Valter Feyles | Western University Canada (original) (raw)

Papers by Valter Feyles

PubMed, Feb 1, 2005

Poor responders represent a challenging group of infertility patients who fail to respond to cont... more Poor responders represent a challenging group of infertility patients who fail to respond to controlled ovarian hyperstimulation during the course of assisted reproduction treatment. Although poor response has been investigated since the eighties, many aspects of this condition are still controversial and no consensus has been reached on the management of these patients. The existing data cannot be easily compared due to the heterogeneity of the research design and methodology and the number of prospective randomized trials of sufficient sample size is limited. In addition, more research in the identification and understanding of underlying factors is needed together with a better understanding of the patho-physiological basis of ovarian ageing and of the progressive reduction in ovarian reserve. This paper provides an overview on the identification, prediction and management of poor responders undergoing medicated assisted reproduction treatment.

Journal of obstetrics and gynaecology Canada, Oct 1, 2003

Cervical pregnancy is a rare condition that can become life-threatening if heavy bleeding occurs.... more Cervical pregnancy is a rare condition that can become life-threatening if heavy bleeding occurs. Grace (pseudonym) is a 32-year-old woman who was admitted to hospital at approximately 6 weeks' gestational age after several days of heavy bleeding. Ultrasonographic examination revealed the presence of cervical pregnancy. She received multiple doses of methotrexate with folinic acid rescue, and did not require surgical intervention. Nine months after the resolution of the cervical pregnancy, Grace again became pregnant. She had an uncomplicated gestation and a normal vaginal delivery of a healthy baby at term. Multiple-dose methotrexate with folinic acid rescue was a safe option for the medical treatment of ectopic cervical pregnancy in this case. Long-term toxicity studies and case reports are required to provide more information regarding safety and for clinicians to individualize treatment regimens.

Biology of Reproduction, Aug 1, 1987

In rats, prostaglandins (PGs) have an essential role in the decidual cell reaction (DCR), but the... more In rats, prostaglandins (PGs) have an essential role in the decidual cell reaction (DCR), but their mechanism

PubMed, 2000

Endometrial calcifications occur sporadically and are associated with infertility. Previous uteri... more Endometrial calcifications occur sporadically and are associated with infertility. Previous uterine trauma during instrumentation and/or uterine infection are likely involved in their pathogenesis. The association between endometrial calcifications and recurrent pregnancy loss has been very infrequently reported. A 28-year-old woman with a history of two consecutive first trimester pregnancy losses presented with ultrasonographic hyperechoic endometrial areas associated with histologic endometrial calcification foci. A third pregnancy conceived before starting micronized oral progesterone supplementation also spontaneously aborted at eight weeks. During the fourth pregnancy, progesterone supplementation was taken for the initial 12 weeks. The endometrial lesions were no longer detectable and the pregnancy progressed to term without complications. Endometrial calcifications, related to intrauterine bone tissue, have been previously treated with curettage or with endoscopic surgery, and to the best of our knowledge, have not been reported to disappear spontaneously. In this case, regression of the endometrial calcifications and a favorable pregnancy outcome occurred in concert with oral micronized progesterone supplementation. A combination of transvaginal ultrasonography and endometrial biopsy appears to be an effective method for diagnosing and monitoring of this rare condition.

Fertility and Sterility, Aug 1, 2013

Objective: To examine whether mood state or infertility stress influences perceptions of risk, pr... more Objective: To examine whether mood state or infertility stress influences perceptions of risk, preferences for embryo transfer, or views on multiple pregnancy. Design: Observational cohort study. Setting: Hospital-based fertility clinic. Patient(s): One hundred seventy-six women participating in IVF treatment. Intervention(s): None. Main Outcome Measure(s): Mood scores, ratings of risk, preference for multiple embryo transfer, and attitudes toward multiple pregnancy. Result(s): Growing feelings of tension across the cycle corresponded with increases in the perceived riskiness of double-embryo transfer, but there was no change in strength of transfer preferences. Women experiencing negative moods, such as depression, viewed twin and triplet pregnancy as less likely, whereas increasing positive feelings across the cycle were associated with increasing desire for twin pregnancy. Overall, women perceived double-and triple-embryo transfer as less risky by cycle end than at cycle beginning and felt more certain about multiple-embryo transfer. Conclusion(s): The dyssynchrony observed among changes in mood, perceptions of risk, and transfer preferences challenges assumptions about the way medical risk information influences transfer preferences, and the findings suggest that mood states experienced during an IVF cycle might affect transfer preferences by influencing attitudes toward multiple pregnancy. Additional considerations beyond providing risk information are needed to facilitate effective patient decision making.

