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Query: KEGG:D06457 (HCG)
 2,659 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cryptorchidism is the most common disorder of sexual differentiation in male children, with an incidence of 3.4 per cent in the term newborn, decreasing to 0.8 per cent at 1 year of age. The mechanisms of normal testicular descent are multifactorial and include an intact hypothalamic-pituitary-testicular axis, as well as a normal gubernaculum and epididymis. In boys with cryptorchidism, the testes demonstrate degenerative changes histologically as early as 1 to 2 years of age. Both testes may be affected, even with a unilateral undescended testis. The most important long-term complications of cryptorchidism include infertility and testicular cancer. The risk of malignancy is approximately 40 times higher in male subjects with cryptorchidism than in normal men, and is highest in male subjects who have had an intra-abdominal testis and in certain intersex conditions. Orchiopexy does not appear to lessen this risk. Hormonal therapy with HCG or LH-RH has remained unproven in clinical trials in the United States; therefore, orchiopexy remains standard treatment. HCG is recommended if the clinician suspects that a testis is retractile, however. Orchiopexy should be performed between 12 and 18 months of age to prevent the degenerative changes that are demonstrable by 2 years.
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PMID:Cryptorchidism: isolated and associated with other genitourinary defects. 288 71

Ultrasound has been employed in diagnosing the luteinized unruptured follicle syndrome (LUF). Eighty-nine of 333 infertility patients were found to have LUF. The patients were divided into three groups. Group 1 was on no fertility medication. Twenty-five of 39 of this group released with HCG alone. Ten of the nonreleasers to HCG did release with HMG mixed with HCG. Group 2 patients had been treated with clomiphene and found to have LUF. Thirteen of 16 patients released with HCG and one of the failures released with HMG-HCG. Group 3 patients had been treated with HMG and had failed to release the ova despite HCG. Thirty-one of 33 did release with HMG-HCG. Twenty-six of 89 patients achieved a pregnancy within six months of therapy and 20 of 36 patients with all fertility factors corrected achieved a pregnancy.
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PMID:New approaches to the diagnosis and therapy of the luteinized unruptured follicle syndrome. 289 May 93

This study of 100 consecutive ectopic pregnancies in Zulu patients emphasises the role of less sophisticated diagnostic methods such as colpopuncture when beta human chorionic gonadotrophin (beta HCG) assay is not available. Infertility (61%) and previous pelvic infection (32%) were associated factors. The ectopic gestation was ruptured in 93% of cases.
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PMID:Ectopic pregnancy: analysis of 100 cases. 290

We conclude that, although many therapies have been advocated, no regimen has proved to be consistently effective in the treatment of idiopathic male infertility. Couples in which the husband is identified as having idiopathic infertility should be advised of the inconsistent and often low conception rates obtained with medical therapy. This should be weighed against the possibility of greater success with in vitro fertilization and the likelihood of success with artificial insemination by donor. Matson and colleagues performed in vitro fertilization on 75 couples in which the husband was oligospermic. When the husband was moderately (5.1 to 11.9 million motile sperm per milliliter) or severely (less than or equal to 5 million motile sperm per milliliter) oligospermic, fertilization rates were 56 and 30 per cent, respectively. This is in comparison to a fertilization rate of 72 per cent in normospermic couples. Following embryo transfer, pregnancy rates were similar in all groups. In vitro fertilization, although expensive and often not covered by insurance policies, may yield results in 1 month. Pharmacologic treatment of the male, which is less expensive, requires several months before improvement might be expected. The decision as to which course to recommend should be made after careful consultation with the couple. If empiric therapy is decided upon, the choice of an agent is somewhat arbitrary. Reasonable initial choices for the oligospermic patient are tamoxifen (or clomiphene citrate) or HCG (HCG may also be used in the patient with idiopathic asthenospermia). Testosterone rebound, with its risk of permanent azoospermia, is not an acceptable initial therapy. Similarly, the results of studies of testolactone, GnRH, pentoxifylline, and kallikrein either demonstrate low pregnancy rates or are too preliminary to recommend at this time. Regardless of the choice of therapy, it should be administered for at least 3 months to include the length of one spermatogenic cycle. The performance of randomized, double-blind, placebo-controlled, cross-over studies of present and future treatments will allow more definite conclusions to be drawn.
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PMID:Medical treatment of idiopathic infertility. 311 25

