Clinical reproduction and fertility最新文献

The association between infertility and occupational group was examined using information collected from 1695 male patients. Although lack of detail in the nine occupational classifications may have diluted effects, mean sperm concentrations were significantly different, being highest in administrative and professional groups and lowest in farming and transport groups. Reported exposures to heat and chemicals were also significantly different between occupations. Greater occupational exposure to toxins may contribute to lower sperm concentrations in some groups such as farmers. More detailed research is needed to elucidate the association between occupation and infertility in men.

Concentrations of LH, FSH, oestradiol (E) and progesterone (P) were measured in serum of 12 women with minimal endometriosis and otherwise unexplained infertility. Values were compared with those on corresponding days relative to the pre-ovulatory LH peak (Day 0) in six fertile women. Three women exhibited cycle profiles of LH, FSH, E and P indistinguishable from those in the control group. In the remaining nine women cycle profiles for FSH and follicular phase profiles for LH were normal but eight exhibited a delay in P secretion and reduced total P output. LH concentrations were elevated during the early luteal phase in five subjects, two of whom had a second LH surge. These data suggest that luteal dysfunction and abnormal secretory patterns for LH may be contributory to infertility associated with endometriosis.

A total of 128 patients undergoing 250 in vitro fertilisation (IVF) treatment cycles were studied to determine the relationship between ovarian stimulation regime, the status of the oestradiol levels in the 2 days prior to human chorionic gonadotrophin (hCG) administration and/or the onset of the luteinizing hormone (LH) surge, and the outcome of treatment cycles. The results demonstrated that hCG administration significantly improved the embryo transfer (ET) and pregnancy rates, although the mean interval between cessation of human menopausal gonadotrophin (hMG), and the onset of the LH surge also influenced the ET rate. hMG in conjunction with clomiphene citrate did not suppress the endogenous LH surge but enhanced the oestradiol levels in the 2 days prior to hCG administration and/or the onset of the LH surge. In stimulated cycles the diurnal rhythm of urinary LH surges was abolished. Finally, in certain patients, the LH pattern appeared to be repeated in sequential treatment cycles.

To determine the clinical value of seminal transferrin measurements, transferrin concentrations in seminal plasma were determined by single radial immunodiffusion. Men with various disorders of spermatogenesis had significantly lower mean values than those with normal semen (170 micrograms/ejaculate, s.e.m. = 18.4), oligospermia (40.5 micrograms, s.e.m. = 7.2) or azoospermia due to primary seminiferous tubule failure (65.9 micrograms, s.e.m. = 29.1). In these subjects with patent genital tracts, seminal transferrin was directly correlated with sperm concentration and indirectly correlated with serum FSH levels. Seminal transferrin increased following gonadotrophin treatment of men with gonadotrophin deficiency from 19.6 micrograms (s.e.m. = 5.5) to 108.6 micrograms (s.e.m. = 31.7). Patients with genital tract obstructions also had low levels; vasal agenesis (21.8 micrograms, s.e.m. = 5.6), vasectomy (48.5 micrograms, s.e.m. = 21.0), epididymal obstruction (46.6 micrograms, s.e.m. = 7.1). These results confirm that most seminal transferrin comes from the testes and reflects Sertoli cell function. However, there is a very wide range of transferrin levels in normal semen and a number of normospermic samples have low values similar to those seen with abnormal Sertoli cell function or obstruction. Thus, measurement of seminal transferrin is of limited diagnostic value.

Immunobeads for IgA, IgG and IgM were used in an indirect test (immunobead test: IBT) to detect human antispermatozoal antibodies, with positive results for at least one class of antibody being found in the serum of 13/169 (7.7%) men tested and 12/172 (6.9%) women. Of those men with antibodies present in serum, 100% had IgG, 62% had IgA and none had IgM, whilst the proportion for women was 75%, 100% and 33% respectively for each class of antibody. Antispermatozoal antibodies in men do not always appear both in semen and serum, but may be present in only one of the fluids tested for IgA (7/13 men; 53%) and IgG (6/14 men; 42.9%). The incidence of antibodies in the serum of oligospermic men was not significantly different from that of normospermic men (chi 2 = 0.06). A total of 481 serum and semen specimens were assayed by both the IBT and tray agglutination tests, and agreement between the two assays occurred in 97.3% (468/481) samples (P less than 0.001).