Human Reproduction, Apr 26, 2012

background: This study evaluated couples' perceptions of preparatory psychosocial counselling pri... more background: This study evaluated couples' perceptions of preparatory psychosocial counselling prior to participation in medically assisted reproduction (MAR). methods: Eighty-three couples about to undergo IUI treatment were asked about their expectations regarding a subsequent single psychosocial counselling session and assessed in terms of their levels of infertility-specific stress, anxiety and depressive symptoms. Afterwards, participants rated their satisfaction with different elements of the session. results: Almost two-thirds of women and one-half of men expected counselling to be important, and the majority anticipated that the session would be helpful and informative. Views of preparatory counselling were significantly more positive afterwards, indicating that a focused session addressing issues of treatment concerns, goal setting and managing infertility stress was more beneficial than anticipated. Those experiencing higher levels of infertility-specific stress expected the counselling session to be more important, and elevated stress and greater utilization of social support were predictive of post-counselling satisfaction. conclusions: Preparatory psychosocial counselling provided with a specific and practical focus appears to be a potentially important and helpful service prior to MAR. Clinics should not assume that patients can accurately judge the benefits of counselling before actually engaging in the session. Identifying patients most likely to benefit and providing a clear rationale may further increase receptivity to this proactive counselling service. While patients characterize this intervention as beneficial, it is not yet known if these benefits translate into improved management of treatment procedures.

Journal SOGC, Sep 1, 2001

Objective: To determine the efficacy and safety of a herbal formulation, Premenefa®, containing c... more Objective: To determine the efficacy and safety of a herbal formulation, Premenefa®, containing chasteberry (Vitex agnus castus), cramp bark (Viburnum opu/us), vitamin E, bioflavonoids (vitamin P complex), borage oil, and flaxseed oil, in controlling premenstrual symptoms. Background: Although many women do not satisfy strict diagnostic criteria for premenstrual syndrome (PMS), they may still experience premenstrual symptoms. Regardless of whether a woman has specific symptoms or a symptom complex such as premenstrual syndrome, persistence of premenstrual symptoms in spite of standard treatment leads many of these women to unsupervised use of non-prescription products, increasingly herbal preparations. However, few randomized studies have assessed effectiveness and safety of herbal products. Methods: This study was a randomized, double-blind, placebocontrolled, crossover trial of a herbal preparation proposed to alleviate premenstrual symptoms (Premenefa®). Participants were randomized to start either on the herbal preparation or on placebo. Crossover occurred after three menstrual cycles. Seventy-four women completed six cycles, three each on formulation and placebo. The primary outcome variable was global scores for 15 premenstrual symptoms. Individual symptom scores were also recorded and analyzed. Results: Global premenstrual symptom scores were significantly lower in the formulation cycles than in the placebo cycles (p < 0.000 I). The difference was observed from the first cycle and increased progressively from the first cycle to the third cycle. Of subjects who completed the study, 62, 78, and 85 percent experienced at least a SO percent lower score while on the herbal preparation for cycles one, two, and three respectively (p = 0.002 for cycles one to two, cycles two to three non-significant). Twenty-three, 34, and 61 percent of subjects experienced at least a 70 percent lower score

Cancer Letters, Dec 1, 1991

Several theories suggest that lung carcinomas are not totally separate entities, but are derived ... more Several theories suggest that lung carcinomas are not totally separate entities, but are derived from a common precursor, probably of endodermal origin. The histological classification of lung cancers is complex, with much overlap between groups broadly designated as small cell (SCLC), squamous cell, adenocarcinoma and all others simply termed non-small cell. It is shown here that in vitro exposure of classic, non-adherent SCLC lines to 10 microM 5&amp;amp;amp;amp;#39; bromodeoxyuridine (BrdU) results in a rapid cell-line dependent change to a morphology consistent with an adherent, non-small cell phenotype. Accompanying this morphological shift is a decreased expression of the amplified N-myc protooncogene. These induced changes underline the morphological relatedness of lung carcinoma cell lines.

Minerva ginecologica, Nov 1, 2019

Fertility and Sterility, Sep 1, 2005

after processing. Cycle stimulation: Continuous low dose (125 mcg) ganirelix acetate daily starti... more after processing. Cycle stimulation: Continuous low dose (125 mcg) ganirelix acetate daily starting with onset of menses and continuing to day of hCG administration compared with leuprolide acetate, 0.5 mg daily, beginning 12 days prior to initiation of FSH for 5 days then decreasing to 0.25mg and continuing to day of hCG administration. Ovulation induction in both groups_start recombinant FSH 150 IU to 450 IU daily with a small amount of LH add-back via hMG. Adjust dose as necessary starting on CD 9. HCG when at least 2 follicles Ն 18mm. RESULTS: CONCLUSION: This preliminary data supports the conclusion that a stimulation protocol using low-dose ganirelix starting with the onset of menses appears to be as good as the traditional luteal leuprolide protocol for women with expected average response to stimulation.

