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Abraham Lightman

Bio: Abraham Lightman is an academic researcher from Technion – Israel Institute of Technology. The author has contributed to research in topics: Embryo transfer & Pregnancy rate. The author has an hindex of 12, co-authored 15 publications receiving 438 citations.

Papers
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Journal ArticleDOI
TL;DR: The sperm motility index provides a reliable and objective reflection of semen motility parameters and quality and represents semen quality assessment obtained by two experienced andrologists.

68 citations

Journal ArticleDOI
TL;DR: Age at chemotherapy did not correlate with the sperm count; hence a prepubertal state did not protect the gonad from the late effects of treatment, and Radiotherapy and chemotherapy combinations that included nitrogen mustard or cyclophosphamide were associated with high rates of oligospermia and azoOSpermia.
Abstract: The aim of this study was to investigate the impact of therapy on long-term gonadal function of young people cured of childhood lymphomas and to assess whether a prepubertal state during the treatment protects the gonads from chemotherapy and/or radiotherapy late effects. Clinical evaluation, semen analysis, and endocrine status were studied in 20 survivors of childhood lymphomas. Five patients received Inverted Y radiotherapy, 2320 cGy (1550-4000); all 20 received chemotherapy as follows: MOPP/ABVD protocol, 9 patients; COMP protocol, 5 patients; MOPP protocol, 3 patients; other protocols, 3 patients. Semen analysis results were as follows: normal values, 4/20 patients; oligospermia, 8/20 patients; azoospermia, 8/20 patients; FSH above normal level, 10/20 patients; 4/5 who received Inverted Y irradiation were azoospermic and 1 was severely oligospermic. Treatment damage to the testis involves tubular germinal elements. Radiotherapy and chemotherapy combinations that included nitrogen mustard or cyclophosphamide were associated with high rates of oligospermia and azoospermia. MOPP/ABVD combination did not have a significant better outcome of sperm counts compared to MOPP alone. Age at chemotherapy did not correlate with the sperm count; hence a prepubertal state did not protect the gonad from the late effects of treatment.

60 citations

Journal ArticleDOI
TL;DR: It is suggested that accelerated dismantling of the pronuclear membrane and subsequent cleavage do not necessarily indicate abnormal chromosomal content and may result in normal pregnancy and in a patient with a small number of embryos, FISH may be used to ascertain diploidy of undocumented embryos, thereby increasing the number of available embryos for transfer.
Abstract: Pronuclei formation is routinely assessed 16-20 h after oocyte insemination in in-vitro fertilization (IVF). Occasionally, the pronuclei disappear before this time, rendering them as 'undocumented'. Since the number of pronuclei detected is used to distinguish normal from abnormal embryos in the context of ploidy, the diploidy of undocumented embryos is questionable, and therefore they are routinely discarded. The introduction of fluorescent in-situ hybridization (FISH) technology allows the assessment of ploidy status in undocumented embryos that continue to cleave to form blostomeres. In this study, we used FISH to analyse the chromosomal status of 23 undocumented embryos obtained from 10 patients. Biopsied blastomeres were fixed and probed for five chromosomes (X, Y, 13, 18, 21). Diploidy was confirmed in 13 (57%) embryos while the remaining 10 embryos displayed various chromosomal anomalies. Six of the diploid embryos were transferred subsequently to the patients. One ongoing pregnancy was achieved following transfer of an undocumented, analysed embryo, which was already cleaved when assessed 20 h after insemination. We suggest that accelerated dismantling of the pronuclear membrane and subsequent cleavage do not necessarily indicate abnormal chromosomal content and may result in normal pregnancy. In a patient with a small number of embryos, FISH may be used to ascertain diploidy of undocumented embryos, thereby increasing the number of available embryos for transfer.

