N. Lolatgis - Academia.edu (original) (raw)

Papers by N. Lolatgis

Research paper thumbnail of Laparoscopic and abdominal hysterectomy: A cost comparison

The Medical journal of Australia

To compare the cost of laparoscopically assisted vaginal hysterectomy (LAVH) with that of total a... more To compare the cost of laparoscopically assisted vaginal hysterectomy (LAVH) with that of total abdominal hysterectomy (TAH) under casemix. Retrospective comparison of the costs, operating time and length of hospital stay. The 16 women undergoing consecutive LAVH and 16 age-matched women undergoing TAH between 1 February 1994 and 31 July 1995; all women were public patients undergoing hysterectomy for benign disease. Monash Medical Centre, a large tertiary teaching hospital in Melbourne, Australia, where casemix is used to determine funding and budget allocation. The difference between the costs of the two procedures was not statistically significant (P = 0.5), despite the cost of laparoscopic hysterectomy including that of disposables. The mean operating time for TAH was 86 minutes (95% CI, 65.5-106.5), compared with 120 minutes (95% CI, 100.8-140.5) for LAVH (P < 0.01). The mean length of stay in the TAH group was 5.75 days, compared with 3.25 days in the LAVH group (P < 0.001). In hysterectomy for benign gynaecological disease, the laparoscopic procedure costs the same as the total abdominal procedure. Audit such as this is important in patient management and in guiding hospitals in funding and bed allocation.

Research paper thumbnail of A novel approach for the repair of an incisional hernia following laparoscopic hysterectomy

Gynaecological Endoscopy, 1996

With the more frequent use of trocars of 10 mm or more in size, there has been an increase in rep... more With the more frequent use of trocars of 10 mm or more in size, there has been an increase in reports of herniation of bowel and other intraabdominal structures at these trocar sites. A novel technique for the repair of these defects using the Verres needle is described.

Research paper thumbnail of Oocyte maturation

Primary oocytes recovered from small and growing follicles of 2*3 mm in the ovaries of untreated ... more Primary oocytes recovered from small and growing follicles of 2*3 mm in the ovaries of untreated women, can be matured in vitro, will fertilize and develop in vitro, and when transferred to the patient, develop to term. However, the implantation rate of cleaved embryos has been disappointingly low and when embryos are allowed to develop beyond the 4-cell in vitro, retardation of development and blockage is frequently observed, with relatively few embryos developing to blastocysts. We have devised new culture systems for human embryos to enable high rates of development of in-vivo matured oocytes to blastocysts within 5-6 days of culture, and high implantation rates of these blastocysts when they are transferred to the patients' uterus. These culture systems are now being used for in-vitro matured oocytes. In order to determine whether embryo developmental competence could be improved, a number of factors were examined. Treat- ment of patients with pure follicle stimulating horm...

Research paper thumbnail of Evolution of a culture protocol for successful blastocyst development and pregnancy

Human Reproduction, 1998

A cell-free culture system was designed for human embryo development to the blastocyst stage by t... more A cell-free culture system was designed for human embryo development to the blastocyst stage by testing a range of culture conditions in a series of protocols. The culture system that was evolved has a brief 1 h exposure to spermatozoa and then culture of the pronucleate zygote for 2 days in IVF-50 medium. Two or three embryos were cultured together in 20 microl microdrops of medium under oil. Embryos were then regrouped and two or three at a similar stage were cultured together in 50 microl microdrops of Gardner's G2 medium under oil from days 3 to 5. Embryos were transferred to fresh G2 medium on day 5 and cultured for a further 1 or 2 days (day 6 or 7). No serum was used in any of the cultures. The embryo transfer medium and G2 medium were supplemented with human serum albumin. The zonae of all blastocysts to be transferred to patients were completely removed enzymatically. Using this protocol, 52% of zygotes developed to blastocysts and 34 out of 35 patients treated received 82 blastocysts and 11 morulae on day 5 or 6. Twenty-one fetal sacs with positive heartbeats (23% implantation rate) were detected in 13 ongoing pregnancies (38% pregnancy rate/transfer or 37%/patient treated). We anticipate that further improvements in embryo development and the selection of viable embryos can be achieved using this simple and effective culture system.