Evidence-based Obstetrics & Gynecology, Dec 1, 2000

OBJECTIVE To compare the uterine effects of raloxifene and estrogen in healthy postmenopausal wom... more OBJECTIVE To compare the uterine effects of raloxifene and estrogen in healthy postmenopausal women. DESIGN Multicentre, randomized, triple-blind, 4-arm, double-placebo-controlled trial. Allocation was by random number table, using coded medications in blocks of 4. SETTING Thirty-two centres in the USA and 1 in the UK. SUBJECTS 415 healthy postmenopausal women, aged 47-60 (mean 55) years, with a normal uterus, endometrial thickness 45 mm, serum estradiol 473 pmol/L, and lumbar spine bone mineral density in the normal range. Time since menopause was 2-8 (mean 4.6) years. INTERVENTION The women were randomized to receive daily, for 12 months, raloxifene 60 mg (n"101) or 150 mg (n"105) plus placebo, estrogen 0.625 mg plus placebo (n"100), or two placebos (n"109). All women also received calcium 520 mg daily. Transvaginal ultrasonography was performed every 3 months, and endometrial biopsy and saline-infusion sonohysterography were performed every 6 months. MAIN OUTCOME MEASURES Endometrial hyperplasia, uterine volume, endometrial thickness. MAIN RESULTS 86% of subjects underwent at least one follow-up endometrial biopsy. Endometrial hyperplasia was detected in 23/88 women (26%) in the estrogen group, 0/84 in the raloxifene 60 mg group, 0/92 in the raloxifene 150 mg group, and 2/94 (2%) in the placebo group (P(0.001). The mean endometrial thickness by transvaginal ultrasonography at baseline was 2.7 mm, with no difference among groups, and at follow-up the mean ($SD) change was 5.5$4.0 mm in the estrogen group, 0.2$1.5 mm in the raloxifene 60 mg group, 0.1$1.3 mm in the raloxifene 150 mg group, and !0.1$2.1 mm in the placebo group (P(0.001 estrogen vs other three groups, NS raloxifene groups vs placebo). Endometrial thickness '5 mm was observed in 70, 5, 4, and 6% of women, respectively. The mean uterine volume at baseline was 32 cm 3 , with no difference among groups, and at follow-up the mean change was 22$21 cm 3 with estrogen, !2$8 cm 3 with raloxifene 60 mg, !2$11 cm 3 with raloxifene 150 mg, and !3$11 cm 3 with placebo (P(0.001 estrogen vs other three groups, NS raloxifene groups vs placebo). Vaginal bleeding was reported more frequently in the estrogen group (29% of women) than in the other three groups (2-6%, P(0.001), as was mastalgia (18% vs 0-4%, P(0.001), but the withdrawal rates because of adverse events were similar among groups. CONCLUSION Raloxifene at daily doses of 60 mg and 150 mg did not stimulate the endometrium in post-menopausal women.

Fertility and Sterility, Sep 1, 2005

Fertility and Sterility, Jun 1, 1996

Setting: University hospital infertility unit. Patients: Four cohorts of couples were defined bas... more Setting: University hospital infertility unit. Patients: Four cohorts of couples were defined based on day 3 FSH determinations with an arbitrary threshold of 20 mIU/mL, only 2:20 mIU/mL, always <20 mIU/mL, current <20 mIUI mL but one previous 2:20 mIU/mL, and current <20 mIU/mL but two or more previous 2:20 mIU/mL (conversion factor to SI unit, 1.00). Intervention: In vitro fertilization-embryo transfer. Main Outcome Measure: Fetal heart activity on luteal day 40 transvaginal ultrasound. Results: No pregnancies occurred in 53 cycles with day 3 FSH only 2:20 mIU/mL. In 1,750 women whose day 3 FSH levels were always <20 mIU/mL, the pregnancy rate (PR) per cycle was 16.5%. In 54 cycles in which day 3 FSH was 2:20 one time only, but <20 mIU/mL during the treatment cycle, the PR was 5.6%. In 11 cycles where two or more previous FSH determinations were 2:20 mIU/mL but with a current day 3 FSH <20 mIU/mL, no pregnancies occurred. Conclusion: Our data leads us to the conclusion that day 3 FSH determination precede every IVF cycle and that cycles with FSH 2: 20 mIU/mL be canceled. It also suggests that women with two previous elevations of day 3 FSH be discouraged from future IVF cycles. The 5.6% pregnancy per cycle with one previously elevated FSH warrants extreme pessimism in discussion of further cycles.

