- Email: [email protected]
Gamete intrafallopian transfer: Ethical considerations, historical development of the procedure, and comparison with other advanced reproductive technologies
Citations from the Literature
FERTILITY
AND STERILITY
Gamete intrnfallopian transfer: Ethical considerations, historical development of the procedure, and comparison with other advanced reproductive technologies Mastroyannis C.; USA FERTIL. STERIL. 1993 6013 (389-402) Objective: To report on ethical considerations regarding GIFT as well as the developmental history of the procedure and to review the literature and compare it with other advanced reproductive technologies (ARTS). Design: Indications. patient screening, recent evaluations, methods of ovarian hyperstimulation and oocyte retrieval-assessment, gamete transfer and pregnancy outcome are discussed in this review. A comparison of GIFT with other ARTS is also attempted. Main Outcome Measures: Gamete intrafallopian transfer pregnancy determination and outcome. Conclusions: Gamete intrafallopian transfer is an ethically acceptable procedure by different religious groups. In a selected group of patients, GIFT is an acceptable and. in some occasions, a preferable procedure to other ARTS. Transvaginal color blood flow imaging of the periovulatory follicle Campbell S.; Bourne T.H.; Waterstone J.; Reynolds K.M.; Crayford T.J.B.; Jurkovic D.; Okokon E.V.; Collins W.P.; GBR FERTIL. STERIL. 1993 6013 (433-438) Objective: To assess intrafollicular blood flow in relation to ovarian morphology and function during the periovulatory period. Design: A prospective, longitudinal study of random, natural ovarian cycles. Setting: The Ovarian Screening Clinic and Endocrine Laboratory of the Department of Obstetrics and Gynaecology. King’s College Hospital, London, United Kingdom. Patients: Women with apparently normal ovarian function awaiting treatment for infertility by IVF-ET during subsequent natural cycles. Interventions: All women were examined by transvaginal ultrasonography with color flow imaging and had a sample of peripheral venous blood taken at each scan for hormone analysis. Main Outcome Measures: The minimum pulsatility index (PI) and maximum peak systolic velocity from vessels within the dominant follicle; the maximum follicular diameters (and hence volume); serum FSH, Ez, LH, and P. Results: The dominant follicle ruptured in IO of I I women. The median interval between the two scans that delineated the time of follicular rupture was 9.5 h (range, 0.0 to 24.5 hours). These cycles appeared to be morphologically and endocrinologically normal. There was an apparent increase in intrafollicular blood flow over the periovulatory period with an insignificant trend toward lower values for the mean PI and a signilicant increase in the peak systolic velocity. These changes appeared to follow the rise in circulating LH. Conclusion: Indexes of blood flow at a given site within the leading follicle can be monitored by transvaginal ultrasonography with color Doppler imaging over the periovulatory period. The increase in the peak systolic velocity and the relatively constant PI suggest a marked increase in blood flow at this time during the ovarian cycle.
307
Effects of selective reduction in triplet gestation: A comparative study of 80 cases managed with or without this procedure Boulot P.; Hedon B.; Pelliccia G.: Peray P.: Laffargue F.; Viala J.L.: FRA FERTIL. STERIL. 1993 60/3 (497-503) Objective: To evaluate the effect of selective termination in triplet pregnancies. Design: Comparative. prospective, nonrandomized study. Setting: All 80 pregnancies were managed in a single tertiary center by the same obstetrical team. Patients: Eighty women with triplet pregnancies were divided into two groups: group I consisted of 48 women who wished to continue their pregnancies without reduction; in group II were 32 women who chose reduction generally to obtain twins. Interventions: Selective terminations were performed after an average term of 9.6 weeks of gestation by transcervical or transabdominal approaches. Main Outcome Measurements: The rate of miscarriage and prematurity. fetal growth, perinatal morbidity and mortality. and maternal complications in the two groups. Results: Prematurity was lower in reduced pregnancies (95.5% in triplets versus 53.5%). especially between 24 to 32 weeks’ gestation where prematurity was reduced by half. Birth weight was >450 g higher in the reduced group. The perinatal mortality rate was lower for reduced pregnancies, but this difference was not statistically significant. Five life-threatening maternal complications occurred in triplets, with none in the reduced group. Conclusions: Selective terminations are effective in decreasing the rate of prematurity. improving fetal growth, and avoiding maternal complications. The procedure thus could be used in triplet gestations. The ultimate decision should be taken by the couple who must be well informed of the risks of the procedure before deciding. Cognitive and psychiatric correlates of functional hypothalamic amenorrhea: A controlled comparison Giles D.E.; Berga S.L.; USA FERTIL. STERIL. 1993 60/3 (486-492) Objective: To assess the association of cognitive function, emotional, and psychiatric history in women with functional hypothalamic amenorrhea compared with amenorrheic and eumenorrheic controls. Design: Each subject was medically evaluated for origin of amenorrhea or to establish eumenorrhea. Subjects completed a structured psychiatric interview and self-report questionnaires. Setting: Patients were recruited from a large reproductive endocrinology practice within a tertiary referral center. Patients/Participants: Consecutive patients who were eligible for the study were invited to participate. Eumenorrheic controls were recruited to match women with functional hypothalamic amenorrhea by age. sex. weight, and season. Main Outcome Measures: Cognitive measures assessed expectation of control, perfectionism, rigidity of ideas and concern about judgments of others (dysfunctional attitudes), coping ability, interpersonal and achievement functioning, and interpersonal dependence. Measures of mood and symptoms included both clinical and self-report scales. Psychiatric diagnoses were determined using Research Diagnostic Criteria and DSM III-R. Results: Women with functional hypothalamic amenorrhea endorsed more dysfunctional attitudes. had Inr J Gynecol Obsret 45