43 citations

Journal ArticleDOI
TL;DR: The combination of oral oestradiol and vaginal progesterone is an effective, simple and inexpensive approach for programmed thaw cycles and agrees with previous reports of higher uterine progester one concentrations after the vaginal application.
Abstract: A simple programmed thaw cycle is described, during which the endometrium is prepared with oral oestradiol, followed by a natural progesterone source. This method involves minimal blood tests and uses inexpensive medications. Originally, an i.m. progesterone-in-oil preparation was used. Although highly successful in achieving high serum progesterone concentrations, the daily injections of the oily compound were found to be problematic from the patients' perspective. To examine the possibility of replacing the injectable progesterone with a vaginal preparation we conducted a prospective randomized study of 1 year's duration, during which time 170 and 184 thawing cycles were done with injectable and vaginal progesterone respectively. Although the progesterone blood concentrations obtained with the injectable preparation were more than twice those obtained with the vaginal progesterone, the clinical pregnancy rates (defined as percentage thawing cycles with gestational sac(s)/embryo transfer as demonstrated on ultrasound, 4 weeks after embryo transfer) were similar for both groups (15.9 and 16.8% respectively). Implantation and abortion rates were also comparable. These results agree with previous reports of higher uterine progesterone concentrations after the vaginal application. We conclude that the combination of oral oestradiol and vaginal progesterone is an effective, simple and inexpensive approach for programmed thaw cycles.

42 citations


Cited by
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Journal ArticleDOI
TL;DR: In this paper, the causes of impaired fertility after cancer treatment in young people are discussed, and which patients are at risk and how their gonadal function should be assessed, and the ethical and legal issues that arise.
Abstract: Estimates suggest that by 2010, one in 715 people in the UK will have survived cancer during childhood. With increasing numbers of children cured, attention has focused on their quality of life. We discuss the causes of impaired fertility after cancer treatment in young people, and outline which patients are at risk and how their gonadal function should be assessed. With the report of a livebirth after orthotopic transplantation of cryopreserved ovarian tissue and the continued development of intracytoplasmic sperm injection for men with poor sperm quality, we assess established and experimental strategies to protect or restore fertility, and discuss the ethical and legal issues that arise.

695 citations

BookDOI
01 Jan 1989
TL;DR: The Biological Significance of Zinc for Man: Problems and Prospects and putative Therapeutic Roles for Zinc are described.
Abstract: 1. Physiology of Zinc: General Aspects.- 2. An Introduction to the Biochemistry of Zinc.- 3. Intestinal Absorption of Zinc.- 4. Promoters and Antagonists of Zinc Absorption.- 5. Systemic Transport of Zinc.- 6. Systemic Interactions of Zinc.- 7. Biochemistry of Zinc in Cell Division and Tissue Growth.- 8. Zinc in Cell Division and Tissue Growth: Physiological Aspects.- 9. Biochemical Pathologies of Zinc Deficiency.- 10. Zinc and Iron in Free Radical Pathology and Cellular Control.- 11. Zinc Status and Food Intake.- 12. Zinc and Reproduction: Effects of Deficiency on Foetal and Postnatal Development.- 13. A Note on Zinc and Immunocompetence.- 14. Zinc and Behaviour.- 15. Neurobiology of Zinc.- 16. Zinc in Endocrine Function.- 17. Severe Zinc Deficiency.- 18. Mild Zinc Deficiency in Human Subjects.- 19. Putative Therapeutic Roles for Zinc.- 20. The Diagnosis of Zinc Deficiency.- 21. Human Zinc Requirements.- 22. Dietary Pattern and Zinc Supply.- 23. Zinc Excess.- 24. The Biological Significance of Zinc for Man: Problems and Prospects.

400 citations

Journal ArticleDOI
TL;DR: For infants and young children with acute diarrhea, zinc supplementation results in clinically important reductions in the duration and severity of diarrhea.
Abstract: Background In developing countries the duration and severity of diarrheal illnesses are greatest among infants and young children with malnutrition and impaired immune status, both factors that may be associated with zinc deficiency In children with severe zinc deficiency, diarrhea is common and responds quickly to zinc supplementation Methods To evaluate the effects of daily supplementation with 20 mg of elemental zinc on the duration and severity of acute diarrhea, we conducted a double-blind, randomized, controlled trial involving 937 children, 6 to 35 months of age, in New Delhi, India All the children also received oral rehydration therapy and vitamin supplements Results Among the children who received zinc supplementation, there was a 23 percent reduction (95 percent confidence interval, 12 percent to 32 percent) in the risk of continued diarrhea Estimates of the likelihood of recovery according to the day of zinc supplementation revealed a reduction of 7 percent (95 percent confidence interval

