Received March 19, 1982; accepted May 20, 1982. Department of Radiology and Radiological Sc,- enc... more Received March 19, 1982; accepted May 20, 1982. Department of Radiology and Radiological Sc,- ences, Vanderbilt University Hospital, Nashville. TN 37232. Address reprint requests to AC Win-field. 'Department of Obstetrics and Gynecology, Vanderbilt University Hospital, ...
Journal of In Vitro Fertilization and Embryo Transfer, 1986
End-organ antiestrogenic effects of clomiphene citrate (CC) have been demonstrated in the female ... more End-organ antiestrogenic effects of clomiphene citrate (CC) have been demonstrated in the female reproductive tract at the levels of the ovary, cervix, and endometrium. However, it has not been established whether this effect is manifested during concomitant human menopausal gonadotropin (hMG) administration, as occurs in hMG/CC stimulations of multiple follicular development. To assess this question a review was made of serum estradiol (E2) and cervical mucus in 47 hMG and 56 hMG/CC stimulations on days -2, -1, 0, and +1 relative to the day of hCG administration. E2 levels (pg/ml) were significantly lower in the hMG as compared to the hMG/CC group. However, comparing the hMG and hMG/CC groups, cervical mucus scores were significantly higher in the former. Furthermore, an analysis of covariance demonstrated that the cervical mucus scores on each day were significantly lower in the hMG/CC group (P less than 0.001). Thus, in hMG/CC stimulations for in vitro fertilization (IVF), despite the concomitant administration of pharmacologic doses of hMG, CC exerts an antiestrogenic effect on at least one end organ, cervical mucus production. Potentially, this antiestrogenic effect in IVF stimulations would be exerted at other female reproductive tract sites including the endometrium; however, its clinical significance, if any, is unclear.
Hexabrix, a monoacidic dimeric iodinated contrast material, was compared with Renografin 60 (diat... more Hexabrix, a monoacidic dimeric iodinated contrast material, was compared with Renografin 60 (diatrizoate meglumine) for safety, tolerance, and efficacy in hysterosalpingography, in a double blind study of 52 patients. No serious adverse reactions were noted in either group of patients. Discomfort during and after the procedure was not statistically different in the two groups. No difference in radiographic quality was seen. It was concluded that Hexabrix, despite reduced osmolality and increased viscosity, offers no significant benefit over Renografin 60, but it is a safe and acceptable contrast agent for hysterosalpingography.
A new fabric of regenerated oxidized cellulose (TC-7) was evaluated for the prevention of postope... more A new fabric of regenerated oxidized cellulose (TC-7) was evaluated for the prevention of postoperative adhesions. Standardized injuries were performed on the uterine fundal serosa, the unilateral uterine cornu, and the contralateral ovary in 24 New Zealand rabbits. TC-7 was applied to the injured surfaces in 12 rabbits utilizing a randomized study design. At second-look laparotomy 3 weeks later, adhesions were graded without knowledge of the treatment category in the 22 rabbits surviving the study. There were no statistically significant differences in adhesion formation between treated and control animals at any of the injury sites. No gross or histologic residua of the TC-7 were evident 3 weeks after intraperitoneal application. Further studies will be needed to clarify the clinical role of this new fabric.
American Journal of Obstetrics and Gynecology, 1997
The coculture of human embryos with epithelial cells may improve both embryo quality and pregnanc... more The coculture of human embryos with epithelial cells may improve both embryo quality and pregnancy rates. In this current study we tested the efficacy of coculture with the buffalo rat liver cell line on pregnancy rates in women with a potentially poor prognosis for success with in vitro fertilization (previous in vitro fertilization failure, advanced maternal age, increased early follicular follicle-stimulating hormone levels, and anovulation). This prospective controlled study evaluated a total of 203 women (135 coculture, 68 controls) undergoing in vitro fertilization. Implantation rates per embryo, clinical pregnancy rates, and continuing/delivered pregnancy rates were analyzed. Buffalo rat liver cells, which are commercially available, are stable in coculture. Implantation rates (number of sacs with fetal heart motion per embryos transferred) were similar for coculture (19%) and control (18%) embryos. No difference in the rate of continuing/delivered pregnancies per retrieval was noted (17% coculture vs 14% control) in the group with advanced maternal age, but coculture caused a trend toward improved pregnancy rates in the group with ovulatory dysfunction (43% coculture vs 14% control) and the group with previous in vitro fertilization failure (34% coculture vs 28% control). This is the first published controlled study to our knowledge that reports the use of the buffalo rat liver cell coculture for human in vitro fertilization in a large number of patients. Our data support consideration of buffalo rat liver coculture for in vitro fertilization for women with previous in vitro fertilization failure and possibly for patients with oocyte or ovulatory dysfunction.
To determine threshold β-hCG levels predictive of an ongoing pregnancy (OP), live birth (LB), and... more 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. Retrospective analysis. Infertility center. Women who had ET performed for IVF cycles between July 2004 and January 2010. Embryo transfer performed on either D3 or D5 after oocyte fertilization. Beta-hCG on day 15 after oocyte fertilization. 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. Initial β-hCG levels are dependent on the day of ET and are a reliable and highly predictive tool for OP outcomes.
