55 women with acquired and congenital disabilities, 42% of whom were disabled after menarche. Although 91% of the entire group had received breast and pelvic examinations and Papanicolaou smears since their disability, only 18.8% had received counseling about sexuality and 64.6% had received information about contraception. However, those disabled after menarche were significantly less likely (P = ,001) to be satisfied with the counseling or method they received. Women with paralysis, impaired motor function, or obvious physical deformity were rarely offered contraceptive information or methods. These findings may be related in part to the characteristics of the patient group. However, we suggest that special attention needs to be directed to those disabled after menarche with respect to issues such as sexuality and contraception. This can be accomplished in part through improved education of health professionals regarding the various aspects of gynecologic health care for the disabled.
In1 J Gynecol Obstet 31
Citations from the Literature
Semen analysis data from fresh and cryopreserved donor ejaculates: Comparison of cryoprotectants and pregnancy rates Keel BA; Webster BW
Department of Obstetrics and Gynecology, University of Kansas School of Medicine, Wichita, KS; USA Fertility and Sterility/SZ/l (loO-105)/1989/ 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). used for The total number of motile sperm per insemination fresh artificial inseminations resulting in conception (132.4 x 106) was significantly greater than the number used for successful glycerol- and TEST-yolk-preserved serum (approximately 24 x 106). 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
Oral immunization with sperm antigens: Possible therapy for sperm antibodies? Congleton L; Potts W; Mathur S
Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC 29425; USA Fertility and Sterility/52/i (106-l 12)/1989/ Young adult male CD-l mice were given intraperitoneal injections (IP) of saline (controls) and pooled sperm or seminal plasma of two autoimmune infertile men and two nonautoimmune fertile men (n = 40 per treatment). Other mice received only an oral challenge with the same antigens (oral controls; n = 20 per treatment). Three weeks after the booster challenge (day 36), 20 mice in each group were orally immunized with the antigens, whereas the other 20 were not (IP controls). Cytotoxic antibody titers (immunoglobulin M) to human sperm were significantly higher in mice IP immunized with sperm or seminal plasma from autoimmune infertile men or orally immunized with autoimmune men’s sperm, in contrast to the controls. Oral challenge with sperm or seminal plasma of autoimmune infertile men after the IP immunization with the same resulted in significantly decreased cytotoxic sperm antibody titers (P < 0.001 versus oral or IP controls in sperm immunization; P < 0.001 versus IP controls in seminal plasma
Citations from the Literature
immunization). Fertility was unaffected by any mode of immunization. It is concluded that, in mice, sperm and seminal antigens from autoimmune infertile men are more immunogenic than those from nonautoimmune fertile men, and oral challenge with the former after an IP establishment of cytotoxic sperm immunity desensitizes the immune mice. These findings may have practical implications in the diagnosis and immunotherapy of infertile men with cytotoxic sperm antibodies.
Transfer of human sperm into the perivitelline space of human oocytes after zona-drilling or zona-puncture Ng S-C; Bongso A; Chang S-I; Sathananthan H; Ratnam S
Department of Obstetrics and Gynecology, National University of Singapore, National University Hospital, Singapore 051I; Singapore Fertility and Sterility/5211 (73-78)/1989/ To evaluate the transfer of sperm from severely oligozoospermit men into the perivitelline space of mature oocytes, zona-drilling with acid phosphate-buffered saline (PBS) and direct zona-puncture in the presence of cytochalasin D were studied. Zona-drilling also was done for eggs from patients with previous failed in vitro fertilization (IVF). Forty-seven eggs from seven patients with oligozoospermia and three patients with failed IVF had a mean of between 2.6 and 3.6 sperm transferred into the perivitelline space. In the group whose eggs had zona-drilling with acid PBS, 1 of 13 eggs fertilized from the oligozoospermic category, while there was no fertilization from the failed IVF category. Karyotyping of the unfertilized eggs after zona-drilling revealed a high incidence (215 and 317, respectively) of possible arrest at anaphase II after reinitiation of meiosis. In the group whose eggs were directly punctured through the zona in the presence of cytochalasin D, there was no fertilization in 23 undamaged eggs. Two of the 15 interpretable karyotypes were aneuploid, but this incidence is within that observed for our unfertilized eggs after IVF. Hence, the use of acid PBS for zona-drilling is not advised. Moreover, transfer of sperm from men with previous failed fertilization resulted in poor fertilization rates.
