[Assisted reproductive technology in the presence of chronic viral disease].

Introduction: The first fertility unit dedicated to the treatment of couples infected with chronic viral diseases in Israel was established at the Rambam Medical Center in 2010. A multidisciplinary approach is needed in order to provide appropriate treatment to the viral disease, and to minimize the risks of infecting the partner, the embryo and others in the fertility unit.

Objective: To review 2 years-experience providing fertility care to couples seropositive for HIV, HBV and HCV.

Differentiation in vivo of cardiac committed human embryonic stem cells in postmyocardial infarcted rats.

Human embryonic stem (HES) cells can give rise to cardiomyocytes in vitro. However, whether undifferentiated HES cells also feature a myocardial regenerative capacity after in vivo engraftment has not been established yet. We compared two HES cell lines (HUES-1 and I6) that were specified toward a cardiac lineage by exposure to bone morphogenetic protein-2 (BMP2) and SU5402, a fibroblast growth factor receptor inhibitor.

The decision-making process for requests for late termination of pregnancy in Israel.

This article outlines and reflects on the current procedure in Israel for requesting late pregnancy terminations and the subsequent decision-making processes. The study population consisted of 183 women who requested late termination of pregnancy (LTP) in Israel during the years 1995-97. The main causes for requests were fetal anomalies and late application.

The endothelin system in human and monkey ovaries: in situ gene expression of the different components.

The endothelin system is composed of three endothelin isoforms (ET-1, ET-2, and ET-3), the endothelin receptors ETA and ETB, and the endothelin-converting enzyme (ECE). Besides having a major vasoactive role, endothelins have roles in different cell types at a local level. We investigated the presence of the different components of the endothelin system in primate ovaries.

Twin gestation: is there a correlation between the location of the gestational sacs at the beginning of pregnancy, and the order of delivery.

Objectives: To determine whether there is a dynamic in the location of amniotic sacs in a twin gestation, during pregnancy.

Study Design: The study group comprised 63 twin pairs discordant for sex, who by vaginal sonography performed between 14 and 16 weeks' gestation, were characterized as first twin (opposite the internal os), and second twin. The order of delivery was recorded in the pregnancies that ended with vaginal birth.

Progesterone antagonist RU 486 accommodates but does not induce labour and delivery in primates.

The hormonal mechanisms of parturition in primates remain controversial. Even so, the well-known decrease of plasma progesterone concentration near term is considered by many as the 'labour inducer'. The progesterone antagonist RU 486, which blocks progesterone activity at the cellular receptor level, appears to be a useful hormonal tool by which to study this tissue.

Localization of renin gene expression to monkey ovarian theca cells by in situ hybridization.

To investigate the sites of renin gene expression and localization of renin in primate ovaries, five cynomolgus (Macaca fascicularis) and one rhesus (Macaca mulatta) monkey were treated with gonadotropins to induce multiple follicle development. One ovary was removed before hCG injection (1200 IU) from three monkeys and one ovary was removed 36 h after hCG administration from three monkeys. In three monkeys, the remaining ovary was removed 3, 5, and 7 days after injection of hCG.

The relationship between endogenous oestradiol and vitamin D3 metabolites in serum and follicular fluid during ovarian stimulation for in-vitro fertilization and embryo transfer.

The present study was undertaken to examine the effect of circulating oestradiol on serum levels of 25-hydroxyvitamin D3 (25-OHD3), 24,25-dihydroxyvitamin D3[24,25-(OH)2D3], and 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3] during gonadotrophin-induced ovarian stimulation in 10 healthy women undergoing in-vitro fertilization and embryo transfer (IVF). The presence of these metabolites in the follicular fluid was also investigated. Plasma oestradiol increased from 25 +/- 3.

Highest concentrations of prorenin and human chorionic gonadotropin in gestational sacs during early human pregnancy.

Prorenin is not only the biosynthetic precursor of renin; under certain circumstances in vitro prorenin exhibits reversible intrinsic renin activity and can form angiotensin from renin substrate with or without cleavage of the prosequence. Prorenin is the predominant form of renin synthesized by reproductive organs (ovary, chorion laeve of the placenta, uterine decidua). Its plasma concentrations increases 10-fold throughout pregnancy to 10-100 times that of renin; amniotic fluid prorenin concentration is even higher.

Systolic or diastolic notch in uterine artery blood flow velocity waveforms in hypertensive pregnant patients: relationship to outcome.

To identify the relationship between a systolic or diastolic notch in uterine artery flow velocity waveforms and pregnancy outcome, we studied 140 hypertensive pregnant women with transvaginal, image-directed pulsed Doppler ultrasound. The subjects were classified according to the presence or absence of a systolic or diastolic notch. In 14 with a systolic and 25 with a diastolic notch, the resistance indexes in the uterine arteries on both sides of the uterus were significantly higher than in 101 subjects without a notch.

Renal artery flow velocity waveforms in normal and hypertensive pregnant women.

Pregnancy is associated with marked changes in renal functions. Hypertensive disorders in pregnancy are frequently accompanied by deteriorated renal functions and by pathological lesions in the glomeruli. Using a pulsed Doppler ultrasound, we measured the resistance to flow in the renal artery in normal and hypertensive pregnant patients.

Flexible protocol for administration of human follicle-stimulating hormone with gonadotropin-releasing hormone antagonist.

Objective: To test, using a primate model, a new approach for achieving individualized pituitary-ovarian responses to controlled ovarian hyperstimulation.