FERTILITY
AND STERILITY
Gamete intrnfallopian transfer: Ethical considerations, historical development of the procedure, and comparison with other advanced reproductive technologies Mastroyannis C.; USA FERTIL. STERIL. 1993 6013 (389-402) Objective: To report on ethical considerations regarding GIFT as well as the developmental history of the procedure and to review the literature and compare it with other advanced reproductive technologies (ARTS). Design: Indications. patient screening, recent evaluations, methods of ovarian hyperstimulation and oocyte retrieval-assessment, gamete transfer and pregnancy outcome are discussed in this review. A comparison of GIFT with other ARTS is also attempted. Main Outcome Measures: Gamete intrafallopian transfer pregnancy determination and outcome. Conclusions: Gamete intrafallopian transfer is an ethically acceptable procedure by different religious groups. In a selected group of patients, GIFT is an acceptable and. in some occasions, a preferable procedure to other ARTS. Transvaginal color blood flow imaging of the periovulatory follicle Campbell S.; Bourne T.H.; Waterstone J.; Reynolds K.M.; Crayford T.J.B.; Jurkovic D.; Okokon E.V.; Collins W.P.; GBR FERTIL. STERIL. 1993 6013 (433-438) Objective: To assess intrafollicular blood flow in relation to ovarian morphology and function during the periovulatory period. Design: A prospective, longitudinal study of random, natural ovarian cycles. Setting: The Ovarian Screening Clinic and Endocrine Laboratory of the Department of Obstetrics and Gynaecology. King’s College Hospital, London, United Kingdom. Patients: Women with apparently normal ovarian function awaiting treatment for infertility by IVF-ET during subsequent natural cycles. Interventions: All women were examined by transvaginal ultrasonography with color flow imaging and had a sample of peripheral venous blood taken at each scan for hormone analysis. Main Outcome Measures: The minimum pulsatility index (PI) and maximum peak systolic velocity from vessels within the dominant follicle; the maximum follicular diameters (and hence volume); serum FSH, Ez, LH, and P. Results: The dominant follicle ruptured in IO of I I women. The median interval between the two scans that delineated the time of follicular rupture was 9.5 h (range, 0.0 to 24.5 hours). These cycles appeared to be morphologically and endocrinologically normal. There was an apparent increase in intrafollicular blood flow over the periovulatory period with an insignificant trend toward lower values for the mean PI and a signilicant increase in the peak systolic velocity. These changes appeared to follow the rise in circulating LH. Conclusion: Indexes of blood flow at a given site within the leading follicle can be monitored by transvaginal ultrasonography with color Doppler imaging over the periovulatory period. The increase in the peak systolic velocity and the relatively constant PI suggest a marked increase in blood flow at this time during the ovarian cycle.
307
Effects of selective reduction in triplet gestation: A comparative study of 80 cases managed with or without this procedure Boulot P.; Hedon B.; Pelliccia G.: Peray P.: Laffargue F.; Viala J.L.: FRA FERTIL. STERIL. 1993 60/3 (497-503) Objective: To evaluate the effect of selective termination in triplet pregnancies. Design: Comparative. prospective, nonrandomized study. Setting: All 80 pregnancies were managed in a single tertiary center by the same obstetrical team. Patients: Eighty women with triplet pregnancies were divided into two groups: group I consisted of 48 women who wished to continue their pregnancies without reduction; in group II were 32 women who chose reduction generally to obtain twins. Interventions: Selective terminations were performed after an average term of 9.6 weeks of gestation by transcervical or transabdominal approaches. Main Outcome Measurements: The rate of miscarriage and prematurity. fetal growth, perinatal morbidity and mortality. and maternal complications in the two groups. Results: Prematurity was lower in reduced pregnancies (95.5% in triplets versus 53.5%). especially between 24 to 32 weeks’ gestation where prematurity was reduced by half. Birth weight was >450 g higher in the reduced group. The perinatal mortality rate was lower for reduced pregnancies, but this difference was not statistically significant. Five life-threatening maternal complications occurred in triplets, with none in the reduced group. Conclusions: Selective terminations are effective in decreasing the rate of prematurity. improving fetal growth, and avoiding maternal complications. The procedure thus could be used in triplet gestations. The ultimate decision should be taken by the couple who must be well informed of the risks of the procedure before deciding. Cognitive and psychiatric correlates of functional hypothalamic amenorrhea: A controlled comparison Giles D.E.; Berga S.L.; USA FERTIL. STERIL. 1993 60/3 (486-492) Objective: To assess the association of cognitive function, emotional, and psychiatric history in women with functional hypothalamic amenorrhea compared with amenorrheic and eumenorrheic controls. Design: Each subject was medically evaluated for origin of amenorrhea or to establish eumenorrhea. Subjects completed a structured psychiatric interview and self-report questionnaires. Setting: Patients were recruited from a large reproductive endocrinology practice within a tertiary referral center. Patients/Participants: Consecutive patients who were eligible for the study were invited to participate. Eumenorrheic controls were recruited to match women with functional hypothalamic amenorrhea by age. sex. weight, and season. Main Outcome Measures: Cognitive measures assessed expectation of control, perfectionism, rigidity of ideas and concern about judgments of others (dysfunctional attitudes), coping ability, interpersonal and achievement functioning, and interpersonal dependence. Measures of mood and symptoms included both clinical and self-report scales. Psychiatric diagnoses were determined using Research Diagnostic Criteria and DSM III-R. Results: Women with functional hypothalamic amenorrhea endorsed more dysfunctional attitudes. had Inr J Gynecol Obsret 45