Journal of Investigative Dermatology, Dec 1, 1990

Journal of obstetrics and gynaecology Canada, 2015

Background: Transvaginal ultrasound guided oocyte retrieval during in vitro fertilization is perf... more Background: Transvaginal ultrasound guided oocyte retrieval during in vitro fertilization is performed routinely around the world and has reduced the occurrence of intra-abdominal injury considerably over laparoscopic procedures. Despite this, injuries do occur. Case: We report a case of a 37-year-old patient who underwent IVF and encountered a ureteric injury during oocyte retrieval, which was recognized early and treated with ureteral stents with full resolution. During a subsequent IVF cycle, stenting of the ureters allowed better visualization, resulting in an uneventful retrieval and subsequent pregnancy. Conclusion: Ureteric injury can occur during transvaginal ultrasound guided egg retrieval. Prompt recognition is vital to successful treatment. Stenting of the ureters is the most common therapeutic modality and can be used in subsequent retrievals to identify the ureters .

Journal of Obstetrics and Gynaecology Canada, 2006

On April 22, 2004, the Assisted Human Reproduction Act came into force, prohibiting the purchase ... more On April 22, 2004, the Assisted Human Reproduction Act came into force, prohibiting the purchase of sperm or eggs from donors in Canada. In response to the concerns of medical professionals and some consumers that prohibiting payment would lead to a decline in the number of gamete donors, Health Canada commissioned research on altruistic donor recruitment and recruitment strategies. Twenty-two studies of sperm donors were located and their findings reviewed. The studies spanned 23 years (1980-2003), were undertaken in a range of countries, and were chosen on the merit of their relevance to the development of recruitment strategies within a policy of altruistic sperm donation. Observations were derived from assessing and comparing the purposes, findings, and implications of the 22 studies. Payment for providing sperm was made in all but three studies, although participants in 15 studies indicated clearly that their motivations were primarily altruistic. Observations indicate that men who are more willing to be identified to offspring in the future share demographic characteristics, such as age and parental status, with those who are prepared to donate altruistically. These characteristics appear to be a factor in motivation to donate altruistically. The studies show that there are men who are prepared to donate sperm without financial payment. The findings suggest that a change is required in the culture of sperm donation, specifically the adoption of a new approach to donor recruitment.

Journal of Obstetrics and Gynaecology Canada, 2006

On April 22, 2004, the Assisted Human Reproduction Act came into force, prohibiting the purchase ... more On April 22, 2004, the Assisted Human Reproduction Act came into force, prohibiting the purchase of sperm or eggs from donors in Canada. In response to the concerns of medical professionals and some consumers that prohibiting payment would lead to a decline in the number of gamete donors, Health Canada commissioned research on altruistic donor recruitment and recruitment strategies. Twenty-two studies of sperm donors were located and their findings reviewed. The studies spanned 23 years (1980-2003), were undertaken in a range of countries, and were chosen on the merit of their relevance to the development of recruitment strategies within a policy of altruistic sperm donation. Observations were derived from assessing and comparing the purposes, findings, and implications of the 22 studies. Payment for providing sperm was made in all but three studies, although participants in 15 studies indicated clearly that their motivations were primarily altruistic. Observations indicate that men who are more willing to be identified to offspring in the future share demographic characteristics, such as age and parental status, with those who are prepared to donate altruistically. These characteristics appear to be a factor in motivation to donate altruistically. The studies show that there are men who are prepared to donate sperm without financial payment. The findings suggest that a change is required in the culture of sperm donation, specifically the adoption of a new approach to donor recruitment.

Journal of Obstetrics and Gynaecology Canada, 2014

During an in vitro fertilization treatment cycle, having embryos retained in the catheter after e... more During an in vitro fertilization treatment cycle, having embryos retained in the catheter after embryo transfer is a relatively uncommon and frustrating event. The reported incidence of retained embryos varies between 1% and 8%. It can be difficult to explain this unwanted event to patients. We wished to determine the incidence and the effect on pregnancy rates of having embryos retained in the transfer catheter, followed by immediate completion of transfer. We performed a retrospective chart review of all IVF cycles with embryos retained in the transfer catheter, followed by repeat transfer, between October 2009 and March 2012. We reviewed IVF cycles with or without ICSI, and included fresh and frozen embryo transfer cycles. All embryos were transferred on the third day after oocyte retrieval. Transabdominal ultrasound was used for guidance during the embryo transfer. A total of 49 IVF treatment cycles with retained embryos that required re-transfer were identified. This represented 7.5% (49/652) of all IVF cycles with embryo transfer during that period. The clinical pregnancy rate in the repeat transfer group was 30.6% (15/49). The clinical pregnancy rate in all cycles in the same time period was 34.8% (227/652). These rates were not significantly different (P=0.521). Having to re-transfer embryos retained in the transfer catheter does not have any significant effect on clinical pregnancy rates during IVF treatment cycles.