Design: Normal ovulatory adult monkeys were selected and randomly assigned to one of the three groups according to onset of spontaneous menses. They had no prior exposure to gonadotropin-releasing hormone (GnRH) antagonist or exogenous gonadotropin therapies.

Cardiovascular responses to hypoxemia in sinoaortic-denervated fetal sheep.

Fetal cardiovascular response to acute hypoxemia is characterized by bradycardia, hypertension, and redistribution of cardiac output. The role of aortic and carotid chemoreceptors in mediating these responses was examined in eight sinoaortic-denervated and nine shamoperated fetal lambs. Blood gases, pH, heart rate, arterial pressure, and blood flow distribution were determined before and during hypoxemia.

Induction of preovulatory luteinizing hormone surge and prevention of ovarian hyperstimulation syndrome by gonadotropin-releasing hormone agonist.

Objective: To use gonadotropin-releasing hormone agonist (GnRH-a) instead of human chorionic gonadotropin (hCG) to induce oocyte maturation for in vitro fertilization (IVF).

Design: Pituitary and ovarian responses to GnRH-a and the outcome of IVF were studied prospectively. Data from patients injected with hCG were analyzed retrospectively.

Effect of calcium channel blocker nifedipine on uterine artery flow velocity waveforms.

Calcium channel blockers have been used successfully in the treatment of pregnancy hypertension and premature labor. Only limited information related to their effect on uterine blood flow during pregnancy is available. In this study we measured the ratio between peak systolic to end-diastolic flow velocity (S/D ratio) in the ascending branch of the uterine artery in nine pregnant patients prior to and following a 10-mg dose of sublingual nifedipine.

The physical and psychomotor development of children conceived by IVF and exposed to high-frequency vaginal ultrasonography (6.5 MHz) in the first trimester of pregnancy.

We examined the physical and psychomotor development of 33 infants conceived by in vitro fertilization (IVF) who were exposed to high-frequency transvaginal ultrasonography (HFTVS) (6.5 MHz) in the first trimester of pregnancy. The study group was composed of 21 singletons and six sets of twins.

Relationship of follicular fluid prorenin to oocyte maturation, steroid levels, and outcome of in vitro fertilization.

Prorenin (PR) is present in high concentrations in the follicular fluid (FF) of the preovulatory follicle. It is the predominant form of renin detected in FF. Its biosynthesis and secretion from the ovary are regulated by gonadotropins.

The physical and mental development of co-sibs surviving selective reduction of multifetal pregnancies.

Fetal reduction in humans is still controversial and considered exploratory. The medical, legal and ethical issues involved have been widely discussed, yet, the long term effects on the surviving co-sibs have not been documented. We report on the psychomotor and physical development of seven children born following fetal reduction in three women, initially bearing 13 fetuses altogether.

Human sperm and hamster oocyte interaction: a model system to assess sperm entry into the oocyte after partial zona dissection.

A model system of hamster oocyte and human sperm interaction was used to assess sperm entry into the perivitelline space after partial zona dissection. The procedure of zona dissection was standardized by creating slits which included one fourth, one eighth, one eighth X 2, or one sixteenth of the zonal circumference. Manipulated eggs were allowed to interact with 1 X 10(6) sperm/mL for 3 hours.

Hemodynamic evaluation of the female pelvic vessels using a high-frequency transvaginal image-directed Doppler system.

Perfusion characteristics of the female pelvic vessels were studied by a high-frequency transvaginal image-directed Doppler system. A 5-MHz Doppler transducer was coupled to a 6.5-MHz probe especially designed for intravaginal use.

First trimester selective reduction in multiple pregnancy guided by transvaginal sonography.

Transvaginal ultrasonography-guided fetal reduction was performed in 11 patients presenting with multiple pregnancies. Embryonic aspiration was carried out in 7 women at 7 to 8 weeks and in 4 patients fetal intrathoracic injection was performed at 9 to 11 weeks, menstrual age. Seven patients delivered healthy babies at greater than 35 weeks, 3 have delivered prematurely 15 to 17 weeks after the procedure with subsequent neonatal death of all sets of twins.

Criteria for transvaginal sonographic diagnosis of ectopic pregnancy.

Transvaginal ultrasonography was performed in 1150 patients suspected of having an ectopic gestation. The criteria for transvaginal sonographic diagnosis of ectopic pregnancy were established by targeted scanning of the pelvic organs and spaces. Sonographic assessment of tubal pregnancy and its differential diagnosis were based on six criteria: (1) the presence or absence of gestational structures within the fallopian tube, (2) the presence or absence of amorphous material in a dilated fallopian tube, (3) the presence or absence of indirect signs of ectopic pregnancy within the pelvis, (4) the echogenicity of a suspected finding relative to the ovary, (5) the presence or absence of flow (of lacunar origin) within the suspected sonographic finding, and (6) the relationship of a suspected sonographic sign to an intentionally displaced ovary.

Transvaginal ultrasonography in the diagnosis and treatment of infertility.

The use of transvaginal sonography (TVS) in the management of infertility is gaining increasing popularity. The improved resolution and better tissue textural differentiation afforded by TVS makes this technique useful in monitoring ovarian follicular growth, ovulation, and corpus luteum formation, and in evaluating the normal anatomy of the uterus and the cervix and their cyclic response to ovarian steroids. Adnexal and cul-de-sac abnormalities related to infertility can also be identified.

Changes in uterine blood flow during human pregnancy.

A transvaginal duplex Doppler ultrasonography system was used to measure blood flow characteristics in the ascending uterine artery before and during pregnancy. The system uses a 5 MHz Doppler transducer coupled to a 6.5 MHz imaging probe.