Medicine and Health Sciences Commons^™

Metabolism Of Arachidonic Acid To Epoxyeicosatrienoic Acids By Human Granulosa Cells May Mediate Steroidogenesis, Bradley Van Voorhis, M. Dunn, J. Falck, R. Bhatt, M. Vanrollins, G. Snyder

Bradley J Van Voorhis

Epoxyeicosatrienoic acids (EETs), cytochrome P-450 metabolites of arachidonic acid, have attracted attention because of their effects on stimulus-response coupling in endocrine, renal, and vascular cells. To investigate a possible role for EETs in ovarian physiology, we conducted a series of experiments using human luteinized granulosa cells. Granulosa cell microsomes produce EETs, which are identified by their comigration with known standards using reverse phase high pressure liquid chromatography. EET synthesis by granulosa cells is NADPH dependent and inhibited by ketoconazole, suggesting an enzymatic mechanism of production. Intact granulosa cells synthesize EETs from exogenous arachidonic acid, and EET production is increased by …

The Effects Of Ru 486 On Immune Function And Steroid-Induced Immunosuppression In Vitro, Bradley Van Voorhis, D. Anderson, J. Hill

Bradley J Van Voorhis

The effect of RU 486 [17 beta-hydroxy-11 beta-(4-dimethylamino-phenol)17 alpha-(prop-1-ynyl)estra- 4,9diene-3-one] on [3H]thymidine incorporation into Concanavalin-A-stimulated human peripheral blood mononuclear cells and its influence on the suppressive effects of cortisol and progesterone were investigated. Cortisol suppressed lymphocyte thymidine incorporation at 10(-5), 10(-6), and 10(-7) M (17.6%, 20%, and 38% of control, respectively; P less than 0.01). Cortisol-induced suppression was reversed when low concentrations of RU 486 (10(-7) and 10(-6) M) were added. RU 486 at 10(-5) M further suppressed lymphocyte thymidine incorporation when added to cultures with cortisol. Progesterone significantly inhibited lymphocyte thymidine incorporation at 10(-5) M (8.2% of control; P …

In Vitro Fertilization Is Associated With An Increase In Major Birth Defects, C. Olson, K. Keppler-Noreuil, P. Romitti, W. Budelier, Ginny Ryan, Amy Sparks, Bradley Van Voorhis

Bradley J Van Voorhis

OBJECTIVE: To determine the risk of major birth defects in cohorts of children conceived through IVF or through IUI as compared with naturally conceived children. DESIGN: Retrospective cohort study. SETTING: Academic medical center. PATIENT(S): Children conceived by IVF or IUI at the University of Iowa from 1989 through 2002, compared with a matched cohort of naturally conceived children. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Outcome data were obtained from Iowa state birth and fetal death certificates and from the Iowa Birth Defects Registry. RESULT(S): Ninety of 1,462 IVF-conceived children (6.2%) and 17 of 343 IUI-conceived children (5.0%) had a major birth …

Sextuplets: An Unusual Complication Of Single Embryo Transfer, L. Mains, Ginny Ryan, Amy Sparks, Bradley Van Voorhis

Bradley J Van Voorhis

OBJECTIVE: To describe an unusual case of a sextuplet gestation after IVF and transfer of a single blastocyst. DESIGN: Case report. SETTING: University-based IVF clinic. PATIENT(S): A 32-year-old female with secondary infertility undergoing IVF-ET. INTERVENTION(S): Transvaginal oocyte retrieval, transfer of a single blastocyst, and multifetal pregnancy reduction. MAIN OUTCOME MEASURE(S): Ultrasound determination of pregnancy viability. RESULT(S): Six intrauterine gestational sacs, each with a fetus having cardiac activity, reduced to a triplet gestation. CONCLUSION(S): Physicians should consider advising patients undergoing IVF-ET to abstain from unprotected intercourse at least 4 days before the anticipated oocyte retrieval. Incomplete aspiration of ovarian follicles is …

A 41-Year-Old Woman With Menorrhagia, Anemia, And Fibroids: Review Of Treatment Of Uterine Fibroids, Bradley Van Voorhis

Bradley J Van Voorhis

Uterine fibroids are common tumors that can cause heavy menstrual bleeding, pelvic pressure symptoms, and reproductive disorders. The incidence of fibroids peaks in the fifth decade of age and they are more common in African American women. Often, fibroids are asymptomatic and require no treatment. However, the case of Ms P, a 41-year-old woman with recurrent uterine fibroids, menorrhagia, anemia, and fatigue who wishes to retain fertility, illustrates the symptoms that require treatment. Evaluation usually begins with a pelvic examination and an ultrasound to determine both the size and location of the fibroids within the uterus. Standard treatment of symptomatic …

Effects Of Smoking On Ovulation Induction For Assisted Reproductive Techniques, Bradley Van Voorhis, Craig Syrop, D. Hammitt, M. Dunn, G. Snyder

Bradley J Van Voorhis

OBJECTIVE: To determine the effects of smoking on ovulation induction for assisted reproductive techniques. DESIGN: Matched, retrospective, cohort study. SETTING: Outpatient University endocrine/infertility program. PATIENTS: Eighteen smokers and 36 nonsmokers: 2 nonsmokers matched to each smoker for age, weight, and history of ovarian surgery. MAIN OUTCOME MEASURES: During a stimulation cycle, the serum estradiol (E2) level, number of follicles, number of oocytes, number of embryos, and ampules of gonadotropins used were compared in the smoking versus the nonsmoking groups by Wilcoxon's signed rank test for paired data. Follicular fluid (FF), testosterone (T), androstenedione (A), E2, A:E2 ratios, and T:E2 ratios …

Progression Of Atypical Endometrial Hyperplasia To Adenocarcinoma Despite Intrauterine Progesterone Treatment With The Levonorgestrel-Releasing Intrauterine System., J. Kresowik, Ginny Ryan, Bradley Van Voorhis

Bradley J Van Voorhis

BACKGROUND: Intrauterine progesterone therapy has been proposed as a potential uterine-sparing treatment for atypical endometrial hyperplasia and adenocarcinoma.

