Steven J. Ory

Conservative treatment of ectopic pregnancy with methotrexate

Six subjects with distal ampullary ectopic pregnancies were treated with four doses of intravenous methotrexate (1.0 mg/kg) followed by four doses of leucovorin (0.1 mg/kg, intramuscularly). The diagnosis was established in all cases by laparoscopy following sonography and radioimmunoassay for serum beta subunit of human chorionic gonadotropin. Subjects were followed with daily quantitative serum beta-human chorionic gonadotropin radioimmunoassay and sonography. Five of the six subjects experienced resolution of their ectopic pregnancy without additional surgical treatment. One subject underwent salpingectomy following treatment. Morbidity also included three patients with mild stomatitis or gastritis, and two patients had transient elevations of serum transaminase levels. Two patients had protracted courses and received blood transfusions. The most abrupt response and most uncomplicated courses were experienced in the three subjects with initial human chorionic gonadotropin levels below 1000 mIU/ml. This preliminary experience suggests that methotrexate may be an effective alternative for the treatment of early ectopic pregnancy.

Methotrexate inhibition of normal trophoblasts in vitro.

Methotrexate is a folic acid inhibitor useful in the treatment of gestational trophoblastic disease. Its effect on normal trophoblast in vitro was studied to help establish a minimum effective dose in vivo for the conservative treatment of ectopic pregnancy. In vitro inhibition of normal trophoblastic cell growth was measured after 48 hours of exposure to variable concentrations of methotrexate (10(-2) to 10(-9) mol/L) and rescue with leucovorin. A modification of Cottes method of trophoblastic cell enrichment was used. Long-term (10 days) linear growth inhibition was observed at concentrations greater than 10(-5) mol/L. Leucovorin control cultures showed no inhibition of cell growth. The study demonstrates that methotrexate is effective in inhibiting normal trophoblastic cell culture growth in vitro at concentrations 1000 times those reported necessary to inhibit deoxyribonucleic acid synthesis in choriocarcinoma cell cultures.

Clinical application of intracytoplasmic sperm injection using in vitro cultured testicular spermatozoa obtained the day before egg retrieval

OBJECTIVE To study the effect of in vitro culture on the quality of human testicular sperm and the efficiency of intracytoplasmic sperm injection with in vitro cultured testicular sperm. DESIGN Clinical study. SETTING A private IVF center. PATIENT(S) Twenty consecutively seen IVF patients undergoing testicular biopsies for ICSI. INTERVENTION(S) The testicular specimens were cultured in vitro for 24 hours and the isolated spermatozoa were microinjected. MAIN OUTCOME MEASURE(S) Preincubation and postculture sperm motility, and fertilization, implantation, and pregnancy rates after intracytoplasmic sperm injection. RESULT(S) Motility increased from initial nonmotile or twitching sperm to free motile sperm in 18 of 20 cases. The injection of in vitro cultured testicular sperm resulted in a fertilization rate of 58%, an implantation rate of 20%, and a pregnancy rate of 45%. CONCLUSION(S) A testicular biopsy procedure can be performed the day before egg retrieval. Despite the low initial sperm quality, a high percentage of the prepared testicular sperm showed increased motility after 24 hours of culture. The injection of in vitro cultured testicular sperm into matured oocytes resulted in fertilization, implantation, and pregnancy rates comparable to those obtained with ejaculated sperm.

A comparison of post-thaw results between cryopreserved embryos derived from intracytoplasmic sperm injection and those from conventional IVF

OBJECTIVE To study the effect of freezing on early stage embryos derived from intracytoplasmic sperm injection (ICSI) or from IVF. DESIGN Prospective, controlled clinical study. SETTING Private IVF center. PATIENT(S) Sixty-seven consecutive patients undergoing frozen-thawed embryo transfer cycles. INTERVENTION(S) Early stage embryos were frozen, thawed, and transferred. MAIN OUTCOME MEASURE(S) Post-thaw survival, implantation and pregnancy rates. RESULT(S) We noted an 88% post-thaw survival rate, an 18% implantation rate, and a 52% pregnancy rate in the ICSI group and 81%, 11%, and 25%, respectively, with conventional fertilization. CONCLUSION(S) Early stage embryos (either zygote or 2-4 cells) derived from ICSI can be frozen with confidence and higher post-thaw survival and pregnancy rates can be achieved when compared with those from conventional IVF.

Prognostic value of beta-human chorionic gonadotropin is dependent on day of embryo transfer during in vitro fertilization

OBJECTIVE To determine threshold β-hCG levels predictive of an ongoing pregnancy (OP), live birth (LB), and multiple gestation (MG) in IVF cycles resulting from day-3 (D3) vs. day-5 (D5) embryo transfers (ET), to compare IVF cycle characteristics and pregnancy outcomes in D3 vs. D5 ET groups, and to assess the degree to which maternal characteristics and cycle parameters were predictive of higher β-hCG levels. DESIGN Retrospective analysis. SETTING Infertility center. PATIENT(S) Women who had ET performed for IVF cycles between July 2004 and January 2010. INTERVENTION(S) Embryo transfer performed on either D3 or D5 after oocyte fertilization. MAIN OUTCOME MEASURE(S) Beta-hCG on day 15 after oocyte fertilization. RESULT(S) Beta-hCG levels were significantly higher with D5 ET compared with D3 ETs (D3: 103.6 ± 4.4 IU/L vs. D5: 198.0 ± 10.6 IU/L), and a multivariate analysis demonstrated that D5 ET was a significant predictor of higher β-hCG levels. The β-hCG thresholds predictive of OP were 78 IU/L and 160 IU/L for D3 and D5 ET, which predicted OP in 96% and 91% of cases, respectively. Similarly, for LB, the β-hCG thresholds were 94 IU/L (79% positive predictive value [PPV]) and 160 IU/L (88% PPV), and for MG were 250 IU/L (18% PPV) and 316 IU/L (34% PPV), respectively. CONCLUSION(S) Initial β-hCG levels are dependent on the day of ET and are a reliable and highly predictive tool for OP outcomes.

Clinical application of nonselective assisted hatching of human embryos.

OBJECTIVE To evaluate the effect of nonselective assisted hatching on pregnancy rate (PR) and to provide an alternative and simplified method for clinical application of assisted hatching. DESIGN Retrospective analysis of clinical data. SETTING Private infertility practice. PATIENT(S) Women from 258 consecutive stimulated IVF cycles. INTERVENTION(S) Assisted hatching was performed on each transferred embryo regardless of patient history, embryo morphology, or other selection criteria routinely applied to many IVF programs. MAIN OUTCOME MEASURE(S) Pregnancy, live birth, and implantation rates. RESULT(S) Of 258 consecutive patients who had nonselective assisted hatching, 109 (42%) had clinical pregnancies, with 93 (36%) live births and 178 (20%) embryos implanted. CONCLUSION(S) Nonselective assisted hatching resulted in an acceptable PR and provided an alternative and simplified method for clinical application of assisted hatching.

International Federation of Fertility Societies Surveillance 2013: preface and conclusions

Surveillance is a triennial worldwide compendium of national rules and regulations for assisted reproductive technology. It was last published in 2010.

Endometrial adenocarcinoma associated with drug-induced hyperprolactinemia.

&NA; A 54‐year‐old woman with hyperprolactinemia and amenorrhea that occurred with phenothiazine and tricyclic antidepressant use developed a stage IBG2 endometrial adenocarcinoma. This is believed to be the first case reported of endometrial carcinoma associated with drug‐induced hyperprolactinemia. (Obstet Gynecol 67:86S, 1986)