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Shushan A, Ezra Y, Samueloff A. Early treatment of gestational diabetes reduces the rate of fetal macrosomia. Am J Perinatol 1997; 14:253-6. [PMID: 9259938 DOI: 10.1055/s-2007-994138] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study tested the hypothesis that to reduce the rate of macrosomic infants in gestational diabetes cases, good glycemic control should be initiated before 34 completed gestational weeks. The study population included 84 women with gestational diabetes, ascertained by universal screening of all women attending the antenatal clinic of the Hadassah Medical Center, over a 2-year period. The 60 women (71%), who initiated treatment before 34 completed weeks, composed the "early" group. The 24 women (29%), who initiated treatment after the 34th week, composed the "late" group. All patients were managed by an intensified protocol, including stringent glycemic control. In the "early" and "late" groups, mean gestational age at the beginning of treatment was 30.0 +/- 3.8 and 36.2 +/- 1.2 weeks, and duration of treatment was 9.6 +/- 4.1 and 3.7 +/- 1.8 weeks, respectively. Maternal characteristics were similar in the two groups. The rate of macrosomic and large-for-gestational-age infants were 5 and 11%, respectively, in the early group as compared to 25 and 29% in the "late" group (p < 0.05). No significant differences were found between the two groups in the mode of delivery or Apgar scores. We conclude that to reduce the rate of macrosomic infants in gestational diabetes cases, good glycemic control should be initiated before 34 completed gestational weeks.
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Eisenberg VH, Eidelman LA, Arbel R, Ezra Y. Legionnaire's disease during pregnancy: a case presentation and review of the literature. Eur J Obstet Gynecol Reprod Biol 1997; 72:15-8. [PMID: 9076416 DOI: 10.1016/s0301-2115(96)02648-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Acute pneumonia complicating pregnancy can have serious consequences for both the mother and the fetus. Streptococcus pneumoniae remains the most common bacterial pathogen, but Legionella pneumophila must be considered as well, especially in severe multisystem disease. With severe disease, premature delivery may occur as has been described in the only previous report of Legionnaire's disease during pregnancy. We present here the first report of Legionnaire's disease in pregnancy, resulting in the term delivery of a healthy infant. Also presented is an extensive review of the literature.
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Revah A, Ezra Y, Farine D, Ritchie K. Failed trial of vacuum or forceps--maternal and fetal outcome. Am J Obstet Gynecol 1997; 176:200-4. [PMID: 9024114 DOI: 10.1016/s0002-9378(97)80036-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Our purpose was to compare the maternal and neonatal morbidity associated with a failed trial of instrumental delivery with that of proceeding directly to cesarean section during the second stage of labor. STUDY DESIGN All second-stage cesarean deliveries between January 1986 and December 1992 in a tertiary care teaching hospital were retrospectively reviewed. Specific maternal and neonatal outcome parameters were studied to compare the failed instrumental group with the direct-to-cesarean section group. RESULTS Of 29,457 live births at > 37 weeks' gestation, 401 women had a cesarean section performed in the second stage of labor. There were 326 cases in which cesarean section was performed directly during the second stage of labor and 75 women who had a failed attempt of instrumental delivery (forceps 33, vacuum 25, both 17) before cesarean delivery was done. The three instrumental groups and the direct-to-cesarean section group did not differ in any of the outcome variables for either mother or newborn. CONCLUSIONS Failed instrumental delivery performed as a trial of forceps and/or vacuum in a setting where a cesarean section can follow promptly is not associated with increased morbidity of either mother or baby.