PubMed, Feb 1, 2005

Poor responders represent a challenging group of infertility patients who fail to respond to cont... more Poor responders represent a challenging group of infertility patients who fail to respond to controlled ovarian hyperstimulation during the course of assisted reproduction treatment. Although poor response has been investigated since the eighties, many aspects of this condition are still controversial and no consensus has been reached on the management of these patients. The existing data cannot be easily compared due to the heterogeneity of the research design and methodology and the number of prospective randomized trials of sufficient sample size is limited. In addition, more research in the identification and understanding of underlying factors is needed together with a better understanding of the patho-physiological basis of ovarian ageing and of the progressive reduction in ovarian reserve. This paper provides an overview on the identification, prediction and management of poor responders undergoing medicated assisted reproduction treatment.

Journal of obstetrics and gynaecology Canada, Oct 1, 2003

Cervical pregnancy is a rare condition that can become life-threatening if heavy bleeding occurs.... more Cervical pregnancy is a rare condition that can become life-threatening if heavy bleeding occurs. Grace (pseudonym) is a 32-year-old woman who was admitted to hospital at approximately 6 weeks&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; gestational age after several days of heavy bleeding. Ultrasonographic examination revealed the presence of cervical pregnancy. She received multiple doses of methotrexate with folinic acid rescue, and did not require surgical intervention. Nine months after the resolution of the cervical pregnancy, Grace again became pregnant. She had an uncomplicated gestation and a normal vaginal delivery of a healthy baby at term. Multiple-dose methotrexate with folinic acid rescue was a safe option for the medical treatment of ectopic cervical pregnancy in this case. Long-term toxicity studies and case reports are required to provide more information regarding safety and for clinicians to individualize treatment regimens.

Biology of Reproduction, Aug 1, 1987

In rats, prostaglandins (PGs) have an essential role in the decidual cell reaction (DCR), but the... more In rats, prostaglandins (PGs) have an essential role in the decidual cell reaction (DCR), but their mechanism

PubMed, 2000

Endometrial calcifications occur sporadically and are associated with infertility. Previous uteri... more Endometrial calcifications occur sporadically and are associated with infertility. Previous uterine trauma during instrumentation and/or uterine infection are likely involved in their pathogenesis. The association between endometrial calcifications and recurrent pregnancy loss has been very infrequently reported. A 28-year-old woman with a history of two consecutive first trimester pregnancy losses presented with ultrasonographic hyperechoic endometrial areas associated with histologic endometrial calcification foci. A third pregnancy conceived before starting micronized oral progesterone supplementation also spontaneously aborted at eight weeks. During the fourth pregnancy, progesterone supplementation was taken for the initial 12 weeks. The endometrial lesions were no longer detectable and the pregnancy progressed to term without complications. Endometrial calcifications, related to intrauterine bone tissue, have been previously treated with curettage or with endoscopic surgery, and to the best of our knowledge, have not been reported to disappear spontaneously. In this case, regression of the endometrial calcifications and a favorable pregnancy outcome occurred in concert with oral micronized progesterone supplementation. A combination of transvaginal ultrasonography and endometrial biopsy appears to be an effective method for diagnosing and monitoring of this rare condition.

Fertility and Sterility, Aug 1, 2013

Objective: To examine whether mood state or infertility stress influences perceptions of risk, pr... more Objective: To examine whether mood state or infertility stress influences perceptions of risk, preferences for embryo transfer, or views on multiple pregnancy. Design: Observational cohort study. Setting: Hospital-based fertility clinic. Patient(s): One hundred seventy-six women participating in IVF treatment. Intervention(s): None. Main Outcome Measure(s): Mood scores, ratings of risk, preference for multiple embryo transfer, and attitudes toward multiple pregnancy. Result(s): Growing feelings of tension across the cycle corresponded with increases in the perceived riskiness of double-embryo transfer, but there was no change in strength of transfer preferences. Women experiencing negative moods, such as depression, viewed twin and triplet pregnancy as less likely, whereas increasing positive feelings across the cycle were associated with increasing desire for twin pregnancy. Overall, women perceived double-and triple-embryo transfer as less risky by cycle end than at cycle beginning and felt more certain about multiple-embryo transfer. Conclusion(s): The dyssynchrony observed among changes in mood, perceptions of risk, and transfer preferences challenges assumptions about the way medical risk information influences transfer preferences, and the findings suggest that mood states experienced during an IVF cycle might affect transfer preferences by influencing attitudes toward multiple pregnancy. Additional considerations beyond providing risk information are needed to facilitate effective patient decision making.