Received March 19, 1982; accepted May 20, 1982. Department of Radiology and Radiological Sc,- enc... more Received March 19, 1982; accepted May 20, 1982. Department of Radiology and Radiological Sc,- ences, Vanderbilt University Hospital, Nashville. TN 37232. Address reprint requests to AC Win-field. 'Department of Obstetrics and Gynecology, Vanderbilt University Hospital, ...
Journal of In Vitro Fertilization and Embryo Transfer, 1986
End-organ antiestrogenic effects of clomiphene citrate (CC) have been demonstrated in the female ... more End-organ antiestrogenic effects of clomiphene citrate (CC) have been demonstrated in the female reproductive tract at the levels of the ovary, cervix, and endometrium. However, it has not been established whether this effect is manifested during concomitant human menopausal gonadotropin (hMG) administration, as occurs in hMG/CC stimulations of multiple follicular development. To assess this question a review was made of serum estradiol (E2) and cervical mucus in 47 hMG and 56 hMG/CC stimulations on days -2, -1, 0, and +1 relative to the day of hCG administration. E2 levels (pg/ml) were significantly lower in the hMG as compared to the hMG/CC group. However, comparing the hMG and hMG/CC groups, cervical mucus scores were significantly higher in the former. Furthermore, an analysis of covariance demonstrated that the cervical mucus scores on each day were significantly lower in the hMG/CC group (P less than 0.001). Thus, in hMG/CC stimulations for in vitro fertilization (IVF), despite the concomitant administration of pharmacologic doses of hMG, CC exerts an antiestrogenic effect on at least one end organ, cervical mucus production. Potentially, this antiestrogenic effect in IVF stimulations would be exerted at other female reproductive tract sites including the endometrium; however, its clinical significance, if any, is unclear.
Hexabrix, a monoacidic dimeric iodinated contrast material, was compared with Renografin 60 (diat... more Hexabrix, a monoacidic dimeric iodinated contrast material, was compared with Renografin 60 (diatrizoate meglumine) for safety, tolerance, and efficacy in hysterosalpingography, in a double blind study of 52 patients. No serious adverse reactions were noted in either group of patients. Discomfort during and after the procedure was not statistically different in the two groups. No difference in radiographic quality was seen. It was concluded that Hexabrix, despite reduced osmolality and increased viscosity, offers no significant benefit over Renografin 60, but it is a safe and acceptable contrast agent for hysterosalpingography.
A new fabric of regenerated oxidized cellulose (TC-7) was evaluated for the prevention of postope... more A new fabric of regenerated oxidized cellulose (TC-7) was evaluated for the prevention of postoperative adhesions. Standardized injuries were performed on the uterine fundal serosa, the unilateral uterine cornu, and the contralateral ovary in 24 New Zealand rabbits. TC-7 was applied to the injured surfaces in 12 rabbits utilizing a randomized study design. At second-look laparotomy 3 weeks later, adhesions were graded without knowledge of the treatment category in the 22 rabbits surviving the study. There were no statistically significant differences in adhesion formation between treated and control animals at any of the injury sites. No gross or histologic residua of the TC-7 were evident 3 weeks after intraperitoneal application. Further studies will be needed to clarify the clinical role of this new fabric.
American Journal of Obstetrics and Gynecology, 1997
The coculture of human embryos with epithelial cells may improve both embryo quality and pregnanc... more The coculture of human embryos with epithelial cells may improve both embryo quality and pregnancy rates. In this current study we tested the efficacy of coculture with the buffalo rat liver cell line on pregnancy rates in women with a potentially poor prognosis for success with in vitro fertilization (previous in vitro fertilization failure, advanced maternal age, increased early follicular follicle-stimulating hormone levels, and anovulation). This prospective controlled study evaluated a total of 203 women (135 coculture, 68 controls) undergoing in vitro fertilization. Implantation rates per embryo, clinical pregnancy rates, and continuing/delivered pregnancy rates were analyzed. Buffalo rat liver cells, which are commercially available, are stable in coculture. Implantation rates (number of sacs with fetal heart motion per embryos transferred) were similar for coculture (19%) and control (18%) embryos. No difference in the rate of continuing/delivered pregnancies per retrieval was noted (17% coculture vs 14% control) in the group with advanced maternal age, but coculture caused a trend toward improved pregnancy rates in the group with ovulatory dysfunction (43% coculture vs 14% control) and the group with previous in vitro fertilization failure (34% coculture vs 28% control). This is the first published controlled study to our knowledge that reports the use of the buffalo rat liver cell coculture for human in vitro fertilization in a large number of patients. Our data support consideration of buffalo rat liver coculture for in vitro fertilization for women with previous in vitro fertilization failure and possibly for patients with oocyte or ovulatory dysfunction.
To determine threshold β-hCG levels predictive of an ongoing pregnancy (OP), live birth (LB), and... more 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. Retrospective analysis. Infertility center. Women who had ET performed for IVF cycles between July 2004 and January 2010. Embryo transfer performed on either D3 or D5 after oocyte fertilization. Beta-hCG on day 15 after oocyte fertilization. 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. Initial β-hCG levels are dependent on the day of ET and are a reliable and highly predictive tool for OP outcomes.
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Papers by Wayne Maxson