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Weinstein D, Ezra Y, Picard R, Furman M, Elchalal U. Expectant management of post-term patients: observations and outcome. THE JOURNAL OF MATERNAL-FETAL MEDICINE 1996; 5:293-7. [PMID: 8930801 DOI: 10.1002/(sici)1520-6661(199609/10)5:5<293::aid-mfm7>3.0.co;2-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Post-term pregnancy is associated with increased perinatal mortality. In a retrospective study based on our post-term protocol from 1990 until May 1995 1,798 post-term pregnant women with reliable dating were evaluated for expectant management. A group of 2,633 pregnant women who delivered between 37 and 41 weeks during 1994 served as a control group. The perinatal mortality (0.56 per 1,000 vs. 0.75 per 1,000 in the control group) was similar in both groups. The incidence of induction of labor (7.45% vs. 7% in the control group), meconium of more than +1 (5.2% vs. 4% in the control group), shoulder dystocia (0.33% vs. 0.19%), high birthweight (> 4,500 g) (1% vs. 1%), and cesarean section rates (7.5% vs. 7% in the control group) were similar. However the fetal distress rates (11.6% vs 16%; P = .004), instrumental deliveries (10.1% vs. 13%, P = .002), and the rate of 5-minute Apgar score of less then 7 (1.1% vs. 5%, P = .000001) were found to be significantly lower in the post-date group than in the control group. We conclude that the expectant management and our intensive observation and follow-up in post-term is indicated for both mother and fetus.
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Weinstein D, Benshushan A, Ezra Y, Rojansky N. Vaginal birth after cesarean section: current opinion. Int J Gynaecol Obstet 1996; 53:1-10. [PMID: 8737297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Although the current literature attests to the merits of a trial of labor in the patient with a prior cesarean section, some controversies remain. For example, can women with two or more sections be allowed a trial of labor and can patients who undergo a trial of labor receive oxytocin or prostaglandins for induction? Also, do certain indications for previous cesarean section such as relative cephalopelvic disproportion/failure to progress or the diagnosis of breech or twins in the present pregnancy constitute an indication for elective repeat cesarean delivery? These questions along with some other controversies are discussed in the light of newly accumulated data in the English literature and our own experience over the last decade in a major university-based tertiary medical center.
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Ezra Y, Rose M, Eldor A. Therapy and prevention of thrombotic thrombocytopenic purpura during pregnancy: a clinical study of 16 pregnancies. Am J Hematol 1996; 51:1-6. [PMID: 8571931 DOI: 10.1002/(sici)1096-8652(199601)51:1<1::aid-ajh1>3.0.co;2-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Thrombotic thrombocytopenic purpura (TTP) is a severe multisystem disorder of unknown pathogenesis, with preference to women. The mortality rate of patients with TTP was 90% until the introduction of plasma therapy that increased the survival rate to 70-80%, with minimal or no sequelae. Of the survivors, 30-60% suffer from relapses, often in association with precipitating factors such as infections, surgery, and pregnancy. Women who are either pregnant or in the postpartum period make up 10-25% of TTP patients, and once the disease occurs during a pregnancy, it tends to recur in subsequent ones. We treated five women who suffered at least one TTP episode during pregnancy. They had a total of 16 pregnancies, eight of which were complicated by TTP. They suffered seven additional TTP episodes that were not associated with pregnancy. We assessed the severity of each TTP episode with a scoring system used in our previous studies. Presented is the course of their disease and their pregnancies, and guidelines for the management and prevention of TTP during pregnancy are provided.
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Weinstein D, Ezra Y, Elchalal U. Management of labor and labor complications. Curr Opin Obstet Gynecol 1995; 7:437-41. [PMID: 8620076 DOI: 10.1097/00001703-199512000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Obstetricians assume a dual role in the provision of health care for both mother and fetus during labor. Not only do they function as consultants for medical and surgical problems peculiar to labor, but they also assume a more broad-based role in the prevention of labor complications to achieve the best possible health maintenance for both patients. This includes the provision of continuous health care throughout pregnancy, delivery, and postpartum management. A summary of the common problems of management of labor and labor complications is provided, including fetal monitoring during labor, augmentation of labor, vaginal delivery after cesarean section, epidural analgesia and its effects on delivery, and fecal incontinence after delivery.