CASE: We present a case of an infertility patient with atypical endometrial hyperplasia who was treated with the levonorgestrel-releasing intrauterine system for 6 months. At follow-up, she was noted to have an increasing endometrial thickness on ultrasonography, and biopsy revealed progression of her lesion to adenocarcinoma.

CONCLUSION: Although there is a need for uterine-sparing treatment for atypical endometrial hyperplasia and early adenocarcinoma, especially in the setting of desired fertility, caution should be exercised. We do not recommend using the levonorgestrel-releasing intrauterine system …

Use Of Oocytes From Anonymous, Matched, Fertile Donors For Prevention Of Heritable Genetic Diseases, Bradley Van Voorhis, R. Williamson, J. Gerard, D. Hammitt, Craig Syrop

Bradley J Van Voorhis

Heritable genetic diseases can be prevented with the use of donor oocytes. We report our experience in using donor oocytes from anonymous, matched, fertile donors in four women with heritable genetic disorders. Our results show that use of donor oocytes is a practical, successful, and currently available technique for the prevention of genetic disorders.

Detection Of Human Immunodeficiency Virus Type 1 In Semen From Seropositive Men Using Culture And Polymerase Chain Reaction Deoxyribonucleic Acid Amplification Techniques, Bradley Van Voorhis, A. Martinez, K. Mayer, D. Anderson

Bradley J Van Voorhis

We have demonstrated that the polymerase chain reaction is a valid and sensitive technique for the detection of human immunodeficiency virus type 1 (HIV-1) proviral deoxyribonucleic acid (DNA) in human semen. The combination of extraction, polymerase chain reaction, and liquid hybridization techniques used in this study was sensitive to a level of detection of one HIV-1 infected cell in 100,000 (or 3 infected cells/test sample). In a series of matched peripheral blood mononuclear cells (PBMC) and semen cells from 25 HIV-1 seropositive homosexual men, HIV-1 DNA was detected by polymerase chain reaction in 23 of 25 PBMC samples and 1 …

Five-Years Of A Mandatory Single-Embryo Transfer (Mset) Policy Dramatically Reduces Twinning Rate Without Lowering Pregnancy Rates, J. Kresowik, B. Stegmann, Amy Sparks, Ginny Ryan, Bradley Van Voorhis

Bradley J Van Voorhis

OBJECTIVE: To report the outcomes of a program policy instituted in 2004 mandating single-embryo transfer (mSET) for all women aged <38 >years, with at least seven zygotes, no prior failed fresh cycle at our center, and at least one good-quality blastocyst. DESIGN: Retrospective cohort study. SETTING: Academic medical center. PATIENT(S): All women 1, 1999, to May 31, 2004 (before mSET) and from June 1, 2004, to May 31, 2009 (after mSET). INTERVENTION(S): mSET policy implementation. MAIN OUTCOME MEASURE(S): Live-birth rate, multiple pregnancy rate, clinical volume, and outcomes of all mSET fresh IVF transfers were analyzed. RESULT(S): Clinical volume was unchanged between …

Primary Hypothyroidism Associated With Multicystic Ovaries And Ovarian Torsion In An Adult, Bradley Van Voorhis, T. Neff, Craig Syrop, F. Chapler

Bradley J Van Voorhis

BACKGROUND: Primary hypothyroidism is known to be associated with multicystic ovaries in juvenile females, but this association has been reported only once previously in an adult. This report describes an unusual case of bilateral multicystic ovaries occurring in an adult patient with profound hypothyroidism. CASE: A 26-year-old woman presented with an acute abdomen and bilateral adnexal masses. An emergency exploratory laparotomy revealed bilateral enlarged multicystic ovaries with torsion of the right ovary. Because this ovary was necrotic, it was removed; pathology revealed multiple hemorrhagic follicular cysts. Laboratory studies to evaluate the cause of the multicystic ovaries revealed negative serum beta-hCG, …

The Efficacy And Cost Effectiveness Of Embryo Cryopreservation Compared With Other Assisted Reproductive Techniques, Bradley Van Voorhis, Craig Syrop, B. Allen, Amy Sparks, D. Stovall

Bradley J Van Voorhis

OBJECTIVE: To evaluate the efficacy and cost effectiveness of embryo cryopreservation compared with other assisted reproductive techniques (ARTs). DESIGN: Retrospective review of medical records and health care costs. SETTING: Tertiary care academic medical school ART program. PATIENTS: For determination of the efficacy of cryopreserved ET, we analyzed 610 patients undergoing the first 1,000 oocyte retrievals in our program. For determination of cost effectiveness, we analyzed the costs associated with 334 initiated ART cycles in 1992. MAIN OUTCOME MEASURES: The ongoing pregnancy rate (PR) per initiated cycle and per oocyte retrieval. The medical costs associated with each procedure. RESULTS: The transfer …

Role, Epidemiology, And Natural History Of Benign Uterine Mass Lesions, Ginny Ryan, Craig Syrop, Bradley Van Voorhis

Bradley J Van Voorhis

No abstract provided.