Implantation after embryo transfer is considered a major obstacle in terms of pregnancy rates after in-vitro fertilization. A flexible approach to the date of replacement, based on the fact that the most suitable embryonic structure for proper implantation is the four- to eight-cell embryo, has been studied. One-hundred-and-twenty patients with various aetiologies of infertility were stimulated with HMG or combined HMG and FSH, then treated by three different methods of embryo replacement. In group I embryos were replaced in mothers 48 h after ovum retrieval; in group II replacements were carried out 72 h after retrieval; and in group III replacements were related to embryonic cleavage development. Mean levels of oestradiol when HCG was given averaged 1301 +/- 121 pg/ml, 1016 +/- 96 pg/ml and 1182 +/- 101 pg/ml in the three groups, respectively. There was no significant difference in the average number of embryos transferred among the various groups. The pregnancy rates per transfer were 21.8, 24.2 and 38.7%, respectively (P less than 0.001). Although more investigation is required, a dynamic approach to embryo replacement might significantly improve pregnancy rates, because of improved interactions between the embryos and the uterus.
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PMID:Comparison of a fixed and dynamic protocol for embryo replacement in an IVF/ET programme. 314 88

The outcome of a series of 115 patients undergoing GIFT by minilaparotomy is described, their duration of infertility ranging between 3 and 19 years. Ovarian stimulation was carried out using clomiphene from day 3 and HMG from day 6, and HCG was used to induce follicular maturation. A maximum of four oocytes, two per oviduct with 100,000 spermatozoa, were replaced. Thirty-six pregnancies were established. The highest incidence of pregnancy was obtained in cases of unexplained infertility (42%) and endometriosis (28%), and the lowest with male factors (13%). The most mature oocytes gave the best results. There were eleven miscarriages (30.5%) and two ectopic pregnancies (5.5%). Eleven of the 23 deliveries involved multiple births.
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PMID:The GIFT experience: an evaluation of the outcome of 115 cases. 328 67

A total of 180 infertile couples were treated with intra-uterine insemination of homologous capacitated sperm. The fertility disorder was: a cervical factor in 80 couples (44.4%), a male factor in 68 others (37.8%) and unexplained infertility in 32 couples (17.8%). All the patients received ovarian stimulation with HMG, and with ultrasonographic monitoring. Insemination was performed when the diameter of the dominant follicle reached 18 mm, and HCG 5,000 UI was given on the same day; another insemination was performed 40 hours later if the dominant follicle was still present. The 0.5 ml insemination sample was prepared through a migration-capacitation procedure into Earles medium which yielded 15% of the total motile spermatozoa in the ejaculate. A total of 22 pregnancies were recorded (12% of the couples) in 659 therapeutic cycles; the results however differed according to the infertility disorder: 18.8% of pregnancies in the cervical factor group, 15.6% in the unexplained infertility group and 2.9% only in the male factor group. The lowest number of inseminated motile spermatozoa for pregnancy to occur was 0.4 million. A mild hyperstimulation syndrome was noted in 28 cycles (3.1%); no complications of infectious or immunologic origin occurred. It appears that a procedure which results in a satisfactory pregnancy rate when the sperm is normal (cervical or unexplained infertility) yields poor conceptional results when the semen is abnormal. In cases where the male factor is predominant, intra-uterine insemination should not be performed in the periovulatory period but at ovulation time, and therefore requires either an accurate detection of the LH peak or complete hormonal and sonographic assessment in a stimulated cycle.
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PMID:[Intra-uterine insemination with activated sperm. Results of conception compared in the various types of infertility in spouses]. 339 1

