Clinical reproduction and fertility最新文献

Artificial insemination by donor (AID) provides a necessary service to a significant number of infertile couples. Its practice has been well controlled in Australia by careful donor screening and selection of suitable recipients. The potential for transmission of several infectious diseases has demanded a vigorous protocol for donor assessment and a strong movement away from the use of fresh semen. The description of human immunodeficiency virus (HIV) transmission by AID has increased the need for vigilance and has mandated, both by common sense and by Health Department Requirement (in Australia), the universal use of frozen donations. Antibody testing for HIV is not fail safe and must be supported by a carefully constructed lifestyle declaration form and a drive to recruit monogamous donors. The recruitment of sufficient donors has always been a problem and the advent of the HIV has not helped. Whilst transmission to laboratory staff appears to represent an extremely low risk, this possibility has required the development of safety protocols and appropriate staff training. This review outlines the current problems of running an AID programme given the knowledge that the HIV can be maintained in liquid nitrogen and transmitted atraumatically to a recipient.

Buserelin [D-Ser(TBU)6-des Gly NH2(10) LHRH ethylamide], an LHRH agonist, was administered intranasally at two dose levels, 200 micrograms t.d.s or 300 micrograms t.d.s., to 20 women with proven endometriosis, many with recurrent disease. Both dose schedules achieved significant suppression of circulating 17 beta-oestradiol levels often to within the postmenopausal range, the larger dose inducing significantly greater suppression (P less than 0.05). Serum FSH values were suppressed below baseline but serum LH remained at pretreatment levels or above, whilst on treatment. Complete resolution of endometriotic deposits was achieved in 68% of cases following 6 months treatment with dramatic and long-standing relief of symptoms with no apparent dose difference. In all other subjects there was significant reduction in the extent of endometriotic deposits and improvement in American Fertility Society classification of disease stage. The most commonly occurring side effect was hot flushes; their intensity and frequency related to the degree of suppression of serum oestradiol and the dose of Buserelin administered.

Although seven babies who were conceived in vitro with donated oocytes have been born in the Monash-Epworth programme, the availability of this service is now threatened because of the scarcity of oocytes for donation. Previously oocytes were donated by infertile women undergoing oocyte collection in the in vitro fertilisation programme, but this supply has been severely curtailed since cryopreservation of their embryos has been made available to them. Other sources of donated oocytes have included collecting oocytes from women undergoing laparoscopic sterilization, infertile women finding their own (known) donors, and fertile women donating all their oocytes for altruistic reasons on an in vitro fertilisation programme. The latter two categories offer the greatest chance of collecting mature oocytes for donation.

Hormone values and semen analyses were studied in 1761 men referred for evaluation of infertility to determine the frequency of isolated deficiency of either FSH, LH, or partial deficiency of both gonadotrophins. There were 17 men (1%) with oligospermia and FSH values at the lower end of the normal range. Without treatment, four pregnancies occurred in this group. Of the remainder, one was treated with gonadotrophin replacement therapy with no improvement in sperm concentration or motility. One man had possible isolated LH deficiency, but was subsequently found to have normal LH and testosterone values. No case of partial gonadotrophin deficiency was found. It was concluded that isolated deficiency of either FSH, LH, or partial deficiency of both gonadotrophins must be extremely rare as a cause of infertility.

Little attention has been given to the psychosocial issues associated with being a semen donor and some of the reasons for this are outlined. An extensive range of psychosocial issues is discussed. These are presented via a 'relationship model' which has been developed to illustrate how the donor, through his act of donating, is involved in a series of relationships. Some of these are interactive, in that they are two-way relationships, while others are non-reactive, being a one-way relationship only. These relationships and their impact need to be considered by, and discussed with, prospective donors. Only then will the donor and not merely his donation be responded to. Discussion of all the issues is essential if the principle of informed consent is to have any meaning. The reports of the Committees of Inquiry that have been set up in various parts of the world (as they relate to the psychosocial aspects of semen donation) are reviewed. They, along with this paper, suggest that a comprehensive service needs to be provided for semen donors and this must include consideration of the psychosocial issues. Suggestions regarding such a service are made.

Protein carboxyl methylase (PCM) activity was measured in human spermatozoa of 16 normal fertile men and 26 men with various forms of asthenospermia. PCM activities were in the range 14-635 pmol/min per 10(9) sperm. Six men with idiopathic asthenospermia had low PCM activity but the defect of sperm motility was not severe (sperm motility 25-50%). One man with zero sperm motility and sparse mitochondria in the midpiece spiral had high PCM activity. Two men, one with idiopathic asthenospermia and the other with asthenospermia following vasoepididymostomy, also had high PCM activities. PCM activity did not correlate with motility or motility index but there was a correlation between PCM activity and the proportion of immature forms in semen. Thus, the relationship between PCM activity and low motility of sperm is not simple and other cells also contribute to overall seminal PCM activity.

The concentrations of prostaglandin E2 (PGE2), prostaglandin F2 alpha (PGF2 alpha), thromboxane B2 (TxB2) and leukotriene B4 (LTB4) were measured in the follicular fluid of 15 hyperstimulated human follicles. All the samples contained these eicosanoids. Ova were recovered in six aspirates; the measured levels of prostanoids and LTB4 did not differ significantly from the levels of nine aspirates without ova. The presence of LTB4 in human follicular fluid suggests that the products of the lipoxygenase pathway of arachidonic acid may also have a role in the function of the follicular fluid.