Early, late, and sequential embryo transfer in in vitro fertilization program: A preliminary report Caspi E; Ron-El R; Golan R; Herman A; Nachum H
Department of Obstetrics and Gynecology, Assaf Harofe Medical Centre, Zerifin 70300; Israel Fertility and Sterility/52/i (146-148)/1989/ The timing of ET was evaluated by transferring four embryos at 44 to 48 hours, 68 to 72 hours, or equally dividing and sequentially transferring at 44 to 48 and 68 to 72 hours after insemination. Fifty-one patients were randomly allocated to one of the above protocols. The mean number of blastomeres of embryos transferred at 68 to 72 hours after insemination was significantly (P < 0.0001) higher than those transferred at 44 to 48 hours. The number of embryos with good morphology was similar in all study groups. The preg-
Citations from the Literature nancy rate was similar in the three protocol groups, 53% at 44 to 48 hours, 59% at 64 to 72 hours, and 41% by sequential transfer. There probably is no advantage in delaying the transfer or dividing the embryos into two sequential transfers. It seems that sequential transfer is not associated with any harmful effect.
Follicular stimulation for high tech pregnancies: Are we playing it safe? Fishel S; Jackson P
Department of Obstetrics and Gynaecology, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH; United Kingdom BR. MED. J/298/6694 (309-311)/1989/ The techniques for in vitro fertilisation have changed and improved at a great rate. The finding that the incidence of pregnancy increases in proportion to the number of conceptuses replaced, up to at least three, generated widespread interest in the use of follicular stimulants in the hope of obtaining many follicles and many conceptuses (or, as in the case of some units, oocytes for anonymous donation). Improvements in the efficiency of freezing techniques led to the more general use of these potent follicular stimulants, with the aim of having a stock of frozen conceptuses preserved for the couple. Almost invariably the minimum ‘blanket’ follicle stimulation is now provided by gonadotrophins (menotrophin), with or without an antioestrogen (clomiphene or tamoxifen). Women with ovulatory problems require more potent follicular stimulants. An outline of the development of such follicle stimulant treatments is shown in the box.
CLINICAL GYNECOLOGY Heuristic determination of relevant diagnostic procedures in a medical expert system for gynecology Small SL; Muechler EK
Department of Computer Science and the Decision Systems Laboratory, University of Pittsburgh, Pittsburgh, PA; USA American Journal of Obstetrics and Gynecology /161/l (1724) /1989/ Many professions including medicine have standard operating procedures for the performance of their tasks. In the construction of expert systems, knowledge engineers have exploited this fact in devising heuristic rules that mimic the standard practice among such personnel (i.e., experts). This article suggests that the expert system designer should not stop at the level of the standard operating procedure heuristic but should instead investigate the reasons that the standard procedures have become standard. Because the experts in a field often do not understand the reasons for the standard operating procedures of their profession, this effort not only rewards the system designer but the expert as well. Because medical training does not always emphasize the logical reasoning underlying certain standard operating procedures, the ability to perform this reasoning is especially important in medicine. Further, a medical expert system for consultation or education would make a valuable impact by incorporating such knowledge and inference rules. This article investigates the development of a computerized medical expert system that applies the principles of artificial intelligence by limiting the number of questions and tests to find the solution for an ill-defined complex problem. Finally, we describe a logic program that tests the basic ideas.
Gynecologic health care of women with disabilities Beckmann CRB; Gittler M; Barzansky BM; Beckmann CA
Department of Obstetrics and Gynecology, Illinois, Chicago, IL; USA
The importance of ultrasonography in infertile women with ‘forgotten’ intrauterine contraceptive devices Ron-El R; Weinraub Z; Langer R; Bukovsky I; Caspi E
Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, 70300; Israel American Journal of Obstetrics and Gynecology/l61/1 (21 l212)/1989/ Seven cases in which an unknown intrauterine contraceptive device in situ was the cause of infertility were referred to our Infertility Clinic after each patient had been told by her physician that she no longer had an intrauterine contraceptive device. In some cases, there were lapses in the infertility workup that might explain how the cause of infertility of an intrauterine contraceptive device in situ was missed. In other cases, a thorough investigation was made and infertility treatment was started without the existence of an intrauterine contraceptive device in situ being diagnosed.
203
University of
Obstetrics and Gynecology /74/l (75-79) /1989/ Information about their gynecologic health care was obtained from 55 women with acquired and congenital disabilities, 42% of whom were disabled after menarche. Although 91% of the entire group had received breast and pelvic examinations and Papanicolaou smears since their disability, only 18.8% had received counseling about sexuality and 64.6% had received information about contraception. However, those disabled after menarche were significantly less likely (P = ,001) to be satisfied with the counseling or method they received. Women with paralysis, impaired motor function, or obvious physical deformity were rarely offered contraceptive information or methods. These findings may be related in part to the characteristics of the patient group. However, we suggest that special attention needs to be directed to those disabled after menarche with respect to issues such as sexuality and contraception. This can be accomplished in part through improved education of health professionals regarding the various aspects of gynecologic health care for the disabled.
In1 J Gynecol Obstet 31