Clinical reproduction and fertility最新文献

The efficiency of two methods of ultrasound-guided aspiration of pre-ovulatory oocytes was compared in 238 treatment cycles, of which 166 were by the transabdominal-transvesical (TA) route and 72 by the transvaginal (TV) route. Successful collection of at least one oocyte was achieved in 86% of TA attempts and in 97% of TV attempts. Significantly less oocytes were collected from follicles by the TA methods than by the TV methods: 374 oocytes were obtained from 797 follicles (46% recovery) and 242 oocytes from 338 follicles (72% recovery), respectively. Although fertilisation occurred more frequently in TA-recovered oocyte (70% versus 54%), the incidence of cleavage per inseminated oocytes collected by these TA and TV methods was similar (49% versus 44%, respectively). Results of this study therefore suggest that the TV method is superior to the TA approach for oocyte recovery.

Twenty-two women with hyperprolactinaemia without evidence of microadenoma, either untreated (n = 3), treated with bromocriptine for a total of less than 1 year (n = 12), or treated with bromocriptine for a total of more than 1 year (n = 7) were followed up by retrospective case-note review for at least 53 months. More than 50% of the women showed a fall in serum prolactin concentrations by more than 40% over the period of follow-up. The occurrence of a fall did not appear to be related to either length of treatment with bromocriptine or to the occurrence of pregnancy. Some women elected to remain untreated, despite symptoms, in preference to taking tablets and having to use contraception. The wisdom of leaving patients untreated in the light of these findings is discussed.

The prevalence and pattern of circulating antisperm antibodies were assessed in the serum of Korean males undergoing vasectomy, vasovasostomy, epididymovasostomy and in a control group of men with normal semen by means of the gelatin agglutination test and the tray agglutination test. Sperm-agglutinating antibodies in serum were positive at a titre of 1:32 or greater in 3% of normospermic control males and in 27% of vasectomized men. No significant changes were observed in prevalence of the antibodies over the period following vasectomy. There were no significant differences in prevalence of antibodies in patients with and without postoperative sperm granulomas. Antibodies were positive in 35% of vasectomized men just prior to vasovasostomy and in 29% of patients 12 months after a successful (patent) reversal operation. There was no significant difference in prevalence of antibodies in patients with successful and unsuccessful vasovasostomies. Antibodies were positive in 20% of men who achieved pregnancies and in 43% of those with persisting infertility in the presence of a patent vasovasostomy. Sperm agglutinating antibodies were present in 5% of the patients with pathological epididymal obstruction. They were negative in patients with a patent epididymovasostomy and positive in 17% of those with an unsuccessful epididymovasostomy. The four patients who achieved a pregnancy after epididymovasostomy were antibody-negative. The prevalence of antibodies in the serum of patients with azoospermia due to surgical vasal obstruction was higher than that in patients with azoospermia due to pathological epididymal obstruction. The agglutination patterns produced by sperm antibodies in the total group of positive sera were tail-to-tail in 56%, head-to-head in 30% and mixed in 14%.

In ejaculates from selected infertile couples, the degree of coagulation revealed significant positive correlations with liquefaction time, sperm count and motility, but negative correlation with semen volume. Comparison of presumptively fertile and infertile ejaculates also showed significant variations in their amount of coagulum and liquefaction time. The study suggested a possible relationship between the coagulation-liquefaction property of human ejaculates and their semen quality.

The plethora of published studies investigating oral contraceptive pill (OC)-induced changes of various plasma lipids and their ratios together with repeated reviews of these studies in the literature, are all based on the assumption that OC-induced favourable or unfavourable lipid profiles decrease or increase a pill-associated cardiovascular risk. Some authorities have been led to recommend choice of pill formulations based on such changes of plasma lipids. In a combined review of relevant cardiovascular and OC epidemiological studies no evidence is found for these assumptions and recommendations. There is no evidence of OC-induced atherosclerotic disease, and pill-induced changes of plasma lipids within normal limits are therefore probably without any clinical relevance. Profound changes towards a so-called favourable plasma lipid profile may, on the contrary, be detrimental in terms of pill-associated cardiovascular events.

Human sperm immaturity was tested by nuclear chromatin decondensation (NCD) in 1% sodium dodecylsulphate (SDS) of spermatozoa used in 74 consecutive IVF treatments. NCD was significantly higher in the presence of 2 mmol/l dithiothreitol (DTT) and after washing sperm from semen with 6 mmol/l ethylenediaminetetraacetic acid (EDTA). NCD was significantly less in insemination suspensions prepared by the swim-up technique than in the original semen. NCD with DTT was inversely correlated with sperm motility and motility index but there were no significant relationships between NCD and other semen analysis variables. There was no significant correlation between any NCD test and the proportion of oocytes fertilised in vitro. The only factors being significantly correlated with the fertilisation rate were proportion of sperm with normal morphology (Kendall correlation, tau = 0.36, P less than 0.001) and sperm concentration (tau = 0.14, P less than 0.05). Logistic regression analysis of fertilisation rates showed that only percentage normal sperm morphology was significant. It is concluded that NCD does not provide additional useful clinical information about sperm fertilising ability in vitro.

The inserter tubes of the more modern copper bearing IUDs are flexible enough to give ('bow') when there is obstruction to the device. The MLCu 250, Copper 7 and Nova T inserters will bow considerably when forces of 1-3 N are exerted and the device obstructed up to 0.75 cm from its proximal end. This suggests that these devices are unlikely to cause cervical damage where their passage into the uterine cavity is impeded by cervical factors, provided the insertion attempt is discontinued when bowing of more than 2 cm off-centre is reached. However this does not apply to obstructions past the internal cervical os. In research circumstances great care should be used as it rapidly becomes possible to exert enough force to produce damage to the uterine muscle.

The immunobead test is excellent for the routine screening of semen for sperm antibodies but the polyacrylamide beads currently used are of variable diameter (3-10 micron) which tends to obscure details of regional binding. Thus the use of smaller latex beads of more uniform diameter has been investigated. Latex beads were coated with IgG by exposure to anti D serum for a mixed antiglobulin reaction (MAR). Rabbit antihuman IgG and IgA antibodies were covalently bound to carboxylated latex microspheres (CLM) by the carbodiimide reaction. Polyacrylamide immunobeads (IBT) with antihuman IgG or IgA antibodies covalently attached were obtained commercially. The IgG IBT and MAR were compared in 55 samples. The MAR was positive in 15 of the 31 IBT positive samples but the proportion of sperm with attached beads was lower. CLM and IBT were compared in 106 samples. Both tests were positive in 34 samples with virtually identical proportions of motile sperm with beads attached and the patterns of attachment were similar. These results show that CLM microspheres give equivalent results to IBT and that as they are smaller and have a more uniform size they provide advantage in ease of detection of positive reactions and in determination of the regional blinding pattern.