The pregnancy-associated and placental proteins PP14 and PAPP-A have been measured in human seminal plasma from normal men. PP14 was a significant protein constituent in most seminal plasma samples; sometimes comprising over 2.5% of the total protein content. The concentration of PP14 in seminal plasma from men with oligospermia was in the reference range of this protein derived from values measured in normal men. However, about 14% of samples from vasectomized subjects contained concentrations of PP14 less than normal. It was found that the concentration of PAPP-A in seminal plasma from vasectomized men and men with oligospermia also fell within the reference range for this protein. However, the concentration of PAPP-A in seminal plasma was significantly higher in those subjects whose sperm motility was above 60% than in those with a lower percentage motility, suggesting a possible role of this protein in sperm function.

Demographic socio-economic and decision-making aspects of sterilization and reversal of sterilization were compared in a group of 103 women requesting reversal (RR) and 117 women about to undergo sterilization (S), to determine the practicality of identifying in advance the woman likely to request reversal. The willingness of patients to pay for these procedures and the ethical implications of these decisions were also examined. RR were younger at the first relationship, birth of first child and birth of last child. There were no differences (RR vs S) between the number of full-term pregnancies, living children and therapeutic abortions. The timing of sterilization (puerperal versus interval) did not influence the decision to be reversed. The level of education, partner's level of education and mean family income were lower in the group requesting reversal. Multiple regression analysis revealed three characteristics which were most discriminatory: youth at first birth; lack of spousal support; and failure to choose 'family complete' as a reason for sterilization. The predictability was not strong enough to provide an accurate assessment of the individual woman. RR were of significantly lower socio-economic standing but were more likely to be prepared to pay a large sum of money for the reversal. The ethical implications of this finding are discussed.

In preliminary experiments, pH measurements were made with pH paper and with a pH electrode on cervical mucus in situ and after aspiration. Paper and electrode gave comparable results with aspirated mucus. Measurements made on mucus in situ and then after aspiration were concordant only when pH paper, but not the pH electrode, was used to measure pH in situ. All spermatozoa were immotile in the post-coital test when the pH of the mucus was below 6. A pH below 6 was found in 38% (23 out of 61) of post-coital tests in which there were fewer than 1% of motile spermatozoa (19% of all tests). The male partners of women who had a mucus pH greater than 6 but had less than 1% of spermatozoa motile in the post-coital test, had slightly poorer quality semen than the partners of women with mucus pH less than 6, or in which there were motile spermatozoa in the mucus.

Three young women with galactosaemia presented with amenorrhoea and elevated plasma levels of FSH and LH. Two of these women are sisters and ovarian biopsy confirmed premature ovarian failure in one and resistant ovary syndrome in the other. The history and ovarian histology suggested that the sister with ovarian failure may have progressed through a stage of 'follicle resistance' prior to follicular atresia. All subjects had specific bioassays for LH which were grossly elevated, and higher than the levels recorded by immunoassay.

Since 1978 technologies applied to human reproductive biology have resulted in totally new ways of making families. Traditionally education has presented science as a value-free body of absolute knowledge, neatly divided into discrete disciplines. This has resulted in a fragmented approach to the teaching of human reproduction. Many students are leaving school today confused and ignorant about contraception and their own fertility. How will education deal with new methods of controlling and promoting human fertility and family planning? Should the curriculum include: the scientific details of the technologies; the nature and known causes of infertility; the recent legislation designed to limit these technologies; the implications for the family as the fundamental social unit? If so, where in the curriculum, and taught by whom? This paper critically examines these possibilities with particular focus on the confused role of genetics in defining parents and families, both in the literature and in recent Victorian legislation designed to regulate new reproductive technologies. A more precise definition of the concept of 'mother' which acknowledges all three components, genetic, birth and social is suggested for inclusion in a broader curriculum about human reproduction, preferably within science education.