Research paper thumbnail of Factors affecting the success of human blastocyst development and pregnancy following in vitro fertilization and embryo transfer 11Portions of these data were previously published in Jones et al. (7)

Fertility and Sterility, 1998

To determine the factors affecting blastocyst development and pregnancy after IVF and ET. Retrosp... more To determine the factors affecting blastocyst development and pregnancy after IVF and ET. Retrospective analysis of data arising from a clinical trial. Private in vitro fertilization clinic. Fifty-six patients aged < or = 40 years, undergoing IVF procedures for infertility, recruited specifically for blastocyst transfer. All zygotes were cultured to days 5 or 6 after insemination, and one to four of the most advanced blastocysts were transferred to the patient's uterus. Development of zygotes to blastocysts in vitro and pregnancy and implantation rates after ET. Fifty-one percent of all zygotes developed to blastocysts. Significant positive correlation between the number of blastocysts formed was observed with the number of oocytes, pronuclear zygotes, and eight-cell embryos formed. There was a negative correlation with male factor infertility. By day 5 or 6, 93% of the patients had at least one blastocysts, and the clinical pregnancy rate per transfer was 43% and the implantation per embryo transferred was 25%. No other clinical factor significantly affected the number of blastocysts formed, pregnancy rate, or implantation rate. The numbers of oocytes, zygotes, and normally developing embryos in culture significantly affects the production of blastocysts in vitro. Male infertility significantly reduces blastocyst production. The number and the quality of the blastocysts transferred significantly influences clinical pregnancy rate.

Research paper thumbnail of P-155 Evolution of a culture protocol for the successful development of blastocysts and pregnancy in the human

Fertility and Sterility, 1997

Research paper thumbnail of Cumulative pregnancy and live birth rates in women with antiphospholipid antibodies undergoing assisted reproduction

Human Reproduction, 1999

The aims of this study were to investigate the influence of antiphospholipid antibodies (APA) on ... more The aims of this study were to investigate the influence of antiphospholipid antibodies (APA) on cumulative pregnancy and live-birth rates in patients undergoing assisted reproductive treatment. Serum samples from 173 patients were collected prior to initiation treatment cycle and tested by enzyme-linked immunosorbent assay (ELISA) for the presence of immunoglobulin (Ig)G, IgM and IgA against cardiolipin, phosphoserine, phosphoethanolamine, phosphoinositol, phosphatidic acid, and phosphoglycerol. Fifty-six samples from patients who had at least two failed cycles by assisted reproductive treatment were also tested by a bioassay for the presence of lupus anticoagulants. Both cumulative pregnancy and live birth rates were not affected by the presence of any specific or any number of seropositive APA. There was no association between multiple assisted reproductive treatment failures and APA seropositivity. Neither the serum concentration of any of the 18 APA, nor the number of positive APA was correlated with the number of assisted reproductive treatment failed cycles or affected the probability of pregnancy. No patient was found to be positive for lupus anticoagulants. Using life table analyses, which has been recognized as the most appropriate method available to analyse assisted reproductive treatment results, we conclude that there is no relationship between circulating APA and assisted reproductive treatment outcome. APA do not affect the early process of implantation or maintenance of pregnancy among assisted reproductive treatment patients.

Research paper thumbnail of Laparoscopic and abdominal hysterectomy: A cost comparison

The Medical journal of Australia

To compare the cost of laparoscopically assisted vaginal hysterectomy (LAVH) with that of total a... more To compare the cost of laparoscopically assisted vaginal hysterectomy (LAVH) with that of total abdominal hysterectomy (TAH) under casemix. Retrospective comparison of the costs, operating time and length of hospital stay. The 16 women undergoing consecutive LAVH and 16 age-matched women undergoing TAH between 1 February 1994 and 31 July 1995; all women were public patients undergoing hysterectomy for benign disease. Monash Medical Centre, a large tertiary teaching hospital in Melbourne, Australia, where casemix is used to determine funding and budget allocation. The difference between the costs of the two procedures was not statistically significant (P = 0.5), despite the cost of laparoscopic hysterectomy including that of disposables. The mean operating time for TAH was 86 minutes (95% CI, 65.5-106.5), compared with 120 minutes (95% CI, 100.8-140.5) for LAVH (P < 0.01). The mean length of stay in the TAH group was 5.75 days, compared with 3.25 days in the LAVH group (P < 0.001). In hysterectomy for benign gynaecological disease, the laparoscopic procedure costs the same as the total abdominal procedure. Audit such as this is important in patient management and in guiding hospitals in funding and bed allocation.

Research paper thumbnail of A novel approach for the repair of an incisional hernia following laparoscopic hysterectomy

Gynaecological Endoscopy, 1996

With the more frequent use of trocars of 10 mm or more in size, there has been an increase in rep... more With the more frequent use of trocars of 10 mm or more in size, there has been an increase in reports of herniation of bowel and other intraabdominal structures at these trocar sites. A novel technique for the repair of these defects using the Verres needle is described.

Research paper thumbnail of Oocyte maturation

Primary oocytes recovered from small and growing follicles of 2*3 mm in the ovaries of untreated ... more Primary oocytes recovered from small and growing follicles of 2*3 mm in the ovaries of untreated women, can be matured in vitro, will fertilize and develop in vitro, and when transferred to the patient, develop to term. However, the implantation rate of cleaved embryos has been disappointingly low and when embryos are allowed to develop beyond the 4-cell in vitro, retardation of development and blockage is frequently observed, with relatively few embryos developing to blastocysts. We have devised new culture systems for human embryos to enable high rates of development of in-vivo matured oocytes to blastocysts within 5-6 days of culture, and high implantation rates of these blastocysts when they are transferred to the patients' uterus. These culture systems are now being used for in-vitro matured oocytes. In order to determine whether embryo developmental competence could be improved, a number of factors were examined. Treat- ment of patients with pure follicle stimulating horm...

