Browsing by Author "Kruger, T. F."
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- ItemAssisted reproduction in the HIV-serodiscordant couple(Health & Medical Publishing Group, 2007-01) Nosarka, S.; Hoogendijk, C. F.; Siebert, T. I.; Kruger, T. F.ENGLISH ABSTRACT: No abstract available
- ItemThe effect on cleavage of two-cell mouse embryos after a delay in embryo retrieval in a human in vitro fertilization programme(Health & Medical Publishing Group, 1985) Kruger, T. F.; Stander, F. S. H.Two-cell mouse embryos are used for quality control in a human in vitro fertilization programme. A controlled experiment was designed to evaluate the effect on cleavage of two-cell mouse embryos after a delay in embryo retrieval. In the test group, two fallopian tubes were incubated in Whittingham's T6 medium for 2 1/2 hours per experiment before the embryos were removed for culture. In the control group embryos were removed from the fallopian tubes immediately after the mice were sacrificed. Five experiments were performed. Eight of 141 two-cell embryos (5,7%) reached the balstocyst stage in the test group, and in the control group 143 of 151 two-cell embryos (94,7%) reached the blastocyst stage after 72 hours. Embryos must be removed immediately after the mice are sacrificed to obtain constant results. If not, poor cleavage can lead to unnecessary confusion in the laboratory.
- ItemHuman 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.
- ItemImplementation of an office-based semen preparation method (SEP-D Kit) for intra-uterine insemination (IUI) : a controlled randomised study to compare the IUI pregnancy outcome between a routine (swim-up) and the SEP-D Kit method(Health & Medical Publishing Group, 2012-03-29) Gentis, R. K.; Siebert, I.; Kruger, T. F.; De Beer-Windt, M. L.The aim of this study was to compare the Sep-D kit with the standard swim-up sperm washing method regarding pregnancy outcomes.
- ItemThe 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.
- ItemIs the use of a GnRH antagonist effective in patients with polycystic ovarian syndrome? A South African perspective(Health & Medical Publishing Group, 2012-01-19) Siebert, T. I.; Kruger, T. F.; Grieve, C. L.; Steyn, D. W.Introduction. Polycystic ovarian disease (PCOS) can account for up to 35 - 40% of the female factor causes of infertility. These patients present as medically complex cases and are challenging to manage and treat successfully. They are resistant to treatment and are often offered controlled ovarian stimulation (COS) and in vitro fertilisation (IVF) technology. Aim. The aim of this study was to assess whether there was a difference in the pregnancy outcomes of women with PCOS when a standard gonadotrophin-releasing hormone (GnRH) antagonist (cetrorelix) protocol was used for ovarian stimulation, compared with non-PCOS patients undergoing IVF. Methods. A retrospective patient record audit was performed on 142 patients with PCOS and 501 non-PCOS patients undergoing a similar cetrorelix-based COS treatment protocol during a specified time period. Results. The main primary outcome was an ongoing pregnancy at 12 weeks, achieved in 34% of patients in the PCOS group and 27% in the non-PCOS group. This was not significantly different (p=0.07). No patient in the PCOS group experienced severe hyperstimulation syndrome. Conclusion. There was no significant difference in pregnancy rates in patients with PCOS undergoing GnRH-antagonist ovarian stimulation compared with non-PCOS patients. The fact that no hyperstimulation syndrome occurred makes this an attractive option for women with PCOS.
- ItemKunsmatige 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.
- ItemLaparoscopic 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.
- ItemLaparoscopic Strassman's metroplasty for bicornuate uterus - is it relevant?(Health & Medical Publishing Group, 2012-09-06) Matsaseng, T.; Kruger, T. F.The mean incidence of bicornuate uterus in Müllerian duct anomalies is approximately 25%, and it is associated with abortion, preterm delivery and term delivery rates of 36%, 23% and 40.6%, respectively. Open abdominal metroplasty has been shown to significantly improve pregnancy outcomes in patients with bicornuate uterus. However, minimally invasive laparoscopic metroplasty could be an alternative. A 24-year-old woman with a bicornuate uterus and poor reproductive outcomes underwent laparoscopic Strassman’s metroplasty. The procedure was completed safely within 180 minutes with minimum blood loss. At follow-up hysteroscopy and laparoscopy 2 months later, minimal adhesions in the pelvis were noted and removed. There were no synechiae in the uterine cavity. It is concluded that laparoscopic metroplasty is a safe and relevant alternative to conventional abdominal metroplasty, with minimal adhesion formation.
- ItemMicrosurgical testicular sperm extraction for testicular failure: the South African experience and first successful pregnancy(Medpharm Publications, 2021-06) Zarrabi, A. D.; Kruger, T. F.BACKGROUND: In men with non-obstructive azoospermia (NOA), biological fatherhood is only possibly by specialised microsurgical sperm retrieval techniques (micro-TESE), only recently introduced to South Africa. This study aimed to analyse the spectrum of causes of NOA and the outcomes of micro-TESE, including live births, following the use of this technique in South Africa METHODS: This was a retrospective review of all micro-TESE cases performed in South Africa by a single surgeon from 2014 to 2018. Data collected prospectively included: patient demographics, preoperative blood results, cause of azoospermia, intraoperative findings and postoperative complications. The primary outcome measured was surgical success of micro-TESE, which was defined as testicular sperm successfully retrieved and cryopreserved. Subsequent live births from assisted reproductive technology (ART) using the cryopreserved sperm were also documented RESULTS: Twenty-six men with NOA underwent micro-TESE between May 2014 and April 2018. Mean preoperative total testosterone level was 12.0 nmol/l (IQR 5.2) and follicle-stimulating hormone level 23.5 IU/l (IQR 15.6). Genetic testing was performed as part of the preoperative work-up in only 10 of the 26 patients. A specific cause of NOA was identified in 9 of the 26 patients and included Klinefelter syndrome (1 patient), Y-chromosome AZFc microdeletion (1 patient), undescended testicles (5 patients) and chemotherapy (2 patients). The average testicular volume was 9.05 ml (IQR 5.6), and the mean duration of surgery 95.8 minutes (IQR 28.0). The overall sperm retrieval rate was 34.6%. A single pregnancy and subsequent live birth were recorded from a total of eight cycles of intracytoplasmic sperm injection (ICSI): four female partners had one ICSI cycle each and two females underwent two cycles each. Frozen and thawed sperm was used in seven of the ICSI cycles and fresh sperm in one cycle CONCLUSION: In this South African series, sperm retrieval rates of micro-TESE for non-obstructive azoospermia were comparable to those reported internationally. Preoperative genetic testing should be increased to optimise the selection of surgical candidates
- ItemOsmolarity studies with different containers and volumes in a human in vitro fertilization programme(Health and Medical Publishing Group (HMPG), 1985-10) Kruger, T. F.; Stander, F. S. H.; Menkveld, R.; Lombard, C. J.[No abstract available]
- ItemOvulasie-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.
