Browsing by Author "Van der Merwe, J. P."

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    A comparative analysis of grade 1 and grade 2 water in the Tygerberg Hospital in vitro fertilisation programme
    (Health and Medical Publishing Group (HMPG), 1987-02) Kruger, T. F.; Van Wyk, H.; Stander, F. S. H.; Smith, K.; Menkveld, R.; Van der Merwe, J. P.
    There are conflicting reports in the literature about the effect of the water source for growth and insemination media in an in vitro fertilisation (IVF) programme. A controlled trial was carried out in which two-cell mouse embryos were cultured in Ham F10 medium containing either grade 1 water (test group) or grade 2 water (control group). Of the two-cell embryos, 92,0% (69 of 75) in the test group and 91,8% (67 of 73) in the control group cleaved to the blastocyst stage (no statistically significant difference). On the basis of this experiment grade 2 water was used in the Tygerberg Hospital human IVF programme with good results. A continuing pregnancy rate of 23% per embryo transfer over a 1-year period is reported.
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    Factors affecting pregnancy outcome in a gamete intrafallopian transfer (GIF) programme
    (Health & Medical Publishing Group, 2003-07) De Bruijn, J. M.; Kruger, T. F.; Van der Merwe, J. P.; Stander, F. S. H.; Lombard, C. J.
    Objective. To identify the factors that most significantly affected pregnancy rates in a gamete intrafallopian transfer (GIFT) programme. Methods. A total of 863 GIFT cycles were analysed retrospectively. The variables found to be associated significantly with pregnancy were then used to obtain multivariate analysis using logistical regression. Results. Overall and ongoing pregnancy rates were significantly better in patients ≤ 38 years than in patients > 38 years (37.3% and 28.4% v. 23.7% and 11.0% respectively), and age was positively associated with success after GIFT (odds ratio (OR) 1.87, 95% confidence interval (CI): 1.22 - 2.85). Metaphase I (MI) oocytes were negatively associated with pregnancy (OR 1.54, 95% CI: 0.28 - 1.04). The highest pregnancy rates occurred when 3 metaphase II (MII) oocytes were transferred (39.8%, OR 7.51, 95% CI: 1.74 - 32.42). With regard to sperm morphology, overall pregnancy rates of 25.5% (≤ 4% normal forms) and 37.2% (> 4% normal forms) were obtained. Morphology of > 4% normal forms was positively associated with pregnancy (OR 1.58, 95% CI: 1.04 - 2.42). Conclusion. The results of this study suggest that the most important factors influencing pregnancy rates in a GIFT programme are the woman's age and those factors pertaining to the characteristics of the gametes. Considering the emotional and financial costs it is important to relate this information to all prospective participants in a GIFT programme.
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    Human pregnancy after transfer of intact frozen-thawed embryos
    (Health & Medical Publishing Group, 1989) Erasmus, E.L.; Van der Merwe, J. P.; Kruger, T. F.; Stander, F. S. H.; Menkveld, R.
    Since the birth of the first baby as a result of in vitro fertilisation (IVF) in 1978, many clinics around the world have achieved pregnancies and births for their patients by using IVF and gamete intrafallopian transfer procedure. With the storage of excess embryos, multiple laparoscopies can be avoided; this has favoured in the development of better cryopreservation techniques. In our clinic 8-cell human embryos are frozen in a 1,5M dimethyl sulphoxide solution as cryoprotectant using the slow freeze-thaw method. Sixteen thawed embryos were replaced in 8 patients, resulting in 1 pregnancy. Of the thawed embryos 51,6% survived the freezing process in that they had 50% or more of the original number of blastomeres and also the zona pellucida intact.
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    The in vitro fertilisation programme at Tygerberg Hospital and the University of Stellenbosch. Five years' experience, April 1983 - January 1988
    (Health & Medical Publishing Group, 1990) Kruger, T. F.; Van der Merwe, J. P.; Odendaal, H. J.; Stander, F. S. H.; Grobler, G. M.; Hulme, V. A.; Erasmus, E. L.; Coetzee, K.; Windt, M.-L.; Swart, Y.; Smith, K.; Menkveld, R.