Follicular fluid lactate levels were measured in women undergoing infertility surgery during the follicular phase or oocyte recovery for in-vitro fertilization (IVF). In the largest ovulatory follicle lactate levels were low in the mid-follicular phase (group 1), 1.6-fold higher just prior to the onset of the luteinizing hormone (LH) surge (group 2) and a further 2.5-fold higher after the onset of the LH surge (group 3). In IVF patients mean lactate levels in all aspirated follicles were similar to those in group 3 subjects, but the levels within each patient were variable and were positively correlated with follicular volume. Basal granulosa cell lactate accumulation in vitro was 3-fold higher in group 3 compared with group 2 subjects, but stimulation by FSH or HCG was higher in group 2 (2- to 3-fold) compared with group 3 (1.4- to 2-fold). These results demonstrate that human follicular fluid lactate levels increase as a function of the maturity and size of the developing follicle. Granulosa cell lactate accumulation in vitro is under gonadotrophic control, which suggests that the effects observed in vivo reflect changes in granulosa cell glycolysis in response to gonadotrophic stimulation. Our findings support the concept that low molecular weight energy metabolites transduce gonadotrophin signals that regulate oocyte maturation.
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PMID:Gonadotrophic control of human granulosa cell glycolysis. 343 44

The effects of HMG (Humegon)-HCG therapy in 6096 cycles in 2166 Japanese women with anovulatory infertility were examined. The rates of ovulation, pregnancy, the ovarian hyperstimulation syndrome, multiple pregnancy, abortion, and malformations in the newborn were recorded, and the possible factors of multiple pregnancies were analyzed. Ovulation occurred in 73.2% of the cases and 64.5% of the treatment cycles. Pregnancy occurred in 23.0% of the cases and 8.6% of the cycles. Ovarian hyperstimulation syndrome with grade I of WHO definition or more was observed in 10.3% of the cases and 5.3% of the cycles. The incidence of the ovarian hyperstimulation syndrome was high in amenorrheic patients, who respond to progestin with bleeding. The multiple pregnancy rate was 20.5%, of which 13.0% was twins and 7.5% triplets or more. The abortion rate was 22.0%, and the abortion rate in multiple pregnancy was significantly higher (P less than 0.05) than that in singleton pregnancy. The external malformation rate was 1.68% in the 594 newborn who could be examined. No significant differences were found in maternal factors, the treatment schedule, or the ovarian response to treatment in singleton and multiple pregnancy groups. This survey revealed that the efficacy and the incidence of adverse effects of Humegon-HCG therapy in a large number of Japanese women were not different from those in Caucasians except for a lower rate of multiple pregnancy, and no special causative factors for multiple pregnancy were found.
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PMID:Results of HMG (Humegon)-HCG therapy in 6096 treatment cycles of 2166 Japanese women with anovulatory infertility. 392 90

The first 13 pregnancies established by in vitro fertilization and embryo transfer. A tubal factor was the main indication for in vitro fertilization (IVF) in 10 patients, whereas in three couples infertility was caused by the infertile sperm. The mean age and duration of infertility in female patients were 33.5 and 11.4 years, respectively. Multiple follicular growth was stimulated by either clomiphene citrate (100-150 mg during 5 days), clomiphene citrate + HMG + HCG, or HMG + HCG. Timing of ovulation was determined by assaying serum estradiol, progesterone and LH levels. The ultrasound monitoring of follicular growth was determined on a daily basis. Endogenous LH surge was observed in one patient, whereas in others 5000-10,000 IU HCG were needed to induce ovulation. All oocytes were recovered by laparoscopy. There were 3.8 oocytes per patient on an average. Fifty-six percent of oocytes were preovulatory. All oocytes were allowed to mature in vitro for 3 to 7 hours (mean 5.7 hours). The fertilization and cleavage rates were 76% and 72% respectively. Only one polyspermic fertilization was observed. Forty-five hours after the insemination the embryos between the 2-cell and 6-cell stages were reimplanted into the uterus. Using various ET cannulas, one to seven embryos per patient (2.7 embryos on the average) were replaced into the uterine cavity, 5 mm below the fundus. Only four embryo replacements were completely atraumatic. No medications were used for the luteal phase support. The corpus luteum function and early pregnancy were controlled by serial measurements of serum progesterone, estradiol and beta HCG. Three clinical miscarriages and full-term deliveries were recorded.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Pregnancy after fertilization in vitro and embryo transfer]. 408 26


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