- ItemResults of phase I of the in vitro fertilization and embryo transfer programme at Tygerberg Hospital(Health and Medical Publishing Group (HMPG), 1985-05) Kruger, T. F.; Van Schouwenburg, J. A. M. H.; Stander, F. S. H.; Van den Heever, A. D.; Van Zyl, J. A.; Menkveld, R.; Kopper, K.; De Villiers, A.; Conradie, E.; Odendaal, H. J.; De Villiers, J. N.Phase I (3 June - 31 October 1983) of the in vitro fertilization (IVF) programme at Tygerberg Hospital is outlined in this article. This programme led to the birth of the first IVF baby in South Africa after fertilization and embryo transfer (ET) took place at this institution. The baby was born on 29 April 1984; a second baby was born on 20 June 1984. During phase I 24 laparoscopies were performed; 32 oocytes were obtained from 56 follicles, of which 62.5% were fertilized. Eleven ETs were performed, which led to 3 pregnancies. An ongoing pregnancy rate of 18% per ET and a pregnancy rate of 12,5% per laparoscopy were achieved.
- ItemResults 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.
- ItemA review of the incidence and survival of childhood and adolescent cancer and the effects of treatment on future fertility and endocrine development(Health & Medical Publishing Group, 2012-03-29) Botha, M. H.; Kruger, T. F.Cancer is not uncommon in children. The reproductive system is an important site for late effects of cancer treatment, and normal pubertal development depends on an undamaged hypothalamic-pituitary-gonadal axis. Fertility compromise can occur due to chemotherapy, radiotherapy to the hypothalamic-pituitary-gonadal axis, or surgery. Cryopreservation techniques of germ cells are improving and may offer hope for fertility preservation.
- ItemThe role of hexoprenaline in suprapubic amniocentesis during late pregnancy : a pilot study(Health & Medical Publishing Group, 1984) Cronje, H. S.; Kruger, T. F.; Bradshaw, D.Suprapubic amniocentesis is often complicated by the fetal head being fixed in the pelvis, oligohydramnios or a hyperirritable myometrium. These factors limit the success rate associated with the procedure. If the myometrium is relaxed with a β2-stimulant, a higher success rate may be achieved. This was investigated in a randomized, prospective, double-blind pilot study using hexoprenaline. When four- or five-fifths of the fetal head was palpable above the pelvis, hexoprenaline (17 amniocenteses) showed no advantage over a placebo (16 amniocenteses). However, when three-fifths or less of the fetal head was palpable above the brim, 4 dry taps were obtained in the control group using a placebo (17 amniocenteses), while none occurred in the study group (19 amniocenteses) (P < 0.05). Elevation of the fetal head was less difficult in the study group, but this difference was not statistically significant. These results suggest that hexoprenaline is not indicated for routine use during amniocentesis. When a dry tap is obtained or when marked difficulty is encountered in lifting the fetal head from the pelvis, 10 μg hexoprenaline administered intravenously 5 minutes before amniocentesis appears to facilitate successful completion of the procedure. However, a larger series is necessary to confirm this observation.
- ItemSevere 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.
- ItemSurgical 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.
- ItemSurrogate motherhood(Health and Medical Publishing Group (HMPG), 2005-12) Nosarka, S.; Kruger, T. F.
- Item'n Vergelykende studie tussen tweeselembrio's van CBA- en F1-muise in 'n menslike in vitro bevrugtingsprogram(Health and Medical Publishing Group (HMPG), 1984-02) Kruger, T. F.; Stander, F. S. H.The two-cell mouse embryo can develop in a chemically defined medium to the blastocyst stage but conditions must be strictly controlled. Fresh T6 (Whittingham's) medium is being used weekly for this purpose in our laboratory and subjected to a 5% CO2-in-air system 24 hours prior to use. Experiments were designed to determine whether two-cell embryos obtained from an F1 (CBA x C57/B1/6) x F1 cross were superior to the easily obtainable CBA x ICR cross. The aim was to get a 90% blastocyst result for use as a quality control. Eight experiments were performed over a 6-week period. The CBA two-cell embryos were compared with the F1 group under identical conditions. A total of 177 two-cell embryos were obtained from the CBA group and 214 two-cell embryos from the F1 group. In the CBA group 51 developed to the blastocyst stage (28.8%) compared with 187 in the F1 group (87,4%) (P<0.0001). In conclusion, it is advisable to obtain F1 mice to use weekly in the laboratory as a quality control measure. The CBA group yields poor cultures, and this lead to unnecessary laboratory confusion.