Human Reproduction, Apr 26, 2012

background: This study evaluated couples' perceptions of preparatory psychosocial counselling pri... more background: This study evaluated couples' perceptions of preparatory psychosocial counselling prior to participation in medically assisted reproduction (MAR). methods: Eighty-three couples about to undergo IUI treatment were asked about their expectations regarding a subsequent single psychosocial counselling session and assessed in terms of their levels of infertility-specific stress, anxiety and depressive symptoms. Afterwards, participants rated their satisfaction with different elements of the session. results: Almost two-thirds of women and one-half of men expected counselling to be important, and the majority anticipated that the session would be helpful and informative. Views of preparatory counselling were significantly more positive afterwards, indicating that a focused session addressing issues of treatment concerns, goal setting and managing infertility stress was more beneficial than anticipated. Those experiencing higher levels of infertility-specific stress expected the counselling session to be more important, and elevated stress and greater utilization of social support were predictive of post-counselling satisfaction. conclusions: Preparatory psychosocial counselling provided with a specific and practical focus appears to be a potentially important and helpful service prior to MAR. Clinics should not assume that patients can accurately judge the benefits of counselling before actually engaging in the session. Identifying patients most likely to benefit and providing a clear rationale may further increase receptivity to this proactive counselling service. While patients characterize this intervention as beneficial, it is not yet known if these benefits translate into improved management of treatment procedures.

Journal SOGC, Sep 1, 2001

Objective: To determine the efficacy and safety of a herbal formulation, Premenefa®, containing c... more Objective: To determine the efficacy and safety of a herbal formulation, Premenefa®, containing chasteberry (Vitex agnus castus), cramp bark (Viburnum opu/us), vitamin E, bioflavonoids (vitamin P complex), borage oil, and flaxseed oil, in controlling premenstrual symptoms. Background: Although many women do not satisfy strict diagnostic criteria for premenstrual syndrome (PMS), they may still experience premenstrual symptoms. Regardless of whether a woman has specific symptoms or a symptom complex such as premenstrual syndrome, persistence of premenstrual symptoms in spite of standard treatment leads many of these women to unsupervised use of non-prescription products, increasingly herbal preparations. However, few randomized studies have assessed effectiveness and safety of herbal products. Methods: This study was a randomized, double-blind, placebocontrolled, crossover trial of a herbal preparation proposed to alleviate premenstrual symptoms (Premenefa®). Participants were randomized to start either on the herbal preparation or on placebo. Crossover occurred after three menstrual cycles. Seventy-four women completed six cycles, three each on formulation and placebo. The primary outcome variable was global scores for 15 premenstrual symptoms. Individual symptom scores were also recorded and analyzed. Results: Global premenstrual symptom scores were significantly lower in the formulation cycles than in the placebo cycles (p < 0.000 I). The difference was observed from the first cycle and increased progressively from the first cycle to the third cycle. Of subjects who completed the study, 62, 78, and 85 percent experienced at least a SO percent lower score while on the herbal preparation for cycles one, two, and three respectively (p = 0.002 for cycles one to two, cycles two to three non-significant). Twenty-three, 34, and 61 percent of subjects experienced at least a 70 percent lower score

Cancer Letters, Dec 1, 1991

Several theories suggest that lung carcinomas are not totally separate entities, but are derived ... more Several theories suggest that lung carcinomas are not totally separate entities, but are derived from a common precursor, probably of endodermal origin. The histological classification of lung cancers is complex, with much overlap between groups broadly designated as small cell (SCLC), squamous cell, adenocarcinoma and all others simply termed non-small cell. It is shown here that in vitro exposure of classic, non-adherent SCLC lines to 10 microM 5&amp;amp;amp;amp;#39; bromodeoxyuridine (BrdU) results in a rapid cell-line dependent change to a morphology consistent with an adherent, non-small cell phenotype. Accompanying this morphological shift is a decreased expression of the amplified N-myc protooncogene. These induced changes underline the morphological relatedness of lung carcinoma cell lines.

Minerva ginecologica, Nov 1, 2019

Fertility and Sterility, Sep 1, 2005

after processing. Cycle stimulation: Continuous low dose (125 mcg) ganirelix acetate daily starti... more after processing. Cycle stimulation: Continuous low dose (125 mcg) ganirelix acetate daily starting with onset of menses and continuing to day of hCG administration compared with leuprolide acetate, 0.5 mg daily, beginning 12 days prior to initiation of FSH for 5 days then decreasing to 0.25mg and continuing to day of hCG administration. Ovulation induction in both groups_start recombinant FSH 150 IU to 450 IU daily with a small amount of LH add-back via hMG. Adjust dose as necessary starting on CD 9. HCG when at least 2 follicles Ն 18mm. RESULTS: CONCLUSION: This preliminary data supports the conclusion that a stimulation protocol using low-dose ganirelix starting with the onset of menses appears to be as good as the traditional luteal leuprolide protocol for women with expected average response to stimulation.