    The results of the in vitro fertilisation programme at Tygerberg Hospital for the period April 1983 to January 1988 are presented. Of the 1117 laparoscopies performed, 825 patients reached the transfer stage. A live-birth rate of 9.3% was achieved. The pregnancy rate after transfer of 4 embryos was 25,9% compared with 15,4% after 2 embryos and 10,8% after 3 embryos (P = 0.0001). The multiple pregnancy rate was 2.8% in the group receiving 2 embryos and 11.7% and 10,4% in those receiving 3 and 4 embryos, respectively. Of the 77 successful pregnancies (90 babies), 1 baby died at 34 weeks' gestation as the result of abruptio placentae due to preeclampsia and 1 cot death occurred. The only congenital abnormality encountered was a cleft palate.
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    Kunsmatige intrauteriene inseminasie met gewaste voorbereide eggenootsemen
    (Health & Medical Publishing Group, 1987-10) De Villiers, T. J.; Kruger, T. F.; Van der Merwe, J. P.; Menkveld, R.
    ENGLISH ABSTRACT: Intra-uterine insemination with washed spermatozoa of the husband was evaluated in 42 infertile couples during 103 treatment cycles. A pregnancy rate of 47.3% was obtained after an average of 2 treatment cycles in a group of patients in whom hostile cervical mucus was the only known cause of infertility. A pregnancy rate of 21.7% was obtained after an average of 2.6 treatment cycles in a group of patients in whom low sperm morphology was the only known cause of infertility. The overall conception rate of 33.3% compares favourably with that in other published series.
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    Laparoscopic myomectomy for infertile patients with intramural fibroids : a retrospective study at a tertiary endoscopic centre
    (Health & Medical Publishing Group, 2011-09) Lourens, Renardo J.; Siebert, T. I.; Kruger, T. F.; Van der Merwe, J. P.
    Background. The safety of laparoscopic myomectomy has been questioned, especially in the case of fibroids. Objectives. To assess the safety of laparoscopic myomectomy for intramural fibroids and study the subsequent effect on fertility. Methods and settings. A retrospective study of a tertiary endoscopic centre specialising in laparoscopic myomectomy. Results. Eighty-seven patients were studied, and there were no major complications. The conversion rate from laparoscopy to laparotomy was 3.4% (3/87), in all cases due to multiple fibroids. There was 1 case of uterine perforation during hysteroscopy. The overall pregnancy rate was 29/64 (45.3%), with a spontaneous pregnancy rate of 18/29 (62.0%). Conclusions. Laparoscopic myomectomy can be regarded as a safe alternative to abdominal myomectomy in the hands of the experienced surgeon, resulting in good subsequent pregnancy rates.
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    Ovulasie-induksie vir in vitro-bevrugting in Tygerberg-hospitaal
    (Health & Medical Publishing Group, 1987) Van der Merwe, J. P.; Kruger, T. F.; Lombard, C. J.; Muller, L. M. M.
    The protocol for in vitro fertilisation (IVF) at Tygerberg Hospital is presented and the results are analysed. Indications for ovulation induction for IVF included the following: (a) irreversible tubal damage; (b) infertility due to immunological factors; (c) male factor - infertility; and (d) endometriosis. A combination of human menopausal gonadotrophin (HMG) and clomiphene citrate (Clomid; Mer-National) and human chorionic gonadotrophin was used. Clomid is given in dosages of 100 mg for 5 days depending on the cycle length. Three doses of HMG (150 IU) are given on alternate days, starting on the second day of clomiphene treatment. If the leading follicle has not reached a mean diameter of 14 mm the day after the last HMG dose, another dose is given. This dosage is continued until the leading follicle reaches a diameter of 14 mm. A total of 109 cycles in 100 patients was analysed. Ova were considered to be mature as soon as the dominant follicle had reached a sonographic average diameter of 18 mm, another two follicles of 16 mm average diameter being present. Serum luteinising hormone levels were determined 4-hourly from the stage when the leading follicles exceeded an average diameter of 14 mm. In this study the pregnancy rate was 21.3% per laparoscopy and 24,4% per embryo transfer. The oestradiol levels on the 5th day of treatment have a predictive value of the length of stimulation.