375 citations

Journal ArticleDOI
TL;DR: PGD of aneuploidy reduced embryo loss after implantation, but implantation rates were not significantly improved, but the proportion of ongoing and delivered babies was increased.
Abstract: Chromosomal abnormalities are responsible for a greatdeal of embryo wastage, which is reflected, at least partially,in decreased implantation and increased miscarriage inolder women. To address this problem the transfer of onlychromosomally normal embryos previously selected bypreimplantation genetic diagnosis (PGD) has been pro-posed. We designed a multi-centre in-vitro fertilization(IVF) study to compare controls and a test group thatunderwent embryo biopsy and PGD for aneuploidy.Patients were matched retrospectively, but blindly, foraverage maternal age, number of previous IVF cycles,duration of stimulation, oestradiol concentrations on dayF1, and average mature follicles. All these parameterswere similar in test and control groups. Only embryosclassified as normal for those chromosomes were trans-ferred after PGD. The results showed that the rates of fetalheart beat (FHB)/embryo transferred between the controland test groups were similar. However, spontaneous abor-tions, measured as FHB aborted/FHB detected, decreasedafter PGD (P

368 citations

Journal ArticleDOI
TL;DR: The relative effectiveness and safety of methods of luteal phase support provided to subfertile women undergoing assisted reproduction using progesterone, hCG or GnRH agonist supplementation in ART cycles was determined.
Abstract: Background Progesterone prepares the endometrium for pregnancy by stimulating proliferation in response to human chorionic gonadotropin (hCG) produced by the corpus luteum in the luteal phase of the menstrual cycle. In assisted reproduction techniques (ART), progesterone and/or hCG levels are low, so the luteal phase is supported with progesterone, hCG or gonadotropin-releasing hormone (GnRH) agonists to improve implantation and pregnancy rates. Objectives To determine the relative effectiveness and safety of methods of luteal phase support provided to subfertile women undergoing assisted reproduction. Search methods We searched databases including the Cochrane Menstrual Disorders and Subfertility Group (MDSG) Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO and trial registers up to November 2014. Further searches were undertaken in August 2015. Selection criteria Randomised controlled trials (RCTs) of luteal phase support using progesterone, hCG or GnRH agonist supplementation in ART cycles. Data collection and analysis We used standard methodological procedures expected by Cochrane. Our primary outcome was live birth or ongoing pregnancy. The overall quality of the evidence was assessed using GRADE methods. Main results Ninety-four RCTs (26,198 women) were included. Most studies had unclear or high risk of bias in most domains. The main limitations in the evidence were poor reporting of study methods and imprecision due to small sample sizes. 1. hCG vs placebo/no treatment (five RCTs, 746 women) Findings suggested benefit for the hCG group in live birth or ongoing pregnancy rates when data were analysed with a fixed-effect model (OR 1.76, 95% CI 1.08 to 2.86, three RCTs, 527 women, I2 = 24%, very low-quality evidence) but there was no clear evidence of a difference using a random-effects model (OR 1.67, 95% CI 0.90 to 3.12). hCG may increase ovarian hyperstimulation syndrome (OHSS) rates (OR 4.28, 95% CI 1.91 to 9.6, one RCT, 387 women, low-quality evidence). 2. Progesterone vs placebo/no treatment (eight RCTs, 875 women) Findings suggested benefit for the progesterone group in live birth or ongoing pregnancy rates when data were analysed with a fixed-effect model (OR 1.77, 95% CI 1.09 to 2.86, five RCTs, 642 women, I2 = 35%, very low-quality evidence) but there was no clear evidence of a difference using a random-effects model (OR 1.77, 95% CI 0.96 to 3.26). OHSS was not reported. 