Evidence-based Obstetrics & Gynecology, Dec 1, 2000

OBJECTIVE To compare the uterine effects of raloxifene and estrogen in healthy postmenopausal wom... more OBJECTIVE To compare the uterine effects of raloxifene and estrogen in healthy postmenopausal women. DESIGN Multicentre, randomized, triple-blind, 4-arm, double-placebo-controlled trial. Allocation was by random number table, using coded medications in blocks of 4. SETTING Thirty-two centres in the USA and 1 in the UK. SUBJECTS 415 healthy postmenopausal women, aged 47-60 (mean 55) years, with a normal uterus, endometrial thickness 45 mm, serum estradiol 473 pmol/L, and lumbar spine bone mineral density in the normal range. Time since menopause was 2-8 (mean 4.6) years. INTERVENTION The women were randomized to receive daily, for 12 months, raloxifene 60 mg (n"101) or 150 mg (n"105) plus placebo, estrogen 0.625 mg plus placebo (n"100), or two placebos (n"109). All women also received calcium 520 mg daily. Transvaginal ultrasonography was performed every 3 months, and endometrial biopsy and saline-infusion sonohysterography were performed every 6 months. MAIN OUTCOME MEASURES Endometrial hyperplasia, uterine volume, endometrial thickness. MAIN RESULTS 86% of subjects underwent at least one follow-up endometrial biopsy. Endometrial hyperplasia was detected in 23/88 women (26%) in the estrogen group, 0/84 in the raloxifene 60 mg group, 0/92 in the raloxifene 150 mg group, and 2/94 (2%) in the placebo group (P(0.001). The mean endometrial thickness by transvaginal ultrasonography at baseline was 2.7 mm, with no difference among groups, and at follow-up the mean ($SD) change was 5.5$4.0 mm in the estrogen group, 0.2$1.5 mm in the raloxifene 60 mg group, 0.1$1.3 mm in the raloxifene 150 mg group, and !0.1$2.1 mm in the placebo group (P(0.001 estrogen vs other three groups, NS raloxifene groups vs placebo). Endometrial thickness '5 mm was observed in 70, 5, 4, and 6% of women, respectively. The mean uterine volume at baseline was 32 cm 3 , with no difference among groups, and at follow-up the mean change was 22$21 cm 3 with estrogen, !2$8 cm 3 with raloxifene 60 mg, !2$11 cm 3 with raloxifene 150 mg, and !3$11 cm 3 with placebo (P(0.001 estrogen vs other three groups, NS raloxifene groups vs placebo). Vaginal bleeding was reported more frequently in the estrogen group (29% of women) than in the other three groups (2-6%, P(0.001), as was mastalgia (18% vs 0-4%, P(0.001), but the withdrawal rates because of adverse events were similar among groups. CONCLUSION Raloxifene at daily doses of 60 mg and 150 mg did not stimulate the endometrium in post-menopausal women.

Fertility and Sterility, Sep 1, 2005

Fertility and Sterility, Jun 1, 1996

Setting: University hospital infertility unit. Patients: Four cohorts of couples were defined bas... more Setting: University hospital infertility unit. Patients: Four cohorts of couples were defined based on day 3 FSH determinations with an arbitrary threshold of 20 mIU/mL, only 2:20 mIU/mL, always <20 mIU/mL, current <20 mIUI mL but one previous 2:20 mIU/mL, and current <20 mIU/mL but two or more previous 2:20 mIU/mL (conversion factor to SI unit, 1.00). Intervention: In vitro fertilization-embryo transfer. Main Outcome Measure: Fetal heart activity on luteal day 40 transvaginal ultrasound. Results: No pregnancies occurred in 53 cycles with day 3 FSH only 2:20 mIU/mL. In 1,750 women whose day 3 FSH levels were always <20 mIU/mL, the pregnancy rate (PR) per cycle was 16.5%. In 54 cycles in which day 3 FSH was 2:20 one time only, but <20 mIU/mL during the treatment cycle, the PR was 5.6%. In 11 cycles where two or more previous FSH determinations were 2:20 mIU/mL but with a current day 3 FSH <20 mIU/mL, no pregnancies occurred. Conclusion: Our data leads us to the conclusion that day 3 FSH determination precede every IVF cycle and that cycles with FSH 2: 20 mIU/mL be canceled. It also suggests that women with two previous elevations of day 3 FSH be discouraged from future IVF cycles. The 5.6% pregnancy per cycle with one previously elevated FSH warrants extreme pessimism in discussion of further cycles.