Research paper thumbnail of Evolution of a culture protocol for successful blastocyst development and pregnancy

Human Reproduction, 1998

A cell-free culture system was designed for human embryo development to the blastocyst stage by t... more A cell-free culture system was designed for human embryo development to the blastocyst stage by testing a range of culture conditions in a series of protocols. The culture system that was evolved has a brief 1 h exposure to spermatozoa and then culture of the pronucleate zygote for 2 days in IVF-50 medium. Two or three embryos were cultured together in 20 microl microdrops of medium under oil. Embryos were then regrouped and two or three at a similar stage were cultured together in 50 microl microdrops of Gardner's G2 medium under oil from days 3 to 5. Embryos were transferred to fresh G2 medium on day 5 and cultured for a further 1 or 2 days (day 6 or 7). No serum was used in any of the cultures. The embryo transfer medium and G2 medium were supplemented with human serum albumin. The zonae of all blastocysts to be transferred to patients were completely removed enzymatically. Using this protocol, 52% of zygotes developed to blastocysts and 34 out of 35 patients treated received 82 blastocysts and 11 morulae on day 5 or 6. Twenty-one fetal sacs with positive heartbeats (23% implantation rate) were detected in 13 ongoing pregnancies (38% pregnancy rate/transfer or 37%/patient treated). We anticipate that further improvements in embryo development and the selection of viable embryos can be achieved using this simple and effective culture system.

Research paper thumbnail of Factors affecting the success of human blastocyst development and pregnancy following in vitro fertilization and embryo transfer 11Portions of these data were previously published in Jones et al. (7)

Fertility and Sterility, 1998

To determine the factors affecting blastocyst development and pregnancy after IVF and ET. Retrosp... more To determine the factors affecting blastocyst development and pregnancy after IVF and ET. Retrospective analysis of data arising from a clinical trial. Private in vitro fertilization clinic. Fifty-six patients aged < or = 40 years, undergoing IVF procedures for infertility, recruited specifically for blastocyst transfer. All zygotes were cultured to days 5 or 6 after insemination, and one to four of the most advanced blastocysts were transferred to the patient's uterus. Development of zygotes to blastocysts in vitro and pregnancy and implantation rates after ET. Fifty-one percent of all zygotes developed to blastocysts. Significant positive correlation between the number of blastocysts formed was observed with the number of oocytes, pronuclear zygotes, and eight-cell embryos formed. There was a negative correlation with male factor infertility. By day 5 or 6, 93% of the patients had at least one blastocysts, and the clinical pregnancy rate per transfer was 43% and the implantation per embryo transferred was 25%. No other clinical factor significantly affected the number of blastocysts formed, pregnancy rate, or implantation rate. The numbers of oocytes, zygotes, and normally developing embryos in culture significantly affects the production of blastocysts in vitro. Male infertility significantly reduces blastocyst production. The number and the quality of the blastocysts transferred significantly influences clinical pregnancy rate.

Research paper thumbnail of P-155 Evolution of a culture protocol for the successful development of blastocysts and pregnancy in the human

Fertility and Sterility, 1997

Research paper thumbnail of Cumulative pregnancy and live birth rates in women with antiphospholipid antibodies undergoing assisted reproduction

Human Reproduction, 1999

The aims of this study were to investigate the influence of antiphospholipid antibodies (APA) on ... more The aims of this study were to investigate the influence of antiphospholipid antibodies (APA) on cumulative pregnancy and live-birth rates in patients undergoing assisted reproductive treatment. Serum samples from 173 patients were collected prior to initiation treatment cycle and tested by enzyme-linked immunosorbent assay (ELISA) for the presence of immunoglobulin (Ig)G, IgM and IgA against cardiolipin, phosphoserine, phosphoethanolamine, phosphoinositol, phosphatidic acid, and phosphoglycerol. Fifty-six samples from patients who had at least two failed cycles by assisted reproductive treatment were also tested by a bioassay for the presence of lupus anticoagulants. Both cumulative pregnancy and live birth rates were not affected by the presence of any specific or any number of seropositive APA. There was no association between multiple assisted reproductive treatment failures and APA seropositivity. Neither the serum concentration of any of the 18 APA, nor the number of positive APA was correlated with the number of assisted reproductive treatment failed cycles or affected the probability of pregnancy. No patient was found to be positive for lupus anticoagulants. Using life table analyses, which has been recognized as the most appropriate method available to analyse assisted reproductive treatment results, we conclude that there is no relationship between circulating APA and assisted reproductive treatment outcome. APA do not affect the early process of implantation or maintenance of pregnancy among assisted reproductive treatment patients.