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Ezra Y, McParland P, Farine D. High delivery intervention rates in nulliparous women over age 35. Eur J Obstet Gynecol Reprod Biol 1995; 62:203-7. [PMID: 8582496 DOI: 10.1016/0301-2115(95)02201-h] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To assess the effect of maternal age and parity on obstetric interventions and pregnancy outcome. STUDY DESIGN A retrospective review of 35,140 deliveries including 4268 parturients aged 35 years or more (1985-1992). Obstetrical interventions and outcome were analyzed in relation to age and parity. RESULTS Nulliparous women aged 35 years or more had a 2-fold increase in cesarean delivery rate over younger nulliparae, and 50% more cesarean deliveries than the multiparae aged 35 years or more. Similar trends were observed in preterm labor, labor induction, breech presentation, and instrumental delivery. Higher risk was encountered in neonatal 1 min Apgar scores < 3, and in admissions to the neonatal intensive care unit. There were no differences in all parameters between women over age 40 and women aged 35-40 years. The perinatal mortality was not increased and was similar in all groups. CONCLUSIONS Nulliparae aged more than 35 years are at increased risk for interventions and cesarean sections. However, women aged 35-40 have a similar risk as women aged over 40 years.
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Ezra Y, Schenker JG. Abortion rate in assisted reproduction--true increase? EARLY PREGNANCY : BIOLOGY AND MEDICINE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR THE INVESTIGATION OF EARLY PREGNANCY 1995; 1:171-5. [PMID: 9363248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Pregnancies achieved by assisted reproduction were considered to carry an increased risk for spontaneous abortion, and ectopic and heterotopic pregnancies. In order to examine the validity of this hypothesis we compared the outcomes of spontaneous pregnancies and assisted reproduction pregnancies using the published reports in the world literature during the last decade. We also studied the outcome of 53,928 in vitro fertilization (IVF) pregnancies reported during the years 1985-91. The reported loss rates in spontaneous pregnancies (abortions and ectopic pregnancies) compared to pregnancies achieved by assisted reproduction were 19% and 30%, respectively. The differences in loss rates between spontaneous and assisted reproduction pregnancies are not completely understood and may originate from predisposing factors such as tubal disease, uterine disorders, corpus luteum dysfunction, and endometriosis that are more frequent in patients suffering from infertility. Increasing maternal age correlates with a higher risk of fetal chromosomal anomalies which results in an increased rate of abortions.
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Revah A, Ezra Y, Farine D, Ritchie K. Failed trial of vacuum and/or forceps — maternal and fetal outcome. Am J Obstet Gynecol 1995. [DOI: 10.1016/0002-9378(95)90784-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Floman Y, Milgrom C, Gomori JM, Kenan S, Ezra Y, Liebergall M. Acute postpartum inflammatory sacroiliitis. A report of four cases. ACTA ACUST UNITED AC 1994. [DOI: 10.1302/0301-620x.76b6.7983112] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report four patients with unilateral postpartum sacroiliitis presenting with agonising unilateral pain, an elevated ESR, elevated alkaline phosphatase levels, leucocytosis and positive bone scans. The diagnosis of a non-infectious inflammatory cause was supported by the postpartum onset, the response to non-steroidal anti-inflammatory drugs, negative aspiration cultures in two cases and the lack of changes in the sacroiliac joints on long-term follow-up radiographs.
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Floman Y, Milgrom C, Gomori JM, Kenan S, Ezra Y, Liebergall M. Acute postpartum inflammatory sacroiliitis. A report of four cases. THE JOURNAL OF BONE AND JOINT SURGERY. BRITISH VOLUME 1994; 76:887-90. [PMID: 7983112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report four patients with unilateral postpartum sacroiliitis presenting with agonising unilateral pain, an elevated ESR, elevated alkaline phosphatase levels, leucocytosis and positive bone scans. The diagnosis of a non-infectious inflammatory cause was supported by the postpartum onset, the response to non-steroidal anti-inflammatory drugs, negative aspiration cultures in two cases and the lack of changes in the sacroiliac joints on long-term follow-up radiographs.