3. Progesterone vs hCG regimens (16 RCTs, 2162 women) hCG regimens included hCG alone and hCG with progesterone. There was no evidence of a difference between progesterone and hCG regimens in live birth or ongoing pregnancy rates (OR 0.95, 95% CI 0.65 to 1.38, five RCTs, 833 women, I2 = 0%, low-quality evidence). Progesterone was associated with lower OHSS rates than hCG regimens (OR 0.46, 95% CI 0.30 to 0.71, 5 RCTs, 1293 women , I2=48%). 4. Progesterone vs progesterone with oestrogen (16 RCTs, 2577 women) There was no evidence of a difference between the groups in rates of live birth or ongoing pregnancy (OR 1.12, 95% CI 0.91 to 1.38, nine RCTs, 1651 women, I2 = 0%, low-quality evidence) or OHSS (OR 0.56, 95% CI 0.2 to 1.63, two RCTs, 461 women, I2 = 0%, low-quality evidence). 5. Progesterone vs progesterone + GnRH agonist (seven RCTs, 1708 women) Live birth or ongoing pregnancy rates were lower in the progesterone-only group than the progesterone plus GnRH agonist group (OR 0.62, 95% CI 0.48 to 0.81, nine RCTs, 2861 women, I2 = 55%, random effects, low-quality evidence). Statistical heterogeneity was high but the direction of effect was consistent across studies. OHSS was reported in one study only; there was no evidence of a difference between the groups (OR 1.00, 95% CI 0.33 to 3.01, one RCT, 300 women, very low quality evidence). 6. Progesterone regimens (45 RCTs, 13,814 women) There were nine different comparisons between progesterone regimens. Findings for live birth or ongoing pregnancy were as follows: intramuscular (IM) versus oral: OR 0.71, 95% CI 0.14 to 3.66 (one RCT, 40 women, very low-quality evidence); IM versus vaginal/rectal: OR 1.37, 95% CI 0.94 to 1.99 (seven RCTs, 2309 women, I2 = 71%, random effects, very low-quality evidence); vaginal/rectal versus oral: OR 1.19, 95% CI 0.83 to 1.69 (four RCTs, 857 women, I2 = 32%, low-quality evidence); low-dose versus high-dose vaginal: OR 0.97, 95% CI 0.84 to 1.11 (five RCTs, 3720 women, I2 = 0%, moderate-quality evidence); short versus long protocol: OR 1.04, 95% CI 0.79 to 1.36 (five RCTs, 1205 women, I2 = 0%, low-quality evidence); micronised versus synthetic: OR 0.9, 95% CI 0.53 to 1.55 (two RCTs, 470 women, I2 = 0%, low-quality evidence); vaginal ring versus gel: OR 1.09, 95% CI 0.88 to 1.36 (one RCT, 1271 women, low-quality evidence); subcutaneous versus vaginal gel: OR 0.92, 95% CI 0.74 to 1.14 (two RCTs, 1465 women, I2 = 0%, low-quality evidence); vaginal versus rectal: OR 1.28, 95% CI 0.64 to 2.54 (one RCT, 147 women, very low-quality evidence). OHSS rates were reported for only two comparisons: IM versus oral, and low versus high-dose vaginal; there was no evidence of a difference between the groups. 7. Progesterone and oestrogen regimens (two RCTs, 1195 women) The included studies compared two different oestrogen protocols. There was no evidence of a difference in live birth or ongoing pregnancy rates between a short or long protocol (OR 1.08, 95% CI 0.81 to 1.43, one RCT, 910 women, low-quality evidence) or between a low or high dose of oestrogen (OR 0.65, 95% CI 0.37 to 1.13, one RCT, 285 women, very low-quality evidence). Neither study reported OHSS. Authors' conclusions hCG or progesterone given during the luteal phase may be associated with higher rates of live birth or ongoing pregnancy than placebo or no treatment, but the evidence is not conclusive. The addition of GnRHa to progesterone appears to improve outcomes. hCG may increase the risk of OHSS compared to placebo. Moreover hCG, with or without progesterone, is associated with higher rates of OHSS than progesterone alone. Neither the addition of oestrogen nor the route of progesterone administration appears to be associated with an improvement in outcomes.

341 citations