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    Results of the in vitro fertilization programme at Tygerberg Hospital, phases II and III
    (Health & Medical Publishing Group, 1986-03) Kruger, T. F.; Van der Merwe, J. P.; Stander, F. S. H.; Menkveld, R.; Van den Heever, A. D.; Kopper, K.; Odendaal, H. J.; Van Zyl, J. A.; De Villiers, J. N.
    Phases II and III of the human in vitro fertilization programme at Tygerberg Hospital are presented. In phase II, 42 laparoscopies were performed and oocytes were obtained from 76% of the follicles aspirated, but with a fertilization rate of only 37%. The viable pregnancy rate per embryo transfer was 4%. Important changes took place in the programme, which led to a fertilization rate of 77% in phase III. Of the 78 patients subjected to laparoscopy, 65 (83%) reached the embryo transfer stage, resulting in a clinical pregnancy rate per embryo transfer of 23%, and with a 19% pregnancy rate per laparoscopy. The changes, methods and results of phases II and III are discussed.
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    Severe ovarian hyperstimulation after follicular aspiration
    (Health & Medical Publishing Group, 1988) Van der Merwe, J. P.; Michell, W. L.; Kruger, T. F.
    In order to maximise the changes of pregnancy, most successful in vitro fertilisation programmes use a combination of ovulation induction agents. This treatment can lead to the hyperstimulation syndrome. Aspiration of the follicles is believed to avoid this syndrome. Despite this approach, hyperstimulation syndrome may still develop. The clinical picture and treatment of a patient with severe hyperstimulation is discussed.
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    Surgical treatment of endometriosis before gamete intrafallopian transfer (GIFT)
    (Health & Medical Publishing Group, 2007) Van der Merwe, J. P.; Kruger, T. F.; Lombard, C. J.
    Objective. To determine whether active pelvic endometriosis impairs the efficacy of GIFT (gamete intrafallopian transfer) and whether prior surgical treatment of endometriosis improves the efficacy of GIFT. Design. Matched controlled retrospective study. Setting. University-based assisted reproduction programme. Patients. Patients who had GIFT between 1990 and 1997 were included in the study. Female patients were laparoscopically diagnosed as having endometriosis. Patients who did not have surgical treatment for endometriosis before GIFT were staged for endometriosis during the GIFT laparoscopy. Two patients, with no signs of endometriosis, were matched for every endometriosis case, and served as controls. Patients were matched for age, number of eggs transferred and percentage of normal sperm morphology. Intervention. Patients in 80 cycles had surgical treatment for endometriosis and 128 patients had GIFT procedures as treatment for endometriosis-related infertility. Main outcome measures. Ongoing pregnancies and deliveries. Statistical analysis. A Mantel-Haenszel approach was used to estimate relative risk of pregnancy outcome in the endometriosis groups versus controls. Results. There was a 22.9% pregnancy rate (11/48) among patients with active endometriosis who had GIFT procedures, versus a 37.0% pregnancy rate (37/100) for the controls, giving a relative risk of 0.62 (95% confidence interval (CI): 0.35 - 1.10, p = 0.082). There was a 36.3% pregnancy rate (29/80) among patients who had surgical treatment for endometriosis before GIFT, versus a 33.3% pregnancy rate (53/159) for the controls, giving a relative risk of 1.07 (95% CI: 0.75 - 1.54, p = 0.647). Conclusion. There is an indication that GIFT pregnancy rates are impared in patients suffering from active endometriosis, while prior surgery may alleviate the impairment.