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Younis JS, Ezra Y, Sherman Y, Simon A, Schenker JG, Laufer N. The effect of estradiol depletion during the luteal phase on endometrial development. Fertil Steril 1994; 62:103-7. [PMID: 8005273 DOI: 10.1016/s0015-0282(16)56823-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine whether luteal E2 is obligatory for obtaining an adequately developed endometrium. DESIGN Survey of women with premature ovarian failure (POF) in a prospective, controlled, randomized study. SETTING In vitro fertilization unit in a tertiary care university medical center. PATIENTS Fourteen amenorrheic women with POF, candidates for oocyte donation, were divided into two distinct groups with seven women in each subgroup. INTERVENTIONS Endometrial priming with a fixed dose of oral micronized E2, 4 mg/d for 14 days, was similarly performed in the study and the control groups. Progesterone replacement during the luteal phase was also identical in the two groups and was accomplished by IM P in oil, 50 mg/d for another 14 days. Only the control group continued to have the same E2 regimen during the luteal phase. MAIN OUTCOME MEASURES AND RESULTS Follicular phase mean E2 levels as well as luteal phase mean P levels were similar in both groups. However, luteal E2 levels differed significantly between the study and the control groups (21 +/- 5 and 692 +/- 199 pg/mL, respectively; conversion factor to SI units, 3.671). Nevertheless, histologic evaluation of endometrial biopsies on days 21 and 26 were similar for both groups. Endometrial gland dating, using light microscopy in the study and the control groups, on day 21, was 19.1 +/- 0.8 and 18.4 +/- 0.5, respectively, and on day 26, 25.4 +/- 0.8 and 25.9 +/- 0.5, respectively. Dating of the stroma in the two biopsies was also similar in both groups. Moreover, transmission electron microscopy performed in two patients of the study group showed typical characteristics of a secretory endometrium. CONCLUSIONS Luteal E2 depletion in the human does not seem to adversely affect the morphological developmental capacity of the endometrium. Our results suggest that E2 secretion by the corpus luteum in the human does not appear to be obligatory for the development of a normal secretory endometrium. The actual receptivity of the endometrium after such preparation needs to be evaluated.
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Ezra Y, Simon A, Sherman Y, Benshushan A, Younis JS, Laufer N. The effect of progesterone administration in the follicular phase of an artificial cycle on endometrial morphology: a model of premature luteinization. Fertil Steril 1994; 62:108-12. [PMID: 8005274 DOI: 10.1016/s0015-0282(16)56824-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To evaluate the effect of premature P administration on artificially prepared endometrium in women with ovarian failure. DESIGN To mimic premature luteinization, patients with ovarian failure were treated with continuous estrogen and episodic P during the follicular phase of artificial cycles. SETTING In vitro fertilization unit at a university hospital. PATIENTS The study group included 16 patients with ovarian failure who were randomly divided into two groups. Group A (8 patients) was treated by episodic P administration during the artificial follicular phase on days 2 and 7 (12.5 mg of P in oil IM), and in group B (8 patients), P (6.25 mg) was added on days 3, 4, and 5. Another 16 patients (group C), age matched to the study group, were arbitrarily allocated to serve as controls and had standard preparatory cycles without P supplementation in the follicular phase. Serum E2 and P levels and endometrial biopsies were taken on days 14 and 26. RESULTS Serum E2 levels were comparable between the study group (group A+B) and controls on both days 14 and 26. Although serum P levels did not differ between the groups on day 26, it was higher in the follicular phase of the study group than in the controls (1.9 +/- 4.0 and 0.2 +/- 0.1 ng/mL, respectively). In the study group, 8 of 16 patients demonstrated early secretory changes in the late follicular phase biopsies, and 9 of 16 women developed stromal-glandular discrepancy in the late luteal phase. This differed significantly from the controls in which only one late luteal biopsy was out of phase. CONCLUSIONS Episodic surges of P during the follicular phase may result in impaired endometrial development that cannot be corrected by P supplementation during the luteal phase. This unique model provides evidence for the potential detrimental effect of premature P secretion in the follicular phase on endometrial function.