Journal of Investigative Dermatology, Dec 1, 1990

Journal of obstetrics and gynaecology Canada, 2015

Background: Transvaginal ultrasound guided oocyte retrieval during in vitro fertilization is perf... more Background: Transvaginal ultrasound guided oocyte retrieval during in vitro fertilization is performed routinely around the world and has reduced the occurrence of intra-abdominal injury considerably over laparoscopic procedures. Despite this, injuries do occur. Case: We report a case of a 37-year-old patient who underwent IVF and encountered a ureteric injury during oocyte retrieval, which was recognized early and treated with ureteral stents with full resolution. During a subsequent IVF cycle, stenting of the ureters allowed better visualization, resulting in an uneventful retrieval and subsequent pregnancy. Conclusion: Ureteric injury can occur during transvaginal ultrasound guided egg retrieval. Prompt recognition is vital to successful treatment. Stenting of the ureters is the most common therapeutic modality and can be used in subsequent retrievals to identify the ureters .

Journal of Obstetrics and Gynaecology Canada, 2006

On April 22, 2004, the Assisted Human Reproduction Act came into force, prohibiting the purchase ... more On April 22, 2004, the Assisted Human Reproduction Act came into force, prohibiting the purchase of sperm or eggs from donors in Canada. In response to the concerns of medical professionals and some consumers that prohibiting payment would lead to a decline in the number of gamete donors, Health Canada commissioned research on altruistic donor recruitment and recruitment strategies. Twenty-two studies of sperm donors were located and their findings reviewed. The studies spanned 23 years (1980-2003), were undertaken in a range of countries, and were chosen on the merit of their relevance to the development of recruitment strategies within a policy of altruistic sperm donation. Observations were derived from assessing and comparing the purposes, findings, and implications of the 22 studies. Payment for providing sperm was made in all but three studies, although participants in 15 studies indicated clearly that their motivations were primarily altruistic. Observations indicate that men who are more willing to be identified to offspring in the future share demographic characteristics, such as age and parental status, with those who are prepared to donate altruistically. These characteristics appear to be a factor in motivation to donate altruistically. The studies show that there are men who are prepared to donate sperm without financial payment. The findings suggest that a change is required in the culture of sperm donation, specifically the adoption of a new approach to donor recruitment.

Journal of Obstetrics and Gynaecology Canada, 2006

On April 22, 2004, the Assisted Human Reproduction Act came into force, prohibiting the purchase ... more On April 22, 2004, the Assisted Human Reproduction Act came into force, prohibiting the purchase of sperm or eggs from donors in Canada. In response to the concerns of medical professionals and some consumers that prohibiting payment would lead to a decline in the number of gamete donors, Health Canada commissioned research on altruistic donor recruitment and recruitment strategies. Twenty-two studies of sperm donors were located and their findings reviewed. The studies spanned 23 years (1980-2003), were undertaken in a range of countries, and were chosen on the merit of their relevance to the development of recruitment strategies within a policy of altruistic sperm donation. Observations were derived from assessing and comparing the purposes, findings, and implications of the 22 studies. Payment for providing sperm was made in all but three studies, although participants in 15 studies indicated clearly that their motivations were primarily altruistic. Observations indicate that men who are more willing to be identified to offspring in the future share demographic characteristics, such as age and parental status, with those who are prepared to donate altruistically. These characteristics appear to be a factor in motivation to donate altruistically. The studies show that there are men who are prepared to donate sperm without financial payment. The findings suggest that a change is required in the culture of sperm donation, specifically the adoption of a new approach to donor recruitment.

Journal of Obstetrics and Gynaecology Canada, 2014

During an in vitro fertilization treatment cycle, having embryos retained in the catheter after e... more During an in vitro fertilization treatment cycle, having embryos retained in the catheter after embryo transfer is a relatively uncommon and frustrating event. The reported incidence of retained embryos varies between 1% and 8%. It can be difficult to explain this unwanted event to patients. We wished to determine the incidence and the effect on pregnancy rates of having embryos retained in the transfer catheter, followed by immediate completion of transfer. We performed a retrospective chart review of all IVF cycles with embryos retained in the transfer catheter, followed by repeat transfer, between October 2009 and March 2012. We reviewed IVF cycles with or without ICSI, and included fresh and frozen embryo transfer cycles. All embryos were transferred on the third day after oocyte retrieval. Transabdominal ultrasound was used for guidance during the embryo transfer. A total of 49 IVF treatment cycles with retained embryos that required re-transfer were identified. This represented 7.5% (49/652) of all IVF cycles with embryo transfer during that period. The clinical pregnancy rate in the repeat transfer group was 30.6% (15/49). The clinical pregnancy rate in all cycles in the same time period was 34.8% (227/652). These rates were not significantly different (P=0.521). Having to re-transfer embryos retained in the transfer catheter does not have any significant effect on clinical pregnancy rates during IVF treatment cycles.