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Abstract
OBJECTIVE To review and appreciate the relevant data on assisted reproduction techniques and their potential complications. DATA RESOURCES Major publications on assisted reproduction that include the information concerning complications associated with this practice. RESULTS Assisted reproduction is a common practice in modern reproductive medicine. Complications are associated with ovulation induction and the extracorporeal methods that are used for IVF-ET, GIFT, and zygote intrafallopian transfer (ZIFT). These complications are associated with laparoscopy, anesthesia, oocyte retrieval, and laboratory facilities. Pregnancies resulting from assisted reproduction are more complicated than spontaneous pregnancies. There are higher rates of ectopic, heterotopic, and multifetal pregnancies; abortions; and premature deliveries. Increased rates of perinatal mortality and morbidity result from prematurity, and higher rates of maternal diseases in pregnancy (preeclampsia, diabetes mellitus, bleeding, anemia) contribute to fetal intra-uterine growth restriction and maternal morbidity. CONCLUSIONS Assisted reproduction practice should be well controlled in view of the potential for complications before and during pregnancies.
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Younis JS, Ezra Y, Brzezinnski A, Fibich T, Schenker JG, Laufer N. The effect of growth hormone on granulosa cell function during in-vitro fertilization. Hum Reprod 1993; 8:1588-92. [PMID: 8300811 DOI: 10.1093/oxfordjournals.humrep.a137896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The effect of growth hormone addition to human menopausal gonadotrophin (HMG), after pituitary down-regulation, on granulosa cell function, in in-vitro fertilization (IVF) was evaluated. Growth hormone or placebo were added in a prospective, randomized and double-blind manner to an existing IVF stimulation protocol. Forty-two normal ovulatory women (< or = 38 years old) with mechanical factor infertility and normal male factor were included in the study. Gonadotrophin-releasing hormone agonist (GnRHa) was given from day 21 of the previous cycle until human chorionic gonadotrophin (HCG) administration. Follicular stimulation with HMG was started after pituitary down-regulation. Growth hormone 12 IU/day or placebo were administered on alternate days, beginning day 1 until day 7 of HMG treatment. Granulosa cell function was evaluated, in all patients, by follicular fluid levels of ovarian steroids and insulin-like growth factor-I (IGF-I). In 14 patients, chosen arbitrarily granulosa lutein cells were cultured in the presence and absence of additional HCG. Follicular fluid levels of oestradiol, progesterone, testosterone and IGF-I were similar in both growth hormone and placebo groups. Basal and post-HCG levels of oestradiol and progesterone did not differ significantly between the two groups of granulosa lutein cell cultures. We conclude that after pituitary down-regulation, in-vivo administration of growth hormone with HMG in young ovulatory women does not seem to affect granulosa cell function when compared to the administration of HMG alone.
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Mordel N, Ezra Y, Benshushan A, Dorembus D, Schenker JG, Sadovsky E. Transverse versus longitudinal uterine incision in cesarean delivery of triplets. THE JOURNAL OF REPRODUCTIVE MEDICINE 1993; 38:695-6. [PMID: 8254591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
It is commonly accepted that cesarean section is the preferred mode of delivery of triplets. The present study was performed to evaluate maternal complications and neonatal outcome in 21 women operated on by a transverse lower segment incision as compared to 8 parturients who underwent surgery by a longitudinal uterine incision. There was no significant difference in mean gestational age at delivery, mean weight of the newborns, Apgar scores, perinatal mortality rates, or intraoperative or postpartum hemorrhage incidence between the two groups. Thus, a transverse lower segment uterine incision should be used in triplet deliveries to increase the chances of a normal vaginal delivery in the future.
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Benshushan A, Ezra Y, Simon A, Mordel N, Lewin A, Laufer N. The effect of gonadotropin-releasing hormone agonist on embryo quality and pregnancy rate following cryopreservation. Fertil Steril 1993; 59:1065-9. [PMID: 8486175 DOI: 10.1016/s0015-0282(16)55929-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To examine the effect of GnRH analogue (GnRH-a) on the quality of frozen-thawed embryos and the pregnancy rate (PR) resulting from transfer. DESIGN A retrospective study of two groups of women undergoing transfers of frozen-thawed embryos. In group 1 ovulation induction with hMG was begun after hypophyseal desensitization with GnRH-a for 2 weeks. In group 2 ovulation was induced with hMG only. The freezing and thawing techniques were identical for both groups. SETTING In vitro fertilization unit at a university hospital. PATIENTS The study group (group 1) included 108 women who underwent 137 transfer cycles of frozen-thawed embryos, and the control group (group 2) included 44 women in 51 cycles of thawed ETs. INTERVENTIONS Ovum pick-up and ET techniques were the same for both groups. Methods of embryo freezing and thawing were identical, as were the morphological criteria for grading the embryos. RESULTS The morphology of embryos was similar in both groups, as was the number of embryos that had at least 50% intact blastomeres (83% +/- 23% and 78% +/- 30% for group 1 and group 2, respectively). The PR (16 of 137 [11.7%] and 6 of 51 [11.8%], respectively) as well as the abortion rate (30%) were similar for both groups. CONCLUSIONS The use of GnRH-a does not affect the quality of embryos nor the pregnancy outcome. Because the yield of frozen embryos per ovum pick-up is higher in cycles stimulated by GnRH-a/hMG, the PR per pick-up cycle is thus anticipated to be higher.
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Abstract
In-vitro fertilization and embryo transfer techniques are now used all over the world (53 countries). The results of 492 of all world units were collected from national surveys and registries of different countries. Since 1985, more than 53,635 women were treated and 34,316 babies were born by 224,473 treatment cycles, followed by more than 160,518 transfer cycles. Only about 65%-75% of all resulting pregnancies attained live births. The remainder ended with spontaneous abortions (26%), or ectopic pregnancies (5.54%). The multiple pregnancy rate (22%) was higher than the normal population and contributed to higher rates of preterm deliveries and perinatal mortality. No increased incidence of chromosomal aberrations and malformations were noted during the years (2.25%). Success rates did not improve significantly within the 5-year period surveyed, in most parts of the world. The indications for treatment were broadened during the years and the procedure became a final step for diagnosis and treatment of unexplained infertility. We conclude that IVF/ET is not an empirical treatment anymore and is a relatively safe procedure, although it should be used only when properly indicated. Male infertility and infertility of unexplained origin may be accepted indications for IVF/ET. More research and centralization of treatment in fewer but large units should be established in order to improve success rates and lower the cost per live birth child. Quality control by professional or public associations should be regulated.
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Benshushan A, Ezra Y, Simon A, Gordon JW, Laufer N. Subzonal insertion, a possible treatment for "defective oocytes". J Assist Reprod Genet 1993; 10:98-9. [PMID: 8499688 DOI: 10.1007/bf01204449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Abstract
OBJECTIVE To define a new category of unexplained infertility and its potential treatment. DESIGN Normal infertile couples underwent prospectively, cross-fertilization attempts in which the wife's oocytes were inseminated by the husband and donor semen. After recurrent failure of fertilization, cross insemination of donor oocytes was attempted with the husband sperm. SETTING In vitro fertilization unit at a teaching hospital. PATIENTS Three couples who were diagnosed as suffering of unexplained infertility and treated by in vitro fertilization (IVF). RESULTS The female partner of these couples produced morphologically normal oocytes that were demonstrated to be functionally defective and failed to fertilize in vitro with both husband and donor sperm. Donated oocytes inseminated by the husband's sperm were fertilized in all patients, demonstrating the normal fertilizing ability of the husbands' semen. One patient conceived and delivered after an oocyte donation. CONCLUSIONS Conclusive diagnosis of defective oocytes as a cause of infertility may be made only after IVF and oocyte donation.
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Ezra Y, Simon A, Yaron A, Laufer N, Navot D. Angiotensin-I-converting enzyme and its correlation with human follicular fluid steroids. Eur J Obstet Gynecol Reprod Biol 1992; 44:71-5. [PMID: 1316850 DOI: 10.1016/0028-2243(92)90316-q] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Angiotensin-I-converting enzyme (ACE) is a peptidyl-dipeptide hydrolase which splits off the dipeptide His-Leu from the decapeptide angiotensin I and thus converts it to angiotensin II. We determined ACE activity in human preovulatory follicular fluid to further establish the intraovarian activity of the renin angiotensin system. Follicular fluids (n = 18) were obtained from eight patients undergoing in vitro fertilization (IVF) and embryo transfer (ET). ACE activity in follicular fluid and serum was determined by fluorescent spectrophotometry. The median follicular fluid ACE activity was 1.12 (range: 0.19-1.56) nmol/min/ml. This value was significantly lower than ACE activity in serum, 1.50 (range: 1.22-1.57) nmol/min/ml (P less than 0.001). In contrast to this 3:4 ratio between follicular fluid and serum ACE when expressed per ml fluid, the values were very similar when expressed per mg of protein: 0.025 vs. 0.023 nmol/min/mg in follicular fluid and serum, respectively. Correlations were sought between follicular fluid ACE activity and both serum and follicular fluid E2 and P4. A highly significant correlation (P less than 0.0005, r = 0.73) was found between ACE activity in follicular fluid and follicular fluid P4. The presence of significant ACE activity in human follicular fluid further supports the local-ovarian activity of the renin angiotensin cascade.
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Abstract
Triplet gestations present a considerable management challenge due to a high rate of antenatal, intrapartum and neonatal complications. The introduction of ovulation inducing agents resulted in a marked increase of these pregnancies. Consequently, triplet conceptions are not considered a rare phenomenon and have become almost routine high risk pregnancies. In our department the triplet gestation frequency increased 2-4 times in a 10 year period from a rate of 0.07-0.14% during 1978-84 to 0.28% of all deliveries in 1987. This high incidence of triplet deliveries results in a threefold increase in the frequency of triplet neonates and their associated complications. It is reasonable to assume that the wide application of various assisted reproductive techniques will result in continuous increase in the incidence of triplets which will in turn require coordinated management of a high risk pregnancy unit, delivery room and neonatal intensive care unit.
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Ezra Y, Krausz MM, Rivkind A, Anteby SO. Successful pregnancy and normal delivery with Marlex mesh replacement of the abdominal wall. Am J Obstet Gynecol 1990; 162:97-8. [PMID: 2301522 DOI: 10.1016/0002-9378(90)90829-v] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A case of a woman who underwent a wide excision of an abdominal wall desmoid tumor is reported. The lesion was covered with Marlex mesh, and she went through an uncomplicated pregnancy and successful delivery. Management is described and discussed.
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Sherer DM, Ezra Y, Beyth Y, Sadovsky E. Sinusoidal fetal heart rate pattern associated with the twin to twin transfusion syndrome. Int J Gynaecol Obstet 1990; 31:71-4. [PMID: 1968022 DOI: 10.1016/0020-7292(90)90185-n] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Sinusoidal fetal heart rate pattern (FHR) is regarded by most authors as signifying a compromised fetus. In most cases, this is secondary to fetal anemia of different causes, usually Rh isoimmunization, more rarely to fetomaternal transfusion, bleeding vasa previa, placental chorioangioma, or traumatic amniocentesis. A case is described which to our knowledge is the first reported of a sinusoidal FHR pattern occurring in the relatively anemic donor twin in a case of the twin to twin transfusion syndrome. The importance of separate antepartum biophysical evaluation of each member of a twin